Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-28T00:01:12.209Z Has data issue: false hasContentIssue false
  • English
  • Français

Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment

Published online by Cambridge University Press:  20 February 2014

P. Monteleone ,
P. Scognamiglio ,
A. M. Monteleone ,
D. Perillo  and
M. Maj
P. Monteleone*
Affiliation:
Department of Medicine and Surgery, University of Salerno, Italy Department of Psychiatry, University of Naples SUN, Italy
P. Scognamiglio
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
A. M. Monteleone
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
D. Perillo
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
M. Maj
Affiliation:
Department of Psychiatry, University of Naples SUN, Italy
*
* Address for correspondence: P. Monteleone, M.D., Chair of Psychiatry, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Sensitivity to punishment (SP) and sensitivity to reward (SR) are personality characteristics that may have relevance for the pathophysiology of eating disorders (EDs). Moreover, personality characteristics are known to modulate the activity of the hypothalamus–pituitary–adrenal (HPA) axis, which is the main component of the endogenous stress response system. As stress has been implicated in the aetiology and the maintenance of EDs, we aimed to study the HPA axis activity in relation to SP and SR, as conceptualized by Gray's reinforcement sensitivity theory (RST), in patients with anorexia nervosa (AN) or bulimia nervosa (BN).

Method

Twenty-five women with AN, 23 women with BN and 19 healthy women volunteered for the study. HPA axis activity was assessed by measurement of the salivary cortisol awakening response (CAR). The subjects’ SP and SR were measured by the behavioural inhibition system (BIS)/behavioural approach system (BAS) scales.

Results

The CAR was significantly enhanced in AN patients, but not in BN patients, compared to healthy women. The CAR correlated significantly with BAS measures, negatively in healthy controls and positively in binge-purging AN patients and BN women. SP, measured by the BIS scale, was higher in patients than in controls.

Conclusions

These findings confirm the occurrence of an enhanced activity of the HPA axis in symptomatic AN, but not in symptomatic BN, and show for the first time that the CAR is associated with SR, as conceptualized by the RST, negatively in healthy subjects but positively in binge-purging ED patients.

Keywords

Anorexia nervosabulimia nervosacortisolpunishmentreward
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 12 , September 2014 , pp. 2653 - 2660
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bartels, M, Van den Berg, M, Sluyter, F, Boomsma, DI, de Geus, EJC (2003). Heritability of cortisol levels: review and simultaneous analysis of twin studies. Psychoneuroendocrinology 28, 121–137.Google Scholar
Bender, R, Lange, S (2001). Adjusting for multiple testing – when and how? Journal of Clinical Epidemiology 54, 343–349.Google Scholar
Bolger, N, Schilling, EA (1991). Personality and the problems of everyday life: the role of neuroticism in exposure and reactivity to daily stressors. Journal of Personality 59, 355–386.Google Scholar
Carpenter, LL, Carvalho, JP, Tyrka, AR, Wier, LM, Mello, AF, Mello, MF, Anderson, GM, Wilkinson, CW, Price, LH (2007). Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Biological Psychiatry 62, 1080–1087.Google Scholar
Carver, CS, White, TL (1994). Behavioral-inhibition, behavioral activation, and affective responses to impending reward and punishment: the BIS/BAS scales. Journal of Personality and Social Psychology 67, 319–333.Google Scholar
Claes, L, Nederkoorn, C, Vandereycken, W, Guerrieri, R, Vertommen, H (2006). Impulsiveness and lack of inhibitory control in eating disorders. Eating Behaviors 7, 196–203.Google Scholar
Cloninger, C (1987). A systematic method for clinical description and classification of personality variants. A proposal. Archives of General Psychiatry 44, 573–588.Google Scholar
Cloninger, C (1999). The Temperament and Character Inventory – Revised. Center for Psychobiology of Personality, Washington University: St Louis, MO.Google Scholar
Clow, A, Thorn, L, Evans, P, Hucklebridge, F (2004). The awakening cortisol response: methodological issues and significance. Stress 7, 29–37.Google Scholar
Corstorphine, E, Mountford, V, Tomlinson, S, Waller, G, Meyer, C (2007). Distress tolerance in the eating disorders. Eating Behaviors 8, 91–97.Google Scholar
Dawe, S, Loxton, NJ (2004). The role of impulsivity in the development of substance use and eating disorders. Neuroscience and Biobehavioral Reviews 28, 343–351.CrossRefGoogle ScholarPubMed
Díaz-Marsá, M, Carrasco, JL, Basurte, E, Pastrana, JI, Sáiz-Ruiz, J, López-Ibor, JJ (2007). Findings with 0.25 mg dexamethasone suppression test in eating disorders: association with childhood trauma. CNS Spectrums 12, 675–680.CrossRefGoogle ScholarPubMed
Dixon, J (1985). BMDP Statistical Software. University of California Press: Berkeley, CA.Google Scholar
Fairburn, CG, Bohn, K (2005). Eating disorder NOS (EDNOS): an example of the troublesome ‘not otherwise specified’ (NOS) category in DSM-IV. Behaviour Research and Therapy 43, 691–701.Google Scholar
Fekedulegn, DB, Andrew, ME, Burchfiel, CM, Violanti, JM, Hartley, TA, Charles, LE, Miller, DB (2007). Area under the curve and other summary indicators of repeated waking cortisol measurements. Psychosomatic Medicine 69, 651–659.CrossRefGoogle ScholarPubMed
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Non-Patient Edition (SCID-I/NP, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-I/P, Version 2). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Fullerton, DT, Wonderlich, SA, Gosnell, BA (1995). Clinical characteristics of eating disorder patients who report sexual or physical abuse. International Journal of Eating Disorders 17, 243–249.Google Scholar
Gray, JA (1970). The psychophysiological basis of introversion-extraversion. Behaviour Research and Therapy 8, 249–266.Google Scholar
Hagan, MM, Shuman, ES, Oswald, KD, Corcoran, KJ, Profitt, JH, Blackburn, K, Schwiebert, MW, Chandler, PC, Birbaum, MC (2002). Incidence of chaotic eating behaviors in binge-eating disorder: contributing factors. Behavioral Medicine 28, 99–105.CrossRefGoogle ScholarPubMed
Harrison, A, Treasure, J, Smillie, LD (2011). Approach and avoidance motivation in eating disorders. Psychiatry Research 188, 396–401.Google Scholar
Hasking, PA (2007). Reinforcement sensitivity, coping, and delinquent behaviour in adolescents. Journal of Adolescence 30, 739–749.Google Scholar
Jacobi, C, Hayward, C, de Zwaan, M, Kraemer, HC, Agras, WS (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin 130, 19–65.Google Scholar
Kane, TA, Loxton, NJ, Staiger, PK, Dawe, S (2004). Does the tendency to act impulsively underlie binge eating and alcohol use problems? An empirical investigation. Personality and Individual Differences 36, 83–94.CrossRefGoogle Scholar
Kaye, WH, Fudge, JL, Paulus, M (2009). New insight into symptoms and neurocircuit function of anorexia nervosa. Nature Reviews Neuroscience 10, 573–584.CrossRefGoogle ScholarPubMed
Kendler, KS, Kuhn, J, Prescott, CA (2004). The interrelationship of neuroticism, sex, and stressful life events in the prediction of episodes of major depression. American Journal of Psychiatry 161, 631–636.CrossRefGoogle ScholarPubMed
Kirschbaum, C, Bartussek, D, Strasburger, CJ (1992). Cortisol responses to psychological stress and correlations with personality traits. Personality and Individual Differences 13, 1353–1357.CrossRefGoogle Scholar
Koob, GF (2008). A role for brain stress systems in addiction. Neuron 59, 11–34.Google Scholar
Kudielka, BM, Hellhammer, DH, Wüst, S (2009). Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology 34, 2–18.Google Scholar
Léonard, S, Steiger, H, Kao, A (2003). Childhood and adulthood abuse in bulimic and nonbulimic women: prevalences and psychological correlates. International Journal of Eating Disorders 33, 397–405.Google Scholar
Leone, L, Pierro, A, Mannetti, L (2002). Validity of the Italian version of Carver & White's BIS/BAS scales (1994): Generalization of structure and relationships to similar constructs. Giornale Italiano di Psicologia 29, 413–436.Google Scholar
Lo Sauro, C, Ravaldi, C, Cabras, PL, Faravelli, C, Ricca, V (2008). Stress, hypothalamic-pituitary-adrenal axis and eating disorders. Neuropsychobiology 57, 95–115.Google Scholar
Loxton, NJ, Dawe, S (2001). Alcohol abuse and dysfunctional eating in adolescent girls: the influence of individual differences in sensitivity to reward and punishment. International Journal of Eating Disorders 29, 455–462.CrossRefGoogle ScholarPubMed
Loxton, NJ, Dawe, S (2006). Reward and punishment sensitivity in dysfunctional eating and hazardous drinking women: associations with family risk. Appetite 47, 361–371.Google Scholar
Loxton, NJ, Dawe, S (2007). How do dysfunctional eating and hazardous drinking women perform on behavioural measures of reward and punishment sensitivity? Personality and Individual Differences 42, 1163–1172.Google Scholar
Mangold, D, Mintz, J, Javors, M, Marino, E (2012). Neuroticism, acculturation and the cortisol awakening response in Mexican American adults. Hormones and Behavior 61, 23–30.Google Scholar
Matton, A, Goossens, L, Braet, C, Vervaet, M (2013). Punishment and reward sensitivity: are naturally occurring clusters in these traits related to eating and weight problems in adolescents? European Eating Disorders Review 21, 184–194.CrossRefGoogle ScholarPubMed
McCleery, JM, Goodwin, GM (2001). High and low neuroticism predict different cortisol responses to the combined dexamethasone–CRH test. Biological Psychiatry 49, 410–415.Google Scholar
McKee, SA, Sinha, R, Weinberger, AH, Sofuoglu, M, Harrison, EL, Lavery, M, Wanzer, J (2011). Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. Journal of Psychopharmacology 25, 490–502.CrossRefGoogle ScholarPubMed
Monteleone, P, Maj, M (2013). Dysfunctions of leptin, ghrelin, BDNF and endocannabinoids in eating disorders: beyond the homeostatic control of food intake. Psychoneuroendocrinology 38, 312–330.Google Scholar
Monteleone, P, Scognamiglio, P, Canestrelli, B, Serino, I, Monteleone, AM, Maj, M (2011 a). Asymmetry of salivary cortisol and alpha-amylase responses to psychosocial stress in anorexia nervosa but not in bulimia nervosa. Psychological Medicine 41, 1963–1969.Google Scholar
Monteleone, P, Scognamiglio, P, Monteleone, AM, Mastromo, D, Steardo, L, Serino, I, Maj, M (2011 b). Abnormal diurnal patterns of salivary α-amylase and cortisol secretion in acute patients with anorexia nervosa. World Journal of Biological Psychiatry 12, 455–461.Google Scholar
Pike, KM, Wilfley, D, Hilbert, A, Fairburn, CG, Dohm, F-A, Striegel-Moore, RH (2006). Antecedent life events of binge-eating disorder. Psychiatry Research 142, 19–29.Google Scholar
Portella, MJ, Harmer, CJ, Flint, J, Cowen, P, Goodwin, GM (2005). Enhanced early morning salivary cortisol in neuroticism. American Journal of Psychiatry 162, 807–809.Google Scholar
Pryce, CR, Rüedi-Bettschen, D, Dettling, AC, Weston, A, Russig, H, Ferger, B, Feldon, J (2005). Long-term effects of early-life environmental manipulations in rodents and primates: potential animal models in depression research. Neuroscience and Biobehavioral Reviews 29, 649–674.Google Scholar
Rijsdijk, FV, Sham, PC, Sterne, A, Purcell, S, McGuffin, P, Farmer, A, Goldberg, D, Mann, A, Cherny, SS, Webster, M, Ball, D, Eley, TC, Plomin, R (2001). Life events and depression in a community sample of siblings. Psychological Medicine 31, 401–410.Google Scholar
Rojo, L, Conesa, L, Bermudez, O, Livianos, L (2006). Influence of stress in the onset of eating disorders: data from a two-stage epidemiologic controlled study. Psychosomatic Medicine 68, 628–635.CrossRefGoogle ScholarPubMed
Schmidt-Reinwald, A, Pruessner, JC, Hellhammer, DH, Federenko, I, Rohleder, N, Schürmeyer, TH, Kirschbaum, C (1999). The cortisol response to awakening in relation to different challenge tests and a 12-hour cortisol rhythm. Life Sciences 64, 1653–1660.Google Scholar
Schommer, NC, Kudielka, BM, Hellhammer, DH, Kirschbaum, C (1999). No evidence for a close relationship between personality traits and circadian cortisol rhythm or a single cortisol stress response. Psychological Reports 84, 840–842.Google Scholar
Silva, J, Ortiz, M, Quiñones, A, Vera-Villarroel, P, Slachevsky, A (2011). Affective style and eating disorders: a field study. Eating and Weight Disorders: EWD 16, e73.Google Scholar
Steiger, H, Gauvin, L, Israël, M, Koerner, N, Ng, Ying Kin NM, Paris, J, Young, SN (2001). Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa. Archives of General Psychiatry 58, 837–843.Google Scholar
Tyrka, AR, Wier, LM, Price, LH, Rikhye, K, Ross, NS, Anderson, GM, Wilkinson, CW, Carpenter, LL (2008). Cortisol and ACTH responses to the Dex/CRH test: influence of temperament. Hormones and Behavior 53, 518–525.Google Scholar
van Os, J, Jones, PB (1999). Early risk factors and adult person–environment relationships in affective disorder. Psychological Medicine 29, 1055–1067.Google Scholar
Vedhara, K, Tuinstra, J, Stra, JT, Miles, JNV, Sanderman, R, Ranchor, AV (2006). Psychosocial factors associated with indices of cortisol production in women with breast cancer and controls. Psychoneuroendocrinology 31, 299–311.Google Scholar
Wonderlich, SA, Brewerton, TD, Jocic, Z, Dansky, BS, Abbott, DW (1997). Relationship of childhood sexual abuse and eating disorders. Journal of the American Academy of Child and Adolescent Psychiatry 36, 1107–1115.CrossRefGoogle ScholarPubMed
Wüst, S, Federenko, I, Hellhammer, DH, Kirschbaum, C (2000). Genetic factors, perceived chronic stress, and the free cortisol response to awakening. Psychoneuroendocrinology 25, 707–720.Google Scholar
Zobel, A, Barkow, K, Schulze-Rauschenbach, S, Von Widdern, O, Metten, M, Pfeiffer, U, Schnell, S, Wagner, M, Maier, W (2004). High neuroticism and depressive temperament are associated with dysfunctional regulation of the hypothalamic-pituitary-adrenocortical system in healthy volunteers. Acta Psychiatrica Scandinavica 109, 392–399.Google Scholar