As social beings, we are constantly confronted with psychosocial stressors (e.g., social evaluation, exclusion, achievement and / or performance; Dickerson & Kemeny, 2004; Kirschbaum et al., 1993; Pruessner et al., 2003), which significantly affect the neuroendocrine (HPAA) and autonomic (ANS) function (Chrousos, 2009; Foley & Kirschbaum, 2010; Mohammadi et al., 2019). In a prolonged fashion and in the lack of habituation, chronic stress leads to cortisol hypersecretion, posing a risk for the development of Hypothalamic-PituitaryAdrenal Axis (HPAA) hyporeactivity. At the same time, this represents a vulnerability for the development of somatic and psychiatric conditions (Chrousos, 2009; McEwan, 1998, 2004; Fries, et al., 2005; Heim et al., 2000; Herman et al., 2005). In this regard, response parameters of the HPAA (e.g., cortisol) and the ANS (e.g., Heart rate variability) are paramount in studying the relationship between reactivity and health/illness (Chrousos, 2009; McEwen, 1998). For example, individuals with psychiatric conditions, such as eating disorders (EDs), exhibit hyporesponsiveness of the stress networks, which is associated with dysregulated biomarkers (Het et al., 2020; Monteleone et al., 2010; 2018a, 2018b; Støving, 2019). Among EDs, Anorexia nervosa (AN) records the highest mortality rate (Arcelus et al., 2011; Erskine et al., 2016; Moskowitz & Weiselberg, 2017) and displays a range of ANS and HPAA irregularities, e.g., bradycardia, hypercortisolemia (Gibson et al., 2020; Giovinazzo et al., 2019; Katzmann, 2005; Mazurak et al., 2011; Miller et al., 2013; Sauro et al., 2008). Maintenance of underweight and fear of weight gain despite being underweight (BMI < 17.5 kg/m2) are typical characteristics (DSM-V, APA, 2013). Treatment outcomes are poor (Harbottle et al., 2008; Murray et al., 2019; Watson & Bulik, 2013) and the disease burden for patients and health care substantial (Schmidt et al., 2016). Therefore, innovative and effective treatments are urgently needed. Concerning onset and maintenance, psychosocial stress has been frequently investigated (Caglar-Nazali et al., 2014; Monteleone et al., 2011, 2018b; Wierenga et al., 2018). Patients commonly showed deficient social skills and higher negative affect accompanied by hyporesponsiveness to psychosocial stress (Het et al., 2015, 2020; Monteleone et al., 2011; 2018b; Putigiano et al., 2001; Vocks et al., 2007; Zonevylle-Bender et al., 2015). However, experimental and controlled studies on the neuroendocrine and autonomic reactivity are underrepresented and ambiguous in PAN. Accordingly, the following investigations address this research gap. Objectives and Method: In order to expand ED-specific data and foster understanding at the psychological and physiological level, the stress response to a psychosocial stressor was investigated in a sample of patients with anorexia nervosa (PAN) which was age- and gender-matched to healthy controls (HC), under highly14 standardized conditions. For this purpose, biomarkers such as salivary cortisol (Study 1), heart rate (HR) and heart rate variability (HRV; see Study 2/Table 1) were assessed in a crosssectional study design under two experimental conditions: 1) rest and 2) stress (see Figure 1/Study 1-2). In addition, psychological stress indicators (PASA, VAS, TICS) and symptoms were analyzed (e.g., SCL-K-9, BDI, EDI). Based on previous evidence, elevated cortisol levels and bradycardia at rest were expected in PAN (vs. HC). A stress hyporeactivity in the examined biomarkers was hypothesized in PAN (vs. HC). Additionally, a reduced sympathetic (SNS) and pronounced parasympathetic (PNS) activity and reactivity was assumed in PAN (vs. HC). Furthermore, a regulation of the HPAA functionality regarding total cortisol expression (AUCG) and reactivity with weight recovery in PAN was postulated. Secondarily, BMI (kg/m2) was analyzed in relation to the derived biomarkers and psychological measures of concern.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:77472 |
| Date | 19 January 2022 |
| Creators | Schmalbach, Ileana |
| Contributors | Berth, Hendrik, Petrowski, Katja, Technische Universität Dresden |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:doctoralThesis, info:eu-repo/semantics/doctoralThesis, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
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