Disordered eating behaviour is associated with blunted cortisol and cardiovascular reactions to acute psychological stress
Introduction
Stress plays a substantial role in disordered eating (Crowther and Chernyk, 1986, Lacey et al., 1986, Cattanach and Rodin, 1988, Koo-Loeb et al., 2000). Disordered eating, particularly bulimia nervosa, is associated with increased negative perceptions of daily life stress and decreased coping skills (Crowther and Chernyk, 1986, Cattanach and Rodin, 1988, Lo Sauro et al., 2008). Increased perceptions of stress and negative affect can precede binges and ultimately contribute to the etiology and maintenance of bulimia nervosa (Abraham and Joseph, 1987, Cattanach et al., 1988, Cattanach and Rodin, 1988, Lingswiler et al., 1989, Troop et al., 1994). These behaviours suggest a potential dysregulation of the stress response in individuals with bulimia nervosa, which could contribute to the stress–illness relationship (Cattanach and Rodin, 1988, Koo-Loeb et al., 1998). Research measuring the neuroendocrine and cardiovascular responses to a standardised stress task in disordered eating individuals and healthy controls has an important part to play in determining whether bulimia is characterised by a general dysregulation of the autonomic stress response.
Few previous studies have used standardised laboratory procedures to investigate cardiovascular and neuroendocrine responses to stress in individuals with disordered eating; those that have produced conflicting results. In a study of hospitalised women with bulimia nervosa versus controls, women with bulimia had significantly blunted cortisol and norepinephrine stress reactions (Pirke et al., 1992). A broadly similar result emerged from a study examining reactions to two stress tasks in non-hospitalised women with bulimia and controls (Koo-Loeb et al., 1998); women with bulimia had blunted sympathetic activation in response to mental stress indicated by blunted systolic blood pressure, heart rate, and epinephrine reactions, and attenuated pre-ejection period reactions. Two additional studies screened female students for disordered eating and stress-tested those with extreme high and low scores. Whereas one study observed no differences between those with disordered eating symptoms and controls in cardiovascular reactions to stress (Cattanach et al., 1988), the other reported that those high in disordered eating symptoms, but not meeting a clinical diagnosis for disordered eating, displayed higher heart rate and blood pressure reactivity compared to a group low in disordered eating symptoms (Koo-Loeb et al., 2000). A more recent study compared the stress reactivity of patients with bulimia nervosa, binge eating disorder, and obesity; although the groups did not vary on most measures of stress reactivity, those with bulimia were reported to show higher heart rate reactivity than the other groups (Messerli-Burgy et al., 2010).
There is no clear consensus emerging from these studies. Differences in previous findings may partially be attributed to the different populations of participants tested: in-patient hospitalised (Pirke et al., 1992), enrolled in an out-patient hospitalisation program (Messerli-Burgy et al., 2010), clinically confirmed diagnosis (Koo-Loeb et al., 1998), and high scores on an eating disorder questionnaire, but no official diagnosis (Cattanach et al., 1988, Koo-Loeb et al., 2000). It should be noted that in the three studies which tested confirmed bulimics, only two had a healthy control group and both showed blunted responses (Pirke et al., 1992, Koo-Loeb et al., 1998); the other study compared bulimics and people with binge eating disorder to an obese population (Messerli-Burgy et al., 2010).
The aim of the present study was to compare neuroendocrine, measured by salivary cortisol, and cardiovascular reactions to an acute psychological stress task in a group of participants who reported disordered eating behaviours versus healthy controls. On balance, it was hypothesised that those with disordered eating would show blunted reactions to mental stress relative to controls, since blunted stress reactivity has been observed in two previous studies comparing bulimics to a healthy control group (Pirke et al., 1992, Koo-Loeb et al., 1998). To our knowledge, this is the first study to measure both cortisol and cardiovascular reactions to the same mental stress task in individuals with disordered eating behaviour. It is important to determine whether dysregulation of the stress response is characteristic of both branches, of the stress effector system: hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system. The one study, to date, to examine this issue measured cortisol and α-amylase, considered a marker of sympathetic nervous system activation (Chatterton et al., 1996), to a standard laboratory stress exposure (Monteleone et al., 2011) in women with anorexia nervosa and bulimia. Relative to those with anorexia nervosa, women with bulimia showed blunted cortisol reactivity, whereas women with anorexia nervosa showed blunted α-amylase reactivity. In the present study, disordered eating and control groups were confirmed by responses to two questionnaires, one of which, the Eating Disorder Examination Questionnaire (Fairburn and Beglin, 1994), is regarded as an appropriate substitute for a clinical interview to diagnose eating disorders.
Section snippets
Participants
Questionnaires measuring problematic eating behaviour were administered to 455 female students (age, M = 19.3, SD = 2.08 years) recruited from University of Birmingham. Only women were targeted as problematic eating behaviour is reasonably well characterised in women and is rarer in men (Anderson, 1995, Woodside et al., 2001). The 12 participants who scored highest on the problematic eating criteria (disordered eating group; DE) and 12 who scored the lowest (healthy control group) were selected to
Validating allocation to control and disordered eating groups
There were no differences between groups in age, height, weight, BMI, or estimated cardio-respiratory fitness. As indicated, the means and standard deviations of these characteristics are displayed in Table 1. As would be expected, the disordered eating group had significantly higher scores than the control group on the SCOFF and EDE-Q. The relevant statistics are presented in Table 2.
Personality and co-morbidity characteristics
The disordered eating group registered higher scores on the questionnaire measure of exercise dependence
Discussion
The present study compared neuroendocrine and cardiovascular reactions to an acute psychological stress task in a group of participants with disordered eating behaviours and healthy controls. The results were in line with our original hypothesis; individuals with disordered eating exhibited blunted salivary cortisol, CO, HR, and SV reactions and an attenuated vasodilatory response to acute psychological stress compared to healthy controls. There were no differences between groups in SBP and DBP
Role of funding source
There were no study sponsors in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Conflict of interest
The authors have no conflict of interest.
Acknowledgements
The authors wish to thank Stephanie Lester, Anna Martin, Lewis Mathews, and Rebecca Price for their help with screening, recruitment and testing.
References (68)
- et al.
Attenuated adrenocortical and blood pressure responses to psychological stress in ad libitum and abstinent smokers
Pharmacol. Biochem. Behav.
(2003) - et al.
Metabolically exaggerated cardiac reactions to acute psychological stress: the effects of resting blood pressure status and possible underlying mechanisms
Biol. Psychol.
(2010) - et al.
Symptoms of depression and cardiovascular reactions to acute psychological stress: evidence from a population study
Biol. Psychol.
(2007) - et al.
Bulimia and binge eating in adolescent females: a comparison
Addict. Behav.
(1986) - et al.
The prevalence of high level exercising in the eating disorders: etiological implications
Compr. Psychiatry
(1997) - et al.
Obsessive compulsiveness and physical activity in anorexia nervosa and high level exercising
J. Psychosom. Res.
(1995) - et al.
Depression and anxiety: associations with biological and perceived stress reactivity to psychological stress protocol in a middle-aged population
Psychoneuroendocrinology
(2010) - et al.
The development of an abbreviated form of the revised Eysenck personality questionnaire (EPQR-A): its use among students in England, Canada, the USA, and Australia
Pers. Indiv. Differ.
(1992) - et al.
High perceived stress in relation to life events is associated with blunted cardiac reactivity
Biol. Psychol.
(2011) - et al.
Preliminary evidence that exercise dependence is associated with blunted cardiac and cortisol reactions to acute psychological stress
Int. J. Psychophysiol.
(2011)
Assessing cardiorespiratory fitness without performing exercise testing
Am. J. Prev. Med.
Attenuated cortisol response to psychological stress but not to CRH or ergometry in young habitual smokers
Pharmacol. Biochem. Behav.
Blunted cardiovascular and catecholamine stress reactivity in women with bulimia nervosa
Psychiatry Res.
Cortisol secretion patters in addiction and addiction risk
Int. J. Psychophysiol.
Cardiovascular stress reactivity and recovery in bulimia nervosa and binge eating disorder
Int. J. Psychophysiol.
Screening for eating disorders in primary care: EDE-Q versus SCOFF
Behav. Res. Ther.
Salivary cortisol responses in prepubertal boys: the effects of parental substance abuse and association with drug use behavior during adolescence
Biol. Psychiatry
Haemodynamic reactions to acute psychological stress and smoking status in a large community sample
Int. J. Psychophysiol.
The effect of a mental challenge test of plasma norepinephrine and cortisol in bulimia nervosa and in controls
Biol. Psychiat.
The hypothalamic–pituitary–adrenal (HPA) axis in habitual smokers
Int. J. Psychophysiol.
State associations with the cortisol awakening response in healthy females
Psychoneuroendocrinology
Blunted hypothalamic–pituitary–adrenocortical axis responsivity to stress in persons with a family history of alcoholism
Int. J. Psychophysiol.
Awakening cortisol response in relation to psychosocial profiles and eating behaviors
Physiol. Behav.
Bulimic vomiting alters pain tolerance and mood
Int. J. Psychiatry Med.
Cardiovascular and neuroendocrine adjustment to public speaking and mental arithmetic stressors
Psychophysiology
Eating disorders in males
The pathological status of exercise dependence
Br. J. Sports Med.
Diagnostic criteria for exercise dependence in women
Br. J. Sports Med.
A general enhancement of the autonomic and cortisol responses during social evaluative threat
Psychosom. Med.
Social neuroscience: autonomic, neuroendocrine, and immune responses to stress
Psychophysiology
Are large physiological reactions to acute psychological stress always bad for health
Soc. Pers. Psychol. Compass.
Body mass index, abdominal adiposity, obesity, and cardiovascular reactions to psychological stress in a large community sample
Psychosom. Med.
The behavioural and health corollaries of blunted physiological reactions to acute psychological stress: revising the reactivity hypothesis
Cited by (91)
Social network size moderates the association between loneliness and cardiovascular reactivity to acute stress
2024, Physiology and BehaviorEmotion regulation tendencies and cardiovascular responses to repeated acute psychological stress
2023, International Journal of PsychophysiologyTesting adverse childhood experiences (ACEs) as a potential moderator of the association between current chronic stress and cardiovascular reactivity
2023, International Journal of PsychophysiologyExtraversion is associated with lower cardiovascular reactivity to acute psychological stress
2023, International Journal of PsychophysiologyBlunted cortisol and normal sympathetic nervous system responses to an acute psychosocial stressor in internet addiction
2022, HeliyonCitation Excerpt :IA is also associated with higher psychological stress (Kuss et al., 2021; Tsumura et al., 2018). A laboratory stress task evoked higher levels of acute psychological stress in individuals addicted to alcohol (Bernardy et al., 2003; Sinha et al., 2009), opioids (Back et al., 2015), heroin (Gerra et al., 2014), and gambling (Kaess et al., 2017), whereas some studies reported normal levels of psychological stress responses to acute stressors in addiction (Back et al., 2008; Ginty et al., 2012; Panknin et al., 2002). Stress responses and exposure to stressors are also related to addiction (Turner and Lloyd, 2003).