Disordered eating behaviour is associated with blunted cortisol and cardiovascular reactions to acute psychological stress

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Summary

Research suggests a potential dysregulation of the stress response in individuals with bulimia nervosa. This study measured both cardiovascular and cortisol reactions to a standardised laboratory stress task in individuals identified as showing disordered eating behaviour to determine whether dysregulation of the stress response is characteristic of the two branches of the stress response system. Female students (N = 455) were screened using two validated eating disorder questionnaires. Twelve women with disordered eating, including self-induced vomiting, and 12 healthy controls were selected for laboratory stress testing. Salivary cortisol and cardiovascular activity, via Doppler imaging and semi-automatic blood pressure monitoring, were measured at resting baseline and during and after exposure to a 10-min mental arithmetic stress task. Compared to controls the disordered eating group showed blunted cortisol, cardiac output, heart rate, and stroke volume reactions to the acute stress, as well as an attenuated vasodilatory reaction. These effects could not be accounted for in terms of group differences in stress task performance, subjective task impact/engagement, age, BMI, neuroticism, cardio-respiratory fitness, or co-morbid exercise dependence. Our findings suggest that disordered eating is characterised by a dysregulation of the autonomic stress-response system. As such, they add further weight to the general contention that blunted stress reactivity is characteristic of a number of maladaptive behaviours and states.

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.

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