Pituitary-adrenal responses to standard and low-dose dexamethasone suppression tests in adult survivors of child abuse

Background: Previous studies indicate that adverse childhood events are associated with persistent changes in corticotropin-releasing factor neuronal systems. Our aim was to determine whether altered glucocorticoid feedback mediates the neuroendocrine sequelae of childhood trauma. Methods. Standard and low-dose dexamethasone suppression tests (DST) were performed in women with a history of child abuse (n = 19), child abuse and major depression (n = 16), major depression and no childhood trauma (n = 10), and no history of mental illness or childhood trauma (n = 19). Secondary analysis with posttraumatic stress disorder (PTSD) as the organizing diagnosis was also conducted. Results: In the low-dose DST, depressed women with a history of abuse exhibited greater cortisol suppression than any comparator group and greater corticotropin suppression than healthy volunteers or nondepressed abuse survivors. There were no differences between nondepressed abuse survivors and healthy volunteers in the low-dose DST or between any subject groups in the standard DST The PTSD analysis produced similar results. Conclusions: Cortisol supersuppression is evident in psychiatrically ill trauma survivors, but not in nondepressed abuse survivors, indicating that enhanced glucocorticoid feedback is not an invariable consequence of childhood trauma but is more related to the resultant psychiatric illness in traumatized individuals. (C) 2004 Society of Biological Psychiatry.