title: Increased psychological and attenuated cortisol and alpha-amylase responses to acute psychosocial stress in female patients with borderline personality disorder.
abstract: OBJECTIVE
  Borderline personality disorder (BPD) is characterized by increased self-reported stress and emotional responding. Knowledge about the psychological and physiological mechanisms that underlie these experiences in BPD patients is scarce. The objective was to assess both psychological and endocrinological responses to a standardized psychosocial stressor in female BPD patients and healthy controls.
  
  
  METHODS
  A total of 15 female BPD patients and 17 healthy control subjects were included in a case-control study. All subjects were free of any medication, had a regular menstrual cycle, and were investigated during the luteal phase of their menstrual cycle. Co-occurring current major depression, current substance abuse/dependence, and lifetime schizophrenia or bipolar I disorder were excluded. Psychological measures of stress, salivary cortisol, salivary alpha-amylase, plasma ACTH, plasma norepinephrine and epinephrine concentrations were measured before, during, and after exposure to a standardized psychosocial stress protocol.
  
  
  RESULTS
  BPD patients displayed maladaptive cognitive appraisal processes regarding the upcoming stressor as well as significantly higher subjective stress, coupled with a substantial cortisol and alpha-amylase hyporeactivity to the stressor in comparison to the controls. No significant differences for ACTH and catecholaminergic responses were observed, while the ACTH:cortisol ratio was higher in BPD patients than in controls.
  
  
  CONCLUSIONS
  Attenuated cortisol responsiveness in BPD patients might in part be explained by decreased adrenal responsiveness to endogenous ACTH and altered central noradrenergic activation as reflected by alpha-amylase.
authors.affiliation: University of Zurich, Institute of Psychology, Dept. of Clinical Psychology & Psychotherapy, Switzerland. u.nater@psychologie.uzh.ch
authors.forename: Urs M
authors.initials: UM
authors.lastname: Nater
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
authors.forename: Elvira
authors.initials: E
authors.lastname: Abbruzzese
authors.forename: Beate
authors.initials: B
authors.lastname: Ditzen
authors.forename: Jens
authors.initials: J
authors.lastname: Gaab
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kleindienst
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ebner-Priemer
authors.forename: Jana
authors.initials: J
authors.lastname: Mauchnik
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ehlert
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D001883:Borderline Personality Disorder / Q000378:metabolism* / Q000523:psychology*; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D009638:Norepinephrine / Q000097:blood; D010556:Personality Tests; D010913:Pituitary-Adrenal System / Q000378:metabolism; D012463:Saliva / Q000201:enzymology / Q000378:metabolism; D012931:Social Environment; D013315:Stress, Psychological / Q000378:metabolism* / Q000523:psychology*; D000516:alpha-Amylases / Q000378:metabolism*
chemical_list: D000324:Adrenocorticotropic Hormone; D000516:alpha-Amylases; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine