title: Sex determines cortisol and alpha-amylase responses to acute physical and psychosocial stress in patients with avoidant personality disorder.
abstract: Avoidant personality disorder (AVPD) has excessive and pervasive anxiety and discomfort in social situations. The aims of this study were to explore the relationship between AVPD and physical and psychological stress and psychological tests.
  
  
  
  We evaluated 93 AVPD patients and 355 nonpatient controls by salivary amylase and cortisol responses during exposure to the Trier Social Stress Test (TSST) and electrical stimulation stress. Spielberger state-trait anxiety inventory (STAI), Profile of Mood State (POMS), Beck Depression Inventory (BDI), Depression and Anxiety Cognition Scale (DACS), and Childhood Trauma Questionnaire (CTQ) were administered.
  
  
  
  Following electrical stimulation, salivary cortisol levels in female AVPD decreased significantly less than that in female's controls, but salivary cortisol levels did not show a difference between male AVPD patients and controls. Salivary alpha-amylase (sAA) levels did not show a difference between females or male AVPD patients and controls. Following TSST exposure, sAA levels did not show a difference between females or male AVPD patients and controls. Salivary cortisol levels did not show a difference between females or male AVPD patients and controls. In the AVPD patients, POMS scores were significantly higher compared with the controls. STAI, BDI, DACS scores, and CTQ significantly increased in the AVPD patients compared with the controls. LF in heart rate variability in AVPD significantly increased more compared with controls.
  
  
  
  These results suggest that heightened sympathetic reactivity in female AVPD co-occurs with attenuated salivary cortisol responses to electric stimulation stress and there is a significant difference between AVPD and controls in mood, anxiety, social cognition, and automatic nerve systems.
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Ishitobi
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Inoue
authors.affiliation: Department of Applied Linguistics Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Oshita
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Chiwa
authors.initials: C
authors.lastname: Kawashima
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Saeko
authors.initials: S
authors.lastname: Aizawa
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Masuda
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maruyama
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Higuma
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanehisa
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Taiga
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Department of Neuropsychiatry Oita University Faculty of Medicine Hasama-Machi Oita 879-5593 Japan.
authors.forename: Jotaro
authors.initials: J
authors.lastname: Akiyoshi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000378:metabolism*; D012737:Sex Factors; D013315:Stress, Psychological / Q000378:metabolism*; D055815:Young Adult; D000516:alpha-Amylases / Q000378:metabolism*
chemical_list: D000516:alpha-Amylases; D006854:Hydrocortisone
keywords: Alpha‐amylase; avoidant personality disorder; cognition; cortisol; social anxiety disorder; stress