title: The Interaction of Childhood Maltreatment, Sex, and Borderline Personality Features in the Prediction of the Cortisol Awakening Response in Adolescents.
abstract: OBJECTIVE
  The study aimed to investigate childhood maltreatment, sex, and borderline personality disorder (BPD) symptoms as prospective predictors of adolescent hypothalamic-pituitary-adrenal (HPA) axis reactivity.
  
  
  METHODS
  A sample of 69 adolescents (30 female and 39 male) were selected from a larger longitudinal study of adolescent development and assessed at 3 time points. BPD symptoms were assessed at T1 (approx. 12.5 years), childhood maltreatment was assessed at T2 (approx. 14.9 years), and multiple assessments of salivary cortisol (cortisol awakening response; CAR) were undertaken at T3 (approx. 15.5 years).
  
  
  RESULTS
  Multivariate linear regression analysis revealed a significant main effect for childhood maltreatment but not for early BPD symptoms as a predictor of lower CAR in adolescence (p = 0.047). The association between childhood maltreatment and attenuated CAR was moderated by both early BPD symptoms (p = 0.024; no childhood maltreatment-dependent attenuation of CAR in the presence of BPD symptoms) and sex (p = 0.012; childhood maltreatment-dependent attenuation of CAR in females only). Furthermore, a 3-way BPD × childhood maltreatment × sex interaction (p = 0.041) indicated that the moderating effect of BPD symptoms was present in females only.
  
  
  CONCLUSIONS
  These findings indicate that attenuation of the HPA axis occurs as a response to early maltreatment rather than being related to the early occurrence of BPD pathology. Traumatized female individuals with BPD symptoms might bypass adaptive HPA axis attenuation.
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kaess
authors.forename: Sarah
authors.initials: S
authors.lastname: Whittle
authors.forename: Julian G
authors.initials: JG
authors.lastname: Simmons
authors.forename: Martina
authors.initials: M
authors.lastname: Jovev
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Allen
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Chanen
mesh_terms: D000293:Adolescent; D001883:Borderline Personality Disorder / Q000378:metabolism* / Q000473:pathology; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D005260:Female; D005783:Gender Identity; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D006854:Hydrocortisone
keywords: Adolescence; Borderline personality disorder; Cortisol; Hypothalamic-pituitary-adrenal axis; Sex