Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: A meta-analysis

•We performed the first meta-analysis on HPA axis functioning in BPD patients.•BPD patients display blunted cortisol following psychosocial stress.•BPD patients are characterized by elevated continuous cortisol output.•Neither single nor pharmacological cortisol assessments differ for BPD patients....

Full description

Saved in:
Bibliographic Details
Published in:Neuroscience and biobehavioral reviews 2019-01, Vol.96, p.316-334
Main Authors: Drews, Elisa, Fertuck, Eric A., Koenig, Julian, Kaess, Michael, Arntz, Arnoud
Format: Article
Language:English
Subjects:
Borderline personality disorder
Borderline Personality Disorder - physiopathology
Cortisol
Humans
Hydrocortisone - metabolism
Hypothalamic-pituitary-adrenal axis
Hypothalamo-Hypophyseal System - physiopathology
Meta-analysis
Pituitary-Adrenal System - physiopathology
Stress response
Stress, Psychological - physiopathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•We performed the first meta-analysis on HPA axis functioning in BPD patients.•BPD patients display blunted cortisol following psychosocial stress.•BPD patients are characterized by elevated continuous cortisol output.•Neither single nor pharmacological cortisol assessments differ for BPD patients. Borderline Personality Disorder (BPD) has been associated with altered hypothalamic-pituitary-adrenal (HPA) axis functioning. However, evidence is inconsistent. Therefore, the present series of meta-analyses aimed to quantify HPA axis functioning in BPD patients based on singular and continuous cortisol assessments and measures of reactivity to pharmacological and psychosocial stress. Case-control studies comparing adult BPD patients and healthy and clinical controls were considered for inclusion. The search resulted in 804 publications, of which 37 studies (k = 81; BPD n = 803, controls n = 1092) were included. Analyses were based on random effect models using standardized mean differences. BPD patients displayed elevated continuous cortisol output and blunted cortisol following psychosocial challenges. Singular cortisol assessments and cortisol after pharmacological challenges were not significantly different. Meta-analyses were limited by inconsistent reporting in individual studies and small samples for some comparisons. Due to the debilitating nature of stress-related symptoms in BPD, more research on elevated continuous cortisol output and blunted cortisol responses to psychosocial stress is warranted.
ISSN:0149-7634
1873-7528
DOI:10.1016/j.neubiorev.2018.11.008