Psychoneuroendocrine:  Research Article

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Abuse-Related Posttraumatic Stress Disorder: Evidence for Chronic
Neuroendocrine Activation in Women

CITATION:  Lemieux, A.M., Coe,C. L. (1995). Abuse-Related Posttraumatic Stress Disorder: Evidence for Chronic Neuroendocrine Activation in Women.  Psychosomatic Medicine 57:105-115 (1995) 105.

ABSTRACT:  The following study tested the hypothesis that women with post-traumatic stress disorder (PTSD) related to childhood sexual abuse would display elevated norepinephrine-to-cortisol ratios similar to that found in male combat veterans diagnosed with PTSD. Twenty-four-hour urine samples were collected from 28 women: 11 women with PTSD who experienced childhood sexual abuse (PTSD+), 8 women who experienced childhood sexual abuse without PTSD (PTSD-], and 9 nonabused controls. All urine samples were tested for creatinine, total catecholamines, free-cortisol, and 17-ketosteroid levels. Psychological testing validated that the PTSD+ group was significantly elevated on all three subscales of the Impact of Events Scale. Both abused groups (PTSD+ and PTSD—) showed a tendency for polyuria, and the PTSD+ group showed a tendency towards obesity. Thus, neuroendocrine values (/j.g/day) were adjusted by creatinine clearance rates (creatinine mg/day/kg body weight). The corrected values indicated that the PTSD+ group had significantly elevated daily levels of norepinephrine, epinephrine, dopamine, and cortisol. However, because of the parallel elevation in cortisol, the norepinephrine-to-cortisol ratio was not significantly elevated in the PTSD+ diagnosed women in contrast to the findings reported for male PTSD patients. This discrepancy may reflect an important gender difference, an interaction between gender and age at onset of the traumatic experience (childhood abuse in females vs. combat experience in young adult males), or physiological variation related to phase of the disorder.


1. Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed-Revised. Washington, DC, American Psychiatric Association, 1987

2. Mason JW, Giller EL, Kosten TR, Ostroff RB, Podd L: Urinary free-cortisol levels in posttraumatic stress disorder patients, j Nerv Ment Dis 174:145-149, 1986

3. Kosten TR, Mason JW, Giller EL, Ostroff RB, Harkness L: Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder. Psychoneuroendorinology 12:13-20, 1987

4. Mason JW, Giller EL, Kosten TR, Harkness L: Elevation of urinary norepinephrine/cortisol ratio in posttraumatic stress disorder. J Nerv Ment Dis 176:498-502, 1988

5. Kosten TR, Wahby V. Giller E, Mason J: The dexamethasone suppression test and thyrotropin-releasing hormone stimulation test in posttraumatic stress disorder. Biol Psychiatry 28:657-664, 1990

6. Yehuda R, Southwick SM, Krystal JH, Bremner D, Charney DS, Mason JW: Enhanced suppression of cortisol following dexamethasone administration in posttraumatic stress disorder. Am J Psychiatry 150:83-86, 1993

7. Davidson JRT, Hughes D, Blazer DG, George LK: Post-traumatic stress disorder in the community: An epidemiological study. Psychol Med 21:713-721, 1991

8. Creamer M: Post-traumatic stress disorder: Some diagnostic and clinical issues. Aust N Z J Psychiatry 24:517:522, 1990

9. Curran PS, Bell A, Loughrey G, Roddy R, Rocke LG: Psychological consequences of the Enniskillen bombing. Br J Psychiatry 156:479-482, 1990

10. Shalev A, Bleich A, Ursanno RJ: Posttraumatic stress disorder: Somatic comorbidity and effort tolerance. Psychosomatics 31:197-203, 1990

11. Albach F, Everaerd W: Posttraumatic stress symptoms in victims of childhood incest. Psychother Psychosom 57:143-151, 1993

12. Chu JA, Dill DL: Dissociative symptoms in relation to childhood physical and sexual abuse. Am J Psychiatry 147:887-892, 1990

13. Kiser LJ, Heston J, Millsap PA, Pruitt DB: Physical and sexual abuse in childhood: Relationship with post-traumatic stress disorder. J Am Acad Child Adolesc Psychiatry 30:776-783, 1991

14. Palmer RL, Chaloner DA, Oppenheimer R: Childhood sexual experiences with adults reported by female psychiatric patients. Br J Psychiatry 160:261-265, 1992

15. Pribor EF, Dinwiddie SH: Psychiatric correlates of incest in childhood. Am J Psychiatry 149:52-56

16. Meikle AW, Daynes RA, Araneo BA: Adrenal androgen secretion and biologic effects. Endocrinol Metab Clin North Am 20:381-400, 1991

17. Parker LN: Control of adrenal androgen secretion. Endocrinol Metab Clin North Am 20:401-421, 1991

18. Lipton MI, Schaffer WR: Physical symptoms related to posttraumatic stress disorder (PTSD) in an aging population. Mil Med 153:316-318, 1988

19. White P, Faustman W: Coexisting physical conditions among
inpatients with post-traumatic stress disorder. Mil Med 154:
66-71, 1989

20. Hurt SW, Friedman RC, Clarkin J, Corn R, Arnoff MS: Psychopathology and the menstrual cycle. In Friedman RC (ed.), Behavior and the Menstrual Cycle. New York, Marcel Dekker, 1982, 299-315

21. Paddison PL, Gise LH, Lebovits A, Strain JJ, Cirasole DM, Levine IP: Sexual abuse and premenstrual syndrome: Comparison between a lower and higher socioeconomic group. Psychosomatics 31:265-272, 1990

22. Briere J, Runtz M: Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Negl 12:51-59, 1988

23. Cunningham J, Pearce T, Pearce P: Childhood sexual abuse and medical complaints in adult women. J Interpersonal Violence 3:131-144, 1988

24. Vieweg WVR, Rowe WT, David JJ, Curnow RT, Spradlin WW: Patterns of urinary excretion among patients with self-induced water intoxication and psychosis. Psychiatry Res 15:71-79, 1985

25. Jubenko GS, Altesman RI, Cassidy JW, Barreira, PJ: Disturbances of thirst and water homeostasis in patients with affective illness. Am J Psychiatry 141:436-437, 1984

26. Felitti VJ: Long-term medical consequences of incest, rape, and molestation. South Med J 84:328-331, 1991

27. Lechner ME, Vogel ME, Garcia-Shelton LM, Leichter JL, Steibel KR: Self-reported medical problems of adult female survivors of childhood sexual abuse. J Fam Pract 36:633-638, 1993

28. Springs FE, Friedrich WN: Health risk behaviors and medical sequelae of childhood sexual abuse. Mayo Clin Proc 67:527-532, 1992

29. Horowitz MJ, Wilner N, Alvarez W: Impact of event scale: A measure of subjective stress. Psychosom Med 41:209-218, 1979

30. Zilberg NJ, Weiss DS, Horowitz MJ: Impact of events scale: A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. J Consult Clin Psychol 50:407-414, 1982

31. Andersen HS, Christensen AK, Petersen GO: Post-traumatic stress reactions amongst rescue workers after a major rail accident. Anx Res 4:245-251, 1991

32. Creamer M, Burgess, Pattison P: Reaction to trauma: A cognitive processing model. J Abnorm Psychol 101:452-459, 1992

33. Feinstein A, Dolan R: Predictors of post-traumatic stress disorder following physical trauma: An examination of the stressor criterion. Psychol Med 21:85-91, 1991

34. Shalev A: Posttraumatic stress disorder among injured survivors of a terrorist attack: Predictive value of early intrusion and avoidance symptoms. J Nerv Ment Dis 180: 505-509, 1992

35. Dahl S: Acute response to rape: a PTSD variant. Acta Psychiatr Scand Suppl 355:56-62, 1989

36. Kang DH, Davidson RJ, Coe CL, Wheeler RE, Tomarken AJ, Ershler WB: Frontal brain asymmetry and immune function. Behav Neurosci 105:860-869, 1991

37. Strauman TJ, Lemieux AM, Coe CL: Self-discrepancy and natural killer cell activity: Immunological consequences of negative self-evaluation. J Pers Soc Psychol 64:1042-1052, 1993

38. Halbreich U, Endicott J, Schacht S, Nee J: The diversity of premenstrual changes as reflected in the premenstrual assessment form. Acta Psychiatr Scand 65:46-65, 1982

39. Halbreich U, Endicott J: Classification of premenstrual syndromes. In Friedman RC (ed), Behavior and the Menstrual Cycle. New York, Marcel Dekker, 1982:243-265

40. Haning RV, Carlson IH, Flood CA, Hackett RJ, Longcope C: Metabolism of dehydroepiandosterone sulfate (DS) in normal women and women with high DS concentrations. J Clin Endocrinol Metab 73:1210-1215, 1991

41. Light KC, Turner JR: Stress-induced changes in the rate of sodium excretion in healthy black and white men. J Psychosom Res 36:497-508, 1992

42. Schaeffer AJ, Del Greco F: Other renal diseases of urologic significane. In Walsh PC, Gittes RF, Perlmutter AD, Stamey TA (eds), Campbell's Urology, Vol 3. Philadelphia, Saunders, 1986, 2342-2361

43. Cohen J, Cohen P: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Hillsdale, NJ, Lawrence Erlbaum Associates, 1983

44. Yehuda R, Southwick S, Giller EL, Ma X, Mason JW: Urinary catecholamine excretion and severity of PTSD symptoms in Vietnam combat veterans. J Nerv Ment Dis 180:321-325, 1992

45. Opstad PK: Androgenic hormones during prolonged physical stress, sleep, and energy deficiency. J Clin Endocrinol Metab 74:1176-1183, 1992

46. Parker L, Eugene J, Farber D, Lifrak E, Lai M, Juler G: Dissociation of adrenal androgen and cortisol levels in acute stress. Horm Metab Res 17:209-212, 1985

47. Garfinkel PE, Brown GM, Stancer HC, Moldofsky H: Hypothalamicpituitary function in anorexia nervosa. Arch Gen Psychiatry 32:739-744, 1975

48. Fava M, Rosenbaum JF, MacLaughlin RA, Tesar GE, Pollack MH, Cohen LS, Hirsch M: Dehydroepiandrosterone-sulfate/cortisol ratio in panic disorder. Psychol Res 345:350, 1989

49. Baum A, Cohen L, Hall M: Control and intrusive memories as possible determinants of chronic stress. Psychosom Med 55:274-286, 1993

50. Yehuda R, Resnick H, Kahuna B, Giller EL: Long-lasting hormonal alterations to extreme stress in humans: Normative or maladaptive. Psychosom Med 55:287-297, 1993

51. Ironson G: The impact of Hurricane Andrew and stress, cognitive difficulties and immune abnormalities in chronic fatigue syndrome. Paper presented at Gender Differences in Stress: Immunological Aspects. Washington DC, April 20, 1993

52. Southwick SM, Krystal JH, Morgan CA, Johnson D, Naby LM, Nicolaou A, Heninger GR, Charney DS: Abnormal noradrenergic function in posttraumatic stress disorder. Arch Gen Psychiatry 50:266-274, 1993

53. Charney DS, Deutch AY, Krystal JH, Southwick SM, Davis M: Psychobiologic mechanisms of posttraumatic stress disorder. Arch Gen Psychiatry 50:294-305, 1993

54. Hollister LE, Moore F: Factors affecting excretion of catecholamines in man: Urine flow, urine pH, and creatinine levels, physical activity, and urinary catecholamine excretion of clearance. Res Commun Chem Pathol Pharmacol 1:193-202, obese and non-obese rhesus monkeys. Obesity Res 1:5-17,1993 1970 60. Bancroft J, Williamson L, Warner P, Rennie D, Smith SK:

55. Baines AD, Ho P: Specific alpha-sub-1, alpha-sub-2, and Perimenstrual complaints in women complaining of PMS, beta-responses to norepinephrine in pyruvate-perfused rat menorragia and dysmenorrhea: Toward a dismantling of kidneys. Am J Physiol 252:F17O-F176, 1987 premenstrual syndrome. Psychosom Med 55:133-145, 1993

56. Blandford DE, Smyth, DD: Renal alpha-sub-2-adrenoceptor 61. Schenker JG, Meirow D, Schenker E: Stress and human blockade decreases sodium and water excretion in the anes- reproduction. Eur J Obstet Gynecol Rep Res 45:1-8, 1992 thetized rat. Eur J Pharmacol 154:117-124, 1988 62. Odink J, Van der Ploeg HM, Van der Berg J, Van Kempen GMJ,

57. Epstein FH, HigginsM: Epidemiology of obesity. In Bjorntorp, Bruinse HW, Louwerse ES: Circadian and circatrigintan P, Brodoff, BN (eds), Obesity. JP. Lippincott Co, 1992, 330-342 rhythms of biogenic amines in premenstrual syndrome

58. Rodin J, Wing RR: Behavioral factors in obesity. Diabetes (PMS). Psychosom Med 52:346-356, 1990 Metab Rev 4:701-725, 1988 63. Horowitz MJ: Stress response syndromes. London, jBson

59. Wolden-Hanson T, Davis GA, Baum ST, Kemnitz JW: Insulin Aronson, 1986