Abstract
Background: Patients with post-traumatic stress disorder (PTSD) showed inconsistencies in their cortisol level, an index of the hypothalamic-pituitary-adrenal (HPA) axis function. This study examined the relationship between dissociation, childhood trauma, and morning cortisol levels in PTSD patients. Methods: This study included 69 patients and 82 healthy controls (HCs). Clinical assessments, including the Childhood Trauma Questionnaire (CTQ) and Peri-traumatic Dissociative Experiences Questionnaire scores (PDEQ), and morning cortisol levels were evaluated. The morning cortisol levels were compared between PTSD with high dissociation (PTSD-HD) and low dissociation (PTSD-LD) groups. The effect of CTQ subtype on morning cortisol levels was analyzed. Outcomes: The PTSD-HD group showed significantly lower cortisol levels than that of the PTSD-LD and HC groups. A significant inverse correlation was found between morning cortisol levels and dissociation. A significant positive correlation was found between dissociation and physical abuse and sexual abuse scores. Morning cortisol levels showed significant positive correlation with emotional abuse, emotional neglect, and physical neglect. There was no moderating or mediating effect of childhood traumatic experience on the relationship between cortisol levels and dissociation. Interpretation: These findings suggest that dissociation is a significant factor related to hypocortisolism in PTSD patients. Additionally, basal morning cortisol levels and dissociation scores were closely associated with the childhood trauma. Funding Statement: This study was supported by a grant from the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT, and Future Planning (NRF-2015M3C7A1028252), and a grant from the Korea Science and Engineering Foundation (KOSEF) funded by the Korean government (NRF2018R1A2A2A05018505). Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: All participants signed an informed consent form approved by the Institutional Review Board before participating (IRB no. 2015-07-025).
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