Linking Hair Cortisol Levels to Phenotypic Heterogeneity of Posttraumatic Stress Symptoms in Highly Traumatized Chinese Women

Abstract

Hypothalamic-pituitary-adrenocortical (HPA) axis dysfunction has been proposed to be associated with the development and maintenance of posttraumatic stress disorder (PTSD) ( 1 Yehuda R. Status of glucocorticoid alterations in post-traumatic stress disorder. Ann N Y Acad Sci. 2009; 1179: 56-69 Crossref PubMed Scopus (298) Google Scholar ). More recently, Steudte et al. ( 2 Steudte S. Kirschbaum C. Gao W. Alexander N. Schönfeld S. Hoyer J. et al. Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biol Psychiatry. 2013; 74: 639-646 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar ) identified hair cortisol as a potential biomarker of PTSD symptoms. Relative to cortisol level in saliva, blood, and urine, hair cortisol level has advantages including reflecting long-term alterations of basal HPA activity and being less affected by a host of potentially confounding factors, such as biological rhythm and environmental disturbances ( 3 Staufenbiel S.M. Penninx BWJH Spijker A.T. Elzinga B.M. van Rossum E.F.C. Hair cortisol, stress exposure, and mental health in humans: A systematic review. Psychoneuroendocrinology. 2013; 38: 1220-1235 Abstract Full Text Full Text PDF PubMed Scopus (426) Google Scholar ). Steudte et al. ( 2 Steudte S. Kirschbaum C. Gao W. Alexander N. Schönfeld S. Hoyer J. et al. Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biol Psychiatry. 2013; 74: 639-646 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar ) reported that hair cortisol levels were negatively associated with severity of intrusion symptoms and avoidance symptoms (at trend level). However, their findings may be limited by a small sample size and a phenotypic model of PTSD symptoms that lacks empirical support (i.e., the tripartite model of DSM-IV). Regarding the phenotypic models of PTSD symptoms, emerging confirmatory factor analytic studies demonstrate that a five-factor model that comprises intrusion, avoidance, emotional numbing, dysphoric arousal, and anxious arousal is superior to the tripartite model defined in DSM-IV and two variations of a four-factor solution ( 4 Armour C. Carragher N. Elhai J.D. Assessing the fit of the dysphoric arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC. J Anxiety Disord. 2013; 27: 109-115 Crossref PubMed Scopus (49) Google Scholar , 5 Harpaz-Rotem I. Tsai J. Pietrzak R.H. Hoff R. The dimensional structure of posttraumatic stress symptomatology in 323,903 U.S. veterans. J Psychiatr Res. 2014; 49: 31-36 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar ). It has been demonstrated that distinct symptom clusters composed of the five-factor model may be linked to different biological processes ( 6 Pietrzak R.H. Gallezot J.D. Ding Y.S. Henry S. Potenza M.N. Southwick S.M. et al. Association of posttraumatic stress disorder with reduced in vivo norepinephrine transporter availability in the locus coeruleus. JAMA Psychiatry. 2013; 70: 1199-1205 Crossref PubMed Scopus (97) Google Scholar , 7 Pietrzak R.H. Henry S. Southwick S.M. Krystal J.H. Neumeister A. Linking in vivo brain serotonin type 1B receptor density to phenotypic heterogeneity of posttraumatic stress symptomatology. Mol Psychiatry. 2013; 18: 399-401 Crossref PubMed Scopus (25) Google Scholar ). To examine further the long-term endocrine correlates of posttraumatic psychopathology, we examined the relationship of hair cortisol levels to heterogeneous symptom dimensions of the newly refined five-factor model of PTSD symptoms in a relatively large sample of highly traumatized Chinese women. Reply to: Linking Hair Cortisol Levels to Phenotypic Heterogeneity of Posttraumatic Stress Symptoms in Highly Traumatized Chinese WomenBiological PsychiatryVol. 77Issue 4PreviewWe would like to thank Wang et al. (1) for their interesting suggestion concerning the use of the five-factor “dysphoric arousal” model of posttraumatic stress disorder (PTSD) symptoms (2) for examining associations with long-term endocrine parameters, instead of the classic DSM-IV–based model. Although the prime focus of our published report (3) concerned the influence of trauma exposure on hair cortisol concentrations (HCC), we concur with the authors that exploration of the five-factor model in this context may have merit for enhancing understanding of associations between HCC and facets of PTSD symptoms. Full-Text PDF