Enhanced suppression of cortisol after dexamethasone in borderline personality disorder. A pilot study

Abstract

Introduction. Some studies have suggested the etiological role of childhood traumatic events in borderline personality disorder (BPD), involving the stress response mechanisms and the activity of hypothalamic-pituitary adrenal (HPA) axis. Recent preliminary results show that BPD, similar to that found in post-traumatic stress disorder (PSD), might have a hypersensitive response to the dexamethasone test.

Methods. Fourteen BPD patients, diagnosed according to DSM-IV criteria, without a major depressive episode or history of bipolar or psychotic disorder, were compared with 10 patients with other personality disorders (OPD). Plasma cortisol was measured at baseline and following an oral test with 0.25 mg of dexamethasone.

Results. Nine out of 14 (64%) BPD patients were cortisol suppressors in the test versus only 2 out of 10 (20%) patients with other personality disorders (chi square 4.6, degree factors [df] 18, p<0.05). The degree of cortisol suppression was significantly greater for BPD patients (73% ) than for patients with other personality disorder (34%). Baseline cortisol concentrations, although lower in BPDpatients, were not significantly different among groups.

Conclusions. BPD could be associated withhypersensitivity of feedback mechanisms of the HPA axissimilar to PSD, which suggests a possible role for traumaticexperiences in the pathogenesis of the disorder.