Mineralocorticoid receptor stimulation effects on stress-induced cortisol and alpha-amylase in female patients with borderline personality disorder and healthy controls: A randomized placebo-controlled experimental study.
Marie Barthauer, Livia Graumann, An Bin Cho et al.
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In 30 seconds
This double-blind, randomized, placebo-controlled experimental study examined mineralocorticoid receptor stimulation and stress responses in 120 female patients with borderline personality disorder (BPD) and 120 healthy controls. Participants received fludrocortisone or placebo before the Trier Social Stress Test or a placebo version. Under placebo, patients with BPD had a blunted cortisol response to stress compared with controls, despite reporting greater subjective affective responses. Fludrocortisone reduced cortisol values across groups and conditions, while salivary alpha-amylase responses were unaffected. Comparable cortisol values after fludrocortisone make increased MR-mediated feedback less likely to be the primary explanation for the blunted response in BPD.
Key findings
- After placebo, female patients with BPD showed a blunted cortisol response to the Trier Social Stress Test compared with healthy controls.
- Fludrocortisone reduced cortisol values in both groups and across stress and placebo-test conditions.
- Salivary alpha-amylase increased with stress across groups and was not affected by mineralocorticoid receptor stimulation.
- Patients with BPD reported greater subjective affective responses to stress despite their blunted cortisol response.
Why it matters
The findings distinguish cortisol responses from subjective stress and salivary alpha-amylase responses in BPD. Although mineralocorticoid receptor stimulation lowered cortisol, the resulting comparable values between patients and controls do not support increased MR-mediated feedback as the primary mechanism for the blunted stress-related cortisol response. This helps refine understanding of stress-system differences in BPD without establishing their underlying cause.
What to keep in mind
The study included only female participants, so the findings may not generalize to males.