Differences in Cortisol Awakening Response between Binge-Purging and Restrictive Patients with Anorexia Nervosa

Malnutrition and childhood trauma were shown to affect in opposite way the cortisol awakening response (CAR) of patients with anorexia nervosa (AN). To assess the influence of binge-purging behaviour on the CAR of AN patients, we measured the CAR of restrictive AN (ANR) or binge-purging AN (ANBP) patients without history of childhood maltreatment. Seventeen ANBP women, 18 ANR women and 42 healthy women collected saliva samples at awakening and after 15, 30 and 60 min, and filled in the Eating Disorder Inventory-2 (EDI-2). ANR and ANBP patients exhibited a CAR significantly higher than healthy women. Moreover, the CAR of ANBP women was even higher than that of ANR women and positively correlated with the bulimia subitem scores of the EDI-2. Present findings show, for the first time, differences in the CAR between ANBP and ANR subtypes, which may suggest a possible connection between the HPA axis functioning and binge-purging. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.