PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Abstract

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.

Keywords:

• IPV
• PTSD
• depression
• comorbidity
• cortisol

Acknowledgement

We would like to acknowledge the Battered Women's Shelters of Akron, OH, for their critical contributions to this research. We thank you for all you do to better the lives of those victimized by intimate partner violence.

Funding

This research was supported by NIMH [grant number K23 MH067648 (D.M.J.)] and pilot funds from the Summa-Kent State Center for the Treatment and Study of Traumatic Stress (D.M.J. and D.L.D.).

Additional information

Funding

Funding: This research was supported by NIMH [grant number K23 MH067648 (D.M.J.)] and pilot funds from the Summa-Kent State Center for the Treatment and Study of Traumatic Stress (D.M.J. and D.L.D.).