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Childhood Maltreatment and Diurnal Cortisol Patterns in Women With Chronic Pain

Nicolson, Nancy A. PhD; Davis, Mary C. PhD; Kruszewski, Denise MA; Zautra, Alex J. PhD

doi: 10.1097/PSY.0b013e3181d9a104
Original Articles

Objective: To assess whether alleged childhood maltreatment is associated with daily cortisol secretion in women with chronic pain.

Method: Women with fibromyalgia (FM group, n = 35) or with osteoarthritis only (OA group, n = 35) completed diaries and collected three saliva samples daily for 30 days, with compliance monitored electronically. Childhood abuse and neglect were assessed by self-report (Childhood Trauma Questionnaire-short form [CTQ-sf]). Multilevel regression analyses estimated associations between maltreatment and diurnal cortisol levels and slopes, controlling for depressive symptoms, posttraumatic stress disorder (PTSD), and daily experience variables.

Results: Women reporting more severe childhood maltreatment had higher cortisol throughout the day. The estimated effect of CTQ on log cortisol (β = 0.007, p = .001) represents a 0.7% increase in raw cortisol level for every unit increase in maltreatment score, which ranged from 25 (no maltreatment) to 106 in this sample. Although different forms of maltreatment were interrelated, emotional and sexual abuse were most closely linked to cortisol levels. Fibromyalgia and osteoarthritis groups showed similar secretory patterns, and maltreatment was associated with elevated cortisol in both. Although maltreatment was related to symptoms of depression, PTSD, and averaged daily reports of positive and negative affect, none of these variables mediated the link between maltreatment and cortisol.

Conclusions: In women with chronic pain, self-reported childhood maltreatment was associated with higher diurnal cortisol levels. These results add to the evidence that abuse in childhood can induce long-term changes in hypothalamic-pituitary-adrenocortical activity. They further underscore the importance of evaluating childhood maltreatment in fibromyalgia and other chronic pain conditions.

CTQ-sf = Childhood Trauma Questionnaire-short form; HPA = hypothalamic-pituitary-adrenocortical; PTSD = posttraumatic stress disorder.

From the Department of Psychiatry and Neuropsychology (N.A.N.), School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands; and the Department of Psychology (M.C.D., D.K., A.J.Z.), Arizona State University, Tempe, Arizona.

Address correspondence and reprint requests to Nancy Nicolson, PhD, Department of Psychiatry and Neuropsychology, Maastricht University, P.O Box 616, 6200MD Maastricht, Netherlands. E-mail:

Received for publication July 9, 2008; revision received December 17, 2009.

This study was supported, in part, by Grant RO1 AR046034 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.J.Z., Principal Investigator).

Copyright © 2010 by American Psychosomatic Society
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