Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis
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Background It is of debate whether or not childhood anxiety disorders (AD) can be captured by one taxonomic construct. This study examined whether perceived arousal (PA), autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis measures can distinguish children with different primary diagnoses of clinical anxiety disorders (AD) from each other, and from a general population reference group (GP).Methods The study sample consisted of 152 AD children (comparing separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia), aged 8- to 12-years, and 200 same-aged reference children. HPA-axis functioning was measured by a diurnal cortisol profile. ANS functioning was measured by continuous measures of skin conductance level in rest and during a mental arithmetic task and high frequency heart rate variability in rest. PA was assessed by a questionnaire.Results The AD sample showed lower high frequency heart rate variability during rest, heightened anticipatory PA, higher basal and reactive skin conductance levels and lower basal HPA-axis functioning compared to the GP sample. The existence of three or more clinical disorders, i.e. a high clinical 'load', was associated with lower basal HPA-axis functioning, higher skin conductance level and lower posttest PA. Specific phobia could be discerned from social phobia and separation anxiety disorder on higher skin conductance level.Conclusions Our findings indicated that children with AD have specific psychophysiological characteristics, which resemble the psychophysiological characteristics of chronic stress. A high clinical 'load' is associated with an altered ANS and HPA-axis functioning. Overall, ANS and HPA-axis functioning relate to AD in general, accept for specific phobia.
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Childhood anxiety disorder is associated with decreased basal HPA tone, increased sympathetic and attenuated parasympathetic activity.
“One factor that might account for these discrepancies is the onset of anxiety symptoms, as childhood anxiety disorder is associated with decreased basal HPA tone, increased sympathetic and attenuated parasympathetic activity (Dieleman et al, 2015).”
From Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond (2017) · cites this paper as Dieleman et al, 2015
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- Authors
- Dieleman, G. C., Huizink, A. C., Tulen, J. H. M., Utens, E. M. W. J., Creemers, H. E., van der Ende, J., & Verhulst, F. C.
- Affiliations
- Erasmus MC (NL)
- Vrije Universiteit Amsterdam (NL)
- University of Amsterdam (NL)
- Corresponding author
- Dieleman, Gwendolyn C.
- ORCID
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 51
- Pages
- 135-150
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2118182252
- Cited by
- 141
- References
- 50
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 12 · 2023: 7 · 2022: 19 · 2021: 14 · 2020: 15 · 2019: 15 · 2018: 11 · 2017: 4 · 2016: 19 · 2015: 10
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- childhood anxiety disorders, hypothalamic-pituitary-adrenal axis, autonomic nervous system, cortisol, skin conductance, heart rate variability, perceived arousal, separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, specific phobia, psychophysiology
- MeSH terms
- Anxiety Disorders, Autonomic Nervous System, Child, Circadian Rhythm, Diagnosis, Differential, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Pituitary-Adrenal System, Surveys and Questionnaires, Saliva, Stress, Psychological
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