Hair cortisol levels in women with medically unexplained symptoms (2021) Fischer et al

Note: cringe worthy, be warned.


Abstract

Stress has been demonstrated to be involved in the development of medically unexplained symptoms.

A key underlying mechanism could be lower levels of cortisol, which can contribute to symptoms such as fatigue or pain.

However, the literature is highly equivocal, which may be due to methodological limitations inherent in short-term cortisol assessment.

The aim of this case-control study was to investigate, for the first time, whether individuals with different forms of medically unexplained symptoms show altered hair cortisol concentrations, a long-term marker of hypothalamic-pituitary-adrenal functioning.

Two groups of women with medically unexplained symptoms were recruited. The first had a functional somatic syndrome, characterised by specific medically unexplained symptoms (i.e., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome, n = 33).

The second had somatic symptom disorder, characterised by excessive thoughts, feelings, and behaviours devoted to various medically unexplained symptoms (n = 23).

These groups were contrasted with healthy controls (n = 30), and women with depression (n = 27).

Cortisol representing the previous three months was extracted from hair. Chronic stress and childhood trauma were assessed (retrospectively).

Women with somatic symptom disorder had lower hair cortisol than healthy controls and women with functional somatic syndromes.

No differences in hair cortisol were found between healthy controls, functional somatic syndromes, and depression.

Neither childhood trauma nor chronic stress was correlated with hair cortisol.

Provided that our findings are replicated, they may suggest that hypocortisolism is found in a specific subgroup of individuals with medically unexplained symptoms, and potentially in those characterised by excessive thoughts, feelings, and behaviours about symptoms.

Link to abstract here

 

“Stress has been demonstrated to be involved”

Has it?

What is “stress”?

What is meant by “demonstrated”?

How was this “demonstrated”?

When was this “demonstrated”?

By whom was this demonstrated”?

Was replication “demonstrated”?

What are the differences between findings of immunological responses to “stress” and those relating to “unexplained symptoms” ?

Or …Is this an obtuse way of referring to the fact that developing symptoms of illness might result in one feeling “stress” of some variety?

If so “involved in development of” would appear a most misleading opening statement.

It is important to be accurate with one’s descriptions and terminology. Should one wish to to perform scientific studies. For ethical and practical considerations.

If subjects do experience “stress” of any variety, those with painful and debilitating symptoms, this is part of the healthy function of bodies warning systems.

This would require investigation by a competent person. Someone with integrity and compassion. A high level of specialist medical and scientific knowledge.

I don’t see this “demonstrated”, here.

 

main results:

"Post-hoc tests of the total sample indicated that individuals with somatic symptom disorder had significantly lower hair cortisol concentrations than healthy controls and individuals with a functional somatic syndrome (both p < .012), whereas there was no difference between individuals with a functional somatic syndrome and healthy controls (p = .935) and individuals with a depressive disorder and healthy controls (p = .161)."
​

 

I am not sure I understand the difference between their two ‘functional’ groups:

As the article is not yet available we don’t yet know any more about how people were allocated to each group, whether this was based on questionnaires or clinical judgement. Given there is no positive evidence that any individuals have a functional disorder rather than an as yet poorly understood biomedical disorder, rather preselection based on deliberate ignoring of some evidence, surely the only difference between the two groups may well turn out to be that the latter are in some way more distressed by their health issues.

So if cortisol is related to stress, isn’t the most obvious explanation that the individuals’ current health condition(s) are the cause of any stress rather and in turn cortisol levels. Certainly I would expect current health to be more relevant to current stress levels rather than hypothetical childhood trauma. In this situation the most obvious controls should be people with a currently better understood condition such as MS, and distinction made between those seemingly coping well with their condition and those struggling with it.

 

Do we know if cortisol levels relate differentially to physical stress and psychological stress? A health condition, regardless of its aetiology, may be a source of psychological stress but it may also be a cause of physical or biological stress.

 

Full article is here: https://www.sciencedirect.com/science/article/pii/S0022395621007469

 

I think, when it comes to any mention of stress, that researchers constantly confuse cause and effect.

If you are doing a job that you enjoy you are probably not stressed at all or not very much.

If you are doing a job that you like but are trying to do it while suffering from severe pain you will very likely start to feel very stressed because of the pain.

Researchers will say that the person is in pain because they are stressed, not that they are stressed because of the pain. And they do this switching of cause and effect whenever it is convenient for them.

Edit : I'm also very dubious about using hair for measurements of anything. What about the effects of soap, shampoo, hair colour, hair spray, pollution etc.

 

Thank you for the link. I saw ‘pre print’ and just assumed the full article was not yet published. This is what they say in terms of aetiology:

This is what they say about patient selection:

So those those in the functional somatic syndrome group had a number of distinct disorders lumped together on the basis of an unevaluated assumption that these were a priori functional disorders, and no discussion of potentially high levels of misdiagnosis.

Those included as having somatic syndrome seem to be selected on the basis of clinical judgement, though with some structure provided for gathering the information for that judgement.

Ever more elaborate structures are built on suppositions and weak evidence. How depressing that volume of evidence is taking the place of reliable evidence.

 

So even using every methodological trick to create a false effect, nothing is found, and they still conclude that it's relevant simply because it's so vague that no one cares what they argue in the conclusion, it's only meant to be used to push the old trope.

BPS research in a nutshell. It's the "throwing papers down the stairs and grading them by what step they fell on" method of research. What a waste. At some point the whole field of clinical psychology may simply have to be regarded as quackery, they can't seriously expect anyone to trust what they produce when this is typical of the quality level. Great work discrediting all expertise, it's actually impressive in a sense.

 

Cortisol is primarily a feed-forward metabolic hormone. It surprises me how many psychologists and medical doctors don't seem to recognise what the "gluco" bit in glucocorticoid means.

The primary purpose of cortisol has nothing to do with psychosocial "stress".

Higher levels of cortisol are needed for a more active lifestyle, whereas lower levels of cortisol (and a flatter curve for people who are not busy in the morning) is needed for sedentary/unemployed lifestyle. The fact that this is never discussed in these sorts of studies just shows how little the authors understand.

The association with stress arises because chronic stress, as a person anticipates a greater level of activity the next day and hence will need a bit more gluconeogenesis.