Developmental traumatology Part I: Biological stress systems

Background: This investigation examined the relationship between trauma, ps ychiatric symptoms and urinary free cortisol (UFC) and catecholamine (epine phrine [EPI] norepinephrine [NE], dopamine [DA]) excretion in prepubertal c hildren with posttraumatic stress disorder (PTSD) secondary to past child m altreatment experiences (n = 18), compared to non-traumatized children with over-anxious disorder (OAD) (n = 10) and healthy controls (n = 24), Methods: Subjects underwent comprehensive psychiatric and clinical assessme nts and 24 hour urine collection for measurements of UFC and urinary catech olamine excretion. Biological and clinical measures were compared using ana lyses of variance. Results: Maltreated subjects with PTSD excreted significantly greater conce ntrations of urinary DA and NE over 24 hours than OAD and control subjects and greater concentrations of 24 hour UFC than control subjects. Post hoc a nalysis revealed that maltreated subjects with PTSD excreted significantly greater concentrations of urinary EPI than OAD subjects. Childhood PTSD was associated with greater co-morbid psychopathology including depressive and dissociative symptoms, lower global assessment of functioning, and increas ed incidents of lifetime suicidal ideation and attempts. Urinary catecholam ine and UFC concentrations showed positive correlations with duration of th e PTSD trauma and severity of PTSD symptoms. Conclusions: These data suggest that maltreatment experiences are associate d with alterations of biological stress systems in maltreated children with PTSD. An improved psychobiological understanding of trauma in childhood ma y eventually lead to better treatments of childhood PTSD. Biol Psychiatry 1 999;45:1259-1270 (C) 1999 Society of Biological Psychiatry.