THE CORTISOL RESPONSE TO PSYCHOLOGICAL STRESS IN TEMPOROMANDIBULAR DYSFUNCTION

The salivary cortisol response to psychological stress and its relatio nship to psychological variables was examined in 36 female temporomand ibular dysfunction (TMD) sufferers and 39 female control participants. Saliva samples were taken at baseline, after completion of a modified version of the Trier Social Stress Test, and after rest. Participants also completed a battery of measures, including Visual Analog Scales for measuring pain intensity and disability and a number of establishe d psychological scales. The TMD group showed a significantly higher co rtisol response to experimental stress than the control group. Closer examination of the data revealed that the TMD group was heterogeneous and composed of a group that hypersecreted cortisol in response to str ess (Hi-SC TMD group) and another group whose cortisol response was no t significantly different from the control group (Lo-SC TMD group). Th e Lo-SC TMD group showed significant negative relationships between co rtisol response and self-reported symptoms of both anxiety and depress ion, plus significantly more use of the Praying or Hoping coping strat egy on the Coping Strategies Questionnaire. A dual relationship betwee n TMD symptoms and the stress response is proposed. First, a biologica l predisposition to TMD is suggested by the stress response in the Hi- SC TMD group. Second, both psychological and biological variables appe ar to be important factors in those TMD patients who respond to stress with low cortisol secretion. (C) 1997 International Association for t he Study of Pain, Published by Elsevier Science B.V.