Abnormal salivary cortisol levels in social phobic patients in response toacute psychological but not physical stress

Background: Little is known about the hypothalamic-pituitary adrenal axis r esponse to acute stressfid behavioral challenges in patients with social ph obia. Methods: Eighteen patients with social phobia and 17 normal volunteers part icipated in two behavioral stressors: a speech task and physical exercise. Results: Normal volunteers (n = 14) demonstrated a significant 50% increase in salivary cortisol levels to the speech task. Three nonresponding normal volunteers demonstrated a 17% decrease. In contrast, patients with social phobia demonstrated dichotomous changes. Seven social phobia patients demon strated a significantly higher 90% increase in salivary cortisol to the spe ech task, whereas the remaining patients (n = 11) were nonresponders demons trating a 32% decrease in cortisol. Both patient groups were significantly more anxious than the normal volunteers. In contrast to the response to a s peech task, social phobics showed a cortisol response to physical exercise of similar magnitude as normal volunteers. Conclusions: The results indicated dichotomies in magnitude and bt distribu tion of the cortisol response to a speech task between social phobia patien ts and normal volunteers. Social phobia patients responded differently than normal volunteers to a stressor associated with social evaluation but not to physical exercise. These results suggest adaptation of distinct biologic al processes spec ftc to different stressfid conditions in social phobia. ( C) 2001 Society of Biological Psychiatry.