Blunted cold pressor test-induced cortisol but not total ghrelin response in women with bulimia nervosa following a standardized sweet-fat liquid meal

• Published in: Appetite Vol. 213; p. 108020
• Main Authors: Smith, Kimberly R., Schreyer, Colleen C., Bello, Nicholas T., Goodman, Ethan, Tamashiro, Kellie L.K., Moran, Timothy H., Guarda, Angela S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2025
• Subjects: Adolescent; Adult; Appetite; Binge; Bulimia nervosa; Bulimia Nervosa - blood; Bulimia Nervosa - physiopathology; Bulimia Nervosa - psychology; Cold pressor test; Cold Temperature; Cortisol; Dietary Fats - administration & dosage; Female; Ghrelin; Ghrelin - blood; HPA axis; Humans; Hunger; Hydrocortisone - blood; Hypothalamo-Hypophyseal System - physiopathology; Meal; Meals; Pituitary-Adrenal System - physiopathology; Stress; Stress, Psychological - blood; Young Adult; Cold pressor test; Ghrelin; Binge; Meal; HPA axis; Cortisol; BN; Bulimia nervosa; Stress
• ISSN: 0195-6663; 1095-8304
• DOI: 10.1016/j.appet.2025.108020

Bulimia nervosa (BN) involves recurrent episodes of uncontrolled eating followed by compensatory behaviors. Stress is implicated in BN, affecting the hypothalamic-pituitary-adrenal (HPA) axis and ghrelin, a key appetite-regulating hormone. Studies report conflicting HPA axis findings in BN, necessitating further investigation. To examine the impact of acute stress on cortisol and serum ghrelin and eating disorder symptoms in women with BN and healthy controls (HC). Participants underwent a socially evaluated cold pressor test (CPT) and control condition (quiet rest) before consuming a sweet-fat liquid meal (530 Kcal milkshake). Hormonal responses and subjective measures of stress, interoception, and appetite were assessed. In BN but not HC, desire to binge remained consistently high in both conditions and correlated with perceived hunger. There were no group differences in total ghrelin levels and levels were not influenced by the CPT. Baseline cortisol levels were similar for HC and BN groups, however BN subjects did not demonstrate a CPT-induced elevation in cortisol as observed in HC. Results confirm HPA axis dysregulation in BN in response to a passive stressor and liquid meal challenge. Meal-related total ghrelin however does not appear to be involved in the stress response in women with or without BN. Desire to binge is persistent in BN, irrespective of the presence or absence of an acute stressor with a sweet-fat liquid meal and may be associated with heightened emotional states in general.