The cortisol response to psychological stress in temporomandibular dysfunction

The salivary cortisol response to psychological stress and its relationship to psychological variables was examined in 36 female temporomandibular 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 established psychological scales. The TMD group showed a significantly higher cortisol 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 stress (Hi-SC TMD group) and another group whose cortisol response was not significantly different from the control group (Lo-SC TMD group). The Lo-SC TMD group showed significant negative relationships between cortisol response and self-reported symptoms of both anxiety and depression, plus significantly more use of the Praying or Hoping coping strategy on the Coping Strategies Questionnaire. A dual relationship between TMD symptoms and the stress response is proposed. First, a biological predisposition to TMD is suggested by the stress response in the Hi-SC TMD group. Second, both psychological and biological variables appear to be important factors in those TMD patients who respond to stress with low cortisol secretion. (C) 1997 International Association for the Study of Pain, Published by Elsevier Science B.V.