Sympathetic and hypothalamic-pituitary-adrenal asymmetry in generalized anxiety disorder

Jonathan W. Reeves, Aaron J. Fisher, Michelle G. Newman, Douglas A. Granger

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Physiologic investigations of generalized anxiety disorder (GAD) have skewed toward assessment of the autonomic nervous system, largely neglecting hypothalamic-pituitary-adrenal (HPA) axis variables. Although these systems coordinate-suggesting a degree of symmetry-to promote adaptive functioning, most studies opt to monitor either one system or the other. Using a ratio of salivary alpha-amylase (sAA) over salivary cortisol, the present study examined symmetry between the sympathetic nervous system (SNS) and HPA axis in individuals with GAD (n=71) and healthy controls (n=37). Compared to healthy controls, individuals with GAD exhibited greater baseline ratios of sAA/cortisol and smaller ratios of sAA/cortisol following a mental arithmetic challenge. We propose that the present study provides evidence for SNS-HPA asymmetry in GAD. Further, these results suggest that increased SNS suppression in GAD may be partially mediated by cortisol activity.

Original languageEnglish (US)
StateAccepted/In press - 2016


  • Asymmetry
  • Cortisol
  • Generalized anxiety disorder
  • Salivary alpha-amylase

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)
  • Experimental and Cognitive Psychology
  • Neuropsychology and Physiological Psychology
  • Arts and Humanities (miscellaneous)
  • Developmental and Educational Psychology


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