Hypothalamic-Pituitary-Adrenal Axis Function in Children and Adults with Severe Antisocial Behavior and the Impact of Early Adversity

Graeme Fairchild, Ellie Baker, Steve Eaton

Research output: Contribution to journalReview articlepeer-review

32 Citations (SciVal)


PURPOSE OF REVIEW: To review recent studies investigating hypothalamic-pituitary-adrenal axis function in children and adolescents with disruptive behavior disorders (DBDs) and adults with antisocial personality disorder. We consider key concepts and methodological issues in cortisol assessment and review studies investigating basal cortisol secretion and stress reactivity in antisocial populations. Lastly, we consider whether cortisol abnormalities predict prognosis or treatment outcomes and the impact of exposure to adversity on hypothalamic-pituitary-adrena (HPA) axis activity.

RECENT FINDINGS: Studies tracking cortisol levels across the day and assessing cortisol awakening responses (CARs) have reported broadly intact, but flatter, diurnal rhythms and lower CARs in children and adolescents with DBDs, whereas findings in antisocial adults have been mixed. Cortisol hyporeactivity to stress is consistently reported in male antisocial populations, whereas no comparable data exist in females. Severe antisocial behavior is associated with cortisol hyporeactivity to stress, and such hyporeactivity predicts poor treatment outcomes. Further research investigating sex differences and the impact of adversity is needed. Harmonization of methods for assessing hypothalamic-pituitary-adrenal axis function and antisocial behavior would enhance progress in this area.

Original languageEnglish
Article number84
Pages (from-to)1-9
Number of pages9
JournalCurrent Psychiatry Reports
Issue number10
Early online date28 Aug 2018
Publication statusPublished - 1 Oct 2018


  • Antisocial behavior
  • Antisocial personality disorder
  • Conduct disorder
  • Cortisol
  • HPA axis
  • Psychopathy

ASJC Scopus subject areas

  • Psychiatry and Mental health


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