Effective outpatient or inpatient psychotherapy over a period of 3 months does not yet lead to a normalisation of correlates of physiological stress response. Furthermore, symptom reports are not necessarily associated with differences in stress physiology (salivary cortisol, alpha-amylase and heart rate variability) in women with anorexia nervosa (AN) and bulimia nervosa (BN), mixed mental disorders and women without mental disorders. Before treatment or at the initial measurement, a mixed picture emerged with elevated cortisol levels in the AN group, while both AN and BN showed higher vagal activity (HF-HRV), presumably as a counter-regulation to stress. There were no group differences in alpha-amylase. After three months of psychotherapy, only vagal activity normalised in the AN/BN groups, suggesting that even after successful treatment, physiological normalisation takes more time and was associated in this sample with psychopathology rather than BMI.

https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0329573