What Can Cause Chronic Cortisol Dysregulation?

When facing a stressor or potential threat, the body releases hormones like cortisol, which can be helpful in small bursts. However, some people experience cortisol dysregulation—which is when cortisol levels are consistently too high or too low—which can lead to health challenges. Understanding more about how, when, and why the body releases cortisol, what may cause dysregulation, and how to address it can be a first step toward improving your well-being. For help managing stress levels or addressing mental health conditions, consider working with an in-person or online therapist.

What is cortisol?

Cortisol is a hormone that has a complex relationship with various body systems. It serves many functions, from reducing inflammation to regulating blood sugar and more. However, it’s most commonly associated with stress.

The body releases cortisol as a reaction to a perceived or potential threat, part of a mechanism known as the fight-or-flight response. This response is intended to prepare the body to fight the threat or flee from it by increasing heart rate, boosting blood flow to muscles, and initiating other helpful bodily functions.

Fight-or-flight can be helpful in the moment, but it can cause problems if engaged over the long term. If you’re struggling with high stress levels, a therapist can help you learn effective coping strategies.

Understanding the role of the HPA axis in the body’s stress response

The hypothalamic-pituitary-adrenal axis (HPA axis) is key to the body’s stress response and to understanding cortisol dysregulation. It involves:

• The hypothalamus, a part of the brain
• The pituitary gland, which is at the base of the brain
• The adrenal glands, which are on top of the kidneys

When the amygdala—the part of the brain that detects danger—perceives a potential threat, it will signal the hypothalamus to release chemical signals that activate the pituitary gland, which signals the adrenal glands. The adrenal glands regulate cortisol levels, so they will increase them as part of the threat response. Cortisol levels then rise to enable the body to respond to the threat, typically returning to baseline once the person is safe again. However, the cortisol levels of a person with dysregulation may remain too high or dip too low after the threat has passed.

What is cortisol dysregulation? 

Typically, morning cortisol levels are high, sometimes referred to as “nature’s alarm clock.” After these peak levels, cortisol usually goes down gradually throughout the day. However, some people may experience unusual levels of this hormone that don’t follow typical patterns.

Cortisol dysregulation or dysfunction occurs when cortisol levels in the body remain too high or too low over time, which can cause health challenges. Cortisol dysfunction has been linked to anxiety and depression and may contribute to symptoms like impaired cognitive function and emotional instability. When prolonged, high or low cortisol levels may even affect brain structure, potentially impacting memory, fear responses, and executive function, according to a 2025 systematic review on the topic. If it’s caused by a diagnosable condition, cortisol dysregulation may also result in additional complications.

If a doctor suspects a person may have dysregulated cortisol levels, they can measure these levels in a few different ways:

• Serum cortisol test (a blood test)
• A urine test
• A salivary cortisol test (a saliva test)

High cortisol vs. low cortisol

Cortisol level dysregulation can mean that a person’s cortisol levels are too high or too low, both of which can cause health complications. With Cushing’s syndrome, for example, elevated cortisol levels are what cause symptoms. With primary adrenal insufficiency (Addison’s disease), however, the adrenal glands are damaged and can’t make enough cortisol, so reduced levels are what cause symptoms.

How cortisol levels may become dysregulated

Since cortisol is the stress hormone, it makes sense that chronic stress can be one cause of lower or higher cortisol levels. Other potential causes can include medical illnesses, certain medications, trauma, and mental illnesses.

Chronic stress

Chronic stress occurs when someone experiences a sense of pressure, overwhelm, or danger for a significant period, leading the body to continually release cortisol. Chronic psychological stress can stem from ongoing stressors like a toxic or abusive relationship, a demanding job, financial instability, chronic pain, or many other causes. Since the fight-or-flight mechanism is intended to be short-term, the body sustaining these higher stress levels may lead to challenges like:

• Muscle pain and tension
• Other types of chronic pain, or trouble with pain rehabilitation
• Insomnia
• Headaches
• Decreased immune system function
• Increased risk factors for various physical illnesses, such as cardiovascular disease
• Increased risk of various mental illnesses, like depression and anxiety

Chronic emotional stress can sometimes create a vicious cycle. External stressors can cause physical and mental symptoms, which may cause more stress and, in turn, more symptoms. Help is available if you're looking to escape the cycle of chronic stress. Online therapy can be a convenient and more affordable way to receive care than in-person therapy.

Medical illnesses and certain medications

Physical health conditions can also cause cortisol dysregulation. For example, Cushing’s disease is a medical condition that can be caused by long-term cortisol production in the body, unrelated to whether one is experiencing stress. Because cortisol usually helps individuals maintain their blood pressure, regulate blood sugar, and reduce inflammation, people with Cushing’s disease often experience the following symptoms: 

• High blood pressure 
• High or low blood sugar
• Inflammation 
• Weight gain
• Stretch marks 
• Memory loss 
• An increased risk of blood clots 
• Roundness in the face 
• Increased fat near the neck and belly 
• Thin arms and legs 
• Easy bruising 
• Weakness in the muscles 

Other medical conditions, like Addison’s disease and certain types of tumors, may also affect cortisol regulation, as can taking or stopping certain medications. Conditions like these are relatively rare, but they can be serious. If you're showing concerning medical symptoms, it’s recommended that you make an appointment with your doctor.

Trauma

Prolonged psychological trauma may be a significant factor associated with repeated cortisol secretion over extended periods. Trauma usually causes stress. Being exposed to constant stress that one cannot easily escape—such as in an abusive relationship or when being raised by a neglectful parent—can cause cortisol to continue to be released in an attempt to prepare the body to protect itself from harm. However, this continued release of cortisol can lead to poor mental and physical health outcomes. Also note that it’s possible for cortisol levels in some people with trauma-related conditions like post-traumatic stress disorder (PTSD) to be too low, which can lead to health complications too.

Other mental health conditions

Some mental health conditions may also have a link to cortisol. For example, a 2023 study of Chinese patients with schizophrenia indicated “abnormal cortisol profiles,” which led researchers to suggest a potential connection between this hormone and some psychotic disorders.

When cortisol dysregulation may require medical care

Signs of cortisol dysregulation can depend on the underlying cause, and they may often be hard to recognize as specifically relating to cortisol issues. If you’re experiencing any concerning symptoms like the following or others, consult with your doctor for a medical evaluation:

• Unexplained weight gain or loss
• Persistent fatigue
• Trouble sleeping, leading to inadequate sleep
• Changes in mood
• Nausea and vomiting
• Dizziness or lightheadedness

Tips for managing your cortisol levels

If you’re experiencing possible symptoms of cortisol dysregulation, meeting with your doctor for a medical evaluation may be recommended, so they can test you for potential underlying conditions. Otherwise, the following tips may help you maintain healthy cortisol levels on a day-to-day basis.

Practice good sleep hygiene

Sleep hygiene refers to practices that can help you get quality, restorative sleep, such as going to bed and waking up at the same times each day and sleeping in a cool, dark, quiet room. Avoiding caffeine and big meals late in the day may also positively impact sleep quality. Since cortisol levels are involved in the body’s sleep-wake cycle, aiming to get adequate sleep each night may help with the regulation of this hormone.

Manage your stress levels

Since dysregulated cortisol levels can be caused by stress, focusing on stress management strategies may be helpful, such as:

• Deep breathing exercises. One study suggests that healthy individuals who received 20 sessions of breathing training showed significantly lower cortisol levels than the control group. Box breathing—where you breathe in for four counts, hold for four, exhale for four, and wait for four before repeating—can be a helpful method to try.
• Progressive muscle relaxation (PMR) techniques. These techniques involve tensing and then relaxing each muscle group in the body, one by one. Research findings on whether PMR can meaningfully lower cortisol levels are mixed, but physiological reports do suggest that it may decrease anxiety, a related measure.
• Mindfulness meditation. Mindfulness means having a nonjudgmental awareness of the present moment, and you might build this skill by practicing mindfulness meditation for a few minutes each day. Research suggests that participants in an eight-week mindfulness program showed decreased cortisol levels after completing it.
• Time in nature. Many people find activities like hiking, gardening, or walking in the park to be soothing, and some research suggests that this time in nature might actually help lower cortisol levels.
• Regular physical exercise. From taking brisk walks to playing basketball to doing high-intensity gym workouts, getting regular exercise may have many potential health benefits. As one example, medical sciences research suggests that routine exercise may be negatively correlated with cortisol levels over time.
• Close, healthy relationships. One study measured cortisol levels in older adults who live in close-knit communities. Its findings suggest that emotional closeness “was significantly associated” with decreased levels of cortisol. It’s just one of the many potential benefits of being socially connected.

Get treatment for past trauma

Research on the topic is ongoing, but some studies indicate that clinical treatment (such as therapy and medication) for trauma-related conditions like PTSD may help modulate cortisol levels over time. PTSD can cause “abnormal fear responses,” or feeling fear and panic in the absence of a direct threat. Treatment may help “teach” the person’s system that they are safe, potentially switching off the fight-or-flight response when it’s not necessary.

How therapy may help with cortisol dysregulation

Physical signs of cortisol dysregulation may mean it’s time to see a doctor. Experiencing the effects of stress, trauma, or psychological disorders may mean it's time to see a therapist. This type of mental health professional can evaluate your symptoms, then make a diagnosis and suggest a treatment plan if applicable. Even if you don’t have a diagnosable condition, they can work with you to implement healthy habits and develop positive coping mechanisms for stress and life’s other challenges.

Exploring online therapy as an option

While therapy can be a helpful tool for feeling more emotionally balanced, not everyone may easily access in-person care..Barriers to therapy, like location, finances, or a lack of nearby options, can sometimes make it challenging to seek support. 

In these cases, individuals might consider online therapy through a platform like BetterHelp. Users can choose between phone, video, or live chat sessions with a licensed online therapist, giving them control over how they receive support. In addition, they can take advantage of extra resources like worksheets, group sessions, journaling prompts, and goal-setting features to support them throughout their therapeutic journey. 

Can online therapy really help?

Studies generally support the effectiveness of internet therapy options. For instance, in one 2018 study, those who participated in internet-based cognitive behavioral therapy (CBT) were reported to have experienced a significant reduction in stress-related symptoms compared to the control group, and online treatment appeared to be just as effective as in-person treatment.