Anxiety and joint hypermobility: An unexpected association

Anxiety and joint hypermobility: An unexpected association – Current Psychiatry. 2018 April

Joint hypermobility syndrome (JHS)—also known as Ehlers-Danlos type 3–hypermobile type (hEDS)—is a poorly recognized connective tissue disorder characterized by increased joint laxity that may affect 10% to 25% of the general population.

Researchers are increasingly recognizing an association between JHS/hEDS and psychiatric symptoms and disorders, specifically anxiety.

In this review, we describe the clinical presentation of JHS/hEDS, propose a new “Neuroconnective phenotype” based on the link between anxiety and JHS/hEDS, and discuss factors to consider when treating anxiety in a patient who has JHS/hEDS.  

JHS/hEDS: A complex disorder

Its known basis is the type and distribution pattern of collagen, and one of the key features used to identify this syndrome is greater joint laxity, meaning increased distensibility of the joints in passive movements as well as a hypermobility in active movements.

Although first described by two dermatologists (Edvard Ehlers and Henri-Alexandre Danlos) at the beginning of the 20th century, JHS/hEDS is now considered a multi-systemic condition.

Thus, JHS/hEDS includes a wide range of musculoskeletal features, and over the recent years, extra-articular symptoms, such as easy bruising or hypertrophic scarring, have gained recognition.

Moreover, individuals with JHS/hEDS frequently present with stress-sensitive illnesses, such as fibromyalgia, or chronic fatigue syndrome. The Table2 provides a description of musculoskeletal and extra-articular features of JHS/hEDS.

The link between JHS/hEDS and anxiety

Psychiatric symptoms are being increasingly recognized as a key feature of JHS/hEDS.

Specifically, JHS/hEDS has been associated with a

  • higher frequency and greater intensity of fears,
  • greater anxiety severity and somatic concerns, and
  • higher frequency of the so-called endogenous anxiety disorders

There also is limited but growing evidence that JHS/hEDS is associated with depressive disorders, eating disorders, and neurodevelopmental disorders as well as alcohol and tobacco misuse.

Moving toward a new phenotype.

The core of the phenotype includes the “anxiety-joint laxity” association and has 5 dimensions that allow for minor overlap

  1. (somatic symptoms,
  2. somatic illnesses,
  3. psychopathology,
  4. behavioral dimensions, and
  5. somatosensory symptoms).

Each of the 5 dimensions includes features that may be present at different degrees with individual variations.

Unfortunately, only this first page of the article is freely available.

6 thoughts on “Anxiety and joint hypermobility: An unexpected association

    1. Zyp Czyk Post author

      I took a look at this theory and found a good write-up at

      I’ve also noticed similarities between several chronic illnesses, like fibromyalgia, CFS, and EDS, but I’m not sure how widely they apply. Other painful chronic illnesses, like sickle cell anemia, have a clear genetic cause that seems separate from these.

      Still, I’m curious about what we will learn about how illness and genetics in the future. We are just beginning to understand more than the most basic principles of the biochemistry of genetics.

      Liked by 1 person

      1. KJT

        Yep, that’s her own website–I meant to link to it, but was short on time and was on mobile. I’d noticed the connections years ago and have always said autism is like being born with a brain predisposed to PTSD because of its hypersensitivity, and that it seemed to correlate with CFS, allergies, LGBT stuff, then hEDS… and then, boom, found her site.

        And you’re right; we know so little about what activates and triggers all this weird crap in our genes and how much of it is environmental, dietary, etc… it’s all in its infancy yet and many delusions persist. Speaking of which, I’m really grateful for your blog and your work in defending chronic pain patients’ access to decent medication. I’ve got both hEDS and endometriosis and a circadian rhythm disorder that absolutely wipe me out with pain and fatigue, and wouldn’t be typing this without those evil nasty bad junkie drugs, opioids. They give me at least a few hours’ relief from the pain, fatigue and hyperalgesia (which I’ve had since childhood, and would have whether I was on opiates or not–a common EDS trait the scaremongers choose to ignore) and it’s absolutely inhumane to cut off people’s access to them. So I’m really grateful for you for maintaining such an informative site, and standing up to the bullies who don’t know what pain even is. Thank you :)

        Liked by 1 person

        1. Zyp Czyk Post author

          And, thank you for your most excellent compliment!

          I hope to provide openly patient-biased information to contradict the dominant myths (and sometimes even research) about pain and opioids. I can’t be impartial when the whole cultural card deck of stigma and misconceptions is stacked against us.


  1. Pingback: Management of chronic pain in EDS – part 2 | EDS and Chronic Pain News & Info

  2. Pingback: hEDS Patients Face Many Physical and Mental Challenges | EDS and Chronic Pain News & Info

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