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
- (somatic symptoms,
- somatic illnesses,
- behavioral dimensions, and
- 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.