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Anxiety and EDS-H / JHS
Did you know that Individuals with hypermobility are (up to 16 times) over-represented among those with panic or anxiety disorders?
Anxiety has been found to be linked with EDS-H / JHS. The following information aims to explain some of the factors which could explain this relationship:
Originally it was thought that people with EDS-H / JHS suffered from anxiety as a reaction to the condition they were suffering from. For example, chronic pain may very well cause many people to feel anxious or depressed. Feeling that nobody understands their disorder (they find it difficult to explain to skeptics because their body often looks perfectly normal) and being accused of hypochondria, or of not getting sufficient rest would understandably cause any patient to become agitated. Frustration often increases as their normal activities become increasingly difficult and anxiety, depression, and sadness are all common. This is undoubtedly a factor for many who suffer from EDS-H / JHS. Anxiety can therefore, often be greatly reduced if the patient finds a doctor who is prepared to work with them to understand their needs, or are fortunate enough to be referred to one of the specialist centres (listed under 'Resources and Links') where they realise they are believed and their symptoms can be treated.
'The Relationship between Anxiety Disorders and Joint Hypermobility Syndrome is so easily missed'
It is now recognised however, that the links between anxiety and EDS-H / JHS are far more complex. Studies have shown physio-logical causes, as well as the psycho-logical ones discussed above.
Physio-logical causes included autonomic dysfunction and/or a compromised function of neuro-developmental conditions in the developing brain. Brief details are given below:
Autonomic Dysfunction (Dysautonomia)
The body's autonomic nervous system regulates all the processes that occur automatically, such as breathing, heart rate, blood pressure and digestion. People with symptomatic-hypermobility often suffer from problems with Dysautonomia.
'Many of the autonomic nervous system problems associated with hypermobility are characterised by an “over-response” to physical and emotional stresses, which often leads to fluctuations in heart rate and blood pressure, as well as digestive and respiratory symptoms. Sickness, pain, emotional stress, and even fatigue itself can raise adrenaline levels, and acute stresses can trigger adrenaline surges, leaving you jittery, anxious, and even more exhausted. Worse, such surges can trigger an excessive counter-response, causing nausea, sweating, lightheadedness, diarrhea, and of course even more fatigue. Even sensory stimuli, such as bright lights or loud noises, can trigger an exaggerated or over-response, causing sensitivity to light and sound.' (Quote: Dr Alan Pocinki MD, PLLC 2010)
'The body’s tendency to overreact to stresses by making too much adrenaline can lead others to think that hypermobile people are “too sensitive,” “irritable,” or “anxious.” Patients themselves may notice this, saying, “I’ve always overreacted to little things. I can’t help it.” It is very important to recognise two things about this phenomenon. First, it is a physical reaction, so that counseling usually will not be effective in treating this type of anxiety. Similarly, adrenaline highs and lows may be mistaken for the mood fluctuations of bipolar disorder, but mood-stabilizing medications usually are not indicated. When medication is required, beta blockers, which block adrenaline, may be as effective with fewer side effects than SSRI’s like Prozac and Lexapro or benzodiazepines like Xanax and Valium. Second, while a feeling of anxiety can be produced by emotional stress, it is just as likely that such symptoms have a physical cause, most often fatigue, pain, or dehydration, and less commonly by a drop in blood sugar or blood pressure. Not surprisingly, researchers have found that anxiety and panic disorder are more common in hypermobile people.' (Quote: Dr A Pocinki MD, PLLC)
In recent years clinical studies, such as the following have lent weight to the calls for more research into EDS-H / JHS and anxiety.
Work (published by Martin-Santos, Bulbena, Porta, Gago, Molina and Duro ‘98) states that ‘Joint laxity is highly prevalent in patients with panic disorder, agoraphobia, or both and may reflect a constitutional disposition to suffer from anxiety. Mitral valve prolapse / Autonomic Dysfunction plays a secondary role in the association between joint hypermobility and anxiety. Joint hypermobility syndrome was found in 67.7% of patients with anxiety disorder but in only 10.1% of psychiatric and 12.5% of medical control subjects. Patients with anxiety disorder were over 16 times more likely than control subjects to have joint laxity. Of the patients with anxiety disorder, those who had joint hypermobility syndrome were younger and more often women and had an earlier onset of the disorder than those without joint hypermobility syndrome.’
Significant association has been found between joint hypermobility syndrome and anxiety disorders (particularly panic, agoraphobia and social phobia) in rheumatologic patients, and, interestingly both joint hypermobility syndrome and anxiety disorders have similar prevalence in the general population, between 10% and 15%, and have similar female predominance .
Unfortunately, the relationship between anxiety disorders and JHS is often neglected, but several lines of research are continuing in the persuit of better understanding of this area. The first involves a branch of genetics that is concerned with the study of the structure and function of the cells and chromosones and considers the genetic predisposition to anxiety and the nature and extent of that contribution. (Gratacos M. 2001 / García Campayo J. 2010 / Morris-Rosendahl D.J 2002).
The second is looking into the significantly high prevalence of autonomic nervous system symptoms (dysautonomia) in joint hypermobility patients as found by Gazit Y. 2003, while the third involves findings which suggest that processes, compromising function in neuro-developmental conditions, may occur in individuals with hypermobility, seemingly enhancing their vulnerability to stress and anxiety (Eccles J. A. 2012).
'We strongly recommend to assess the lifetime prevalence of anxiety disorders, especially panic disorder, in joint hypermobility patients. Panic disorder is a proper medical condition, not merely a reaction caused by another illness. These data could shed new light onto the challenging and prevalent psychosomatic field.’
(Antonio Bulbena, Director, Guillem Pailhez, Carolina Baeza, Andrea Bulbena-Cabre, Institute Neuropsychiatry 2011)
Below are extracts from a report in the British Journal of Psychiatry, where the authors have been able to present, for the first time, a neuroimaging study of hypermobility that also examines autonomic dysfunction / interoceptive sensitivity (the malfunction or faulty regulation in the involuntary nervous system and the individual's ability to perceive and processes bodily signals, both of which are commonly found in patients with EDS-H / JHS). The authors tested for associations between regional cerebral grey matter and hypermobility in 72 healthy volunteers using voxel-based morphometry of structural brain scans:
Brain structure and joint hypermobility
Findings suggest that processes compromising function in neuro-developmental conditions may occur in individuals with hypermobility, putatively enhancing vulnerability to stress and anxiety.
'Our findings specifically link hypermobility to the structural integrity of a brain centre implicated in normal and abnormal emotions and physiological responses. Our observations endorse hypermobility as a multisystem phenotype and suggest potential mechanisms mediating clinical vulnerability to neuropsychiatric symptoms...
To conclude, we present the first neuroimaging study of hypermobility that also examines autonomic and interoceptive indices. The observed differences in the structural integrity of specific emotional brain regions provide a starting point for future research into constitutional vulnerabilities to common psychiatric symptoms that have the potential to inform more individually tailored therapeutic approaches.'
Ref: Jessica A. Eccles, MB BCh, MRCPsych, Department of Psychiatry, Brighton and Sussex Medical School, and Sussex Partnership National Health Service (NHS) Foundation Trust, Sussex Dec '11
‘I have a right to be treated by medical professionals that do not solely focus on my psychiatric issues as being the source of my problems. EDS causes anxiety and depression, chronic pain causes anxiety and depression, POTS causes adrenaline rushes and tachycardia. It’s all very complicated, and there are psychiatric issues, but they are symptoms of a bigger problem and should be treated as such. Don’t dismiss me as anxious or depressed without treating my other problems too.
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