Link: Hypermobility, Hyperactivity of Autonomic Nervous System and Psychopathology

A recently published doctoral thesis by Jessica Anne ECCLES has studied "the relevance of joint hypermobility and autonomic symptoms, particularly orthostatic intolerance, to clinical psychopathology."

Joint hypermobility is a widespread, poorly recognized, connective tissue condition. Affected individuals are reportedly overrepresented among panic or anxiety disorders, irritable bowel syndrome, fibromyalgia, and chronic fatigue. Dysfunction or dysregulation of the autonomic nervous system, typically postural tachycardia syndrome is often found. Structural differences in amygdala have been reported in association with joint hypermobility. The relevance of hypermobility and autonomic dysfunction to general psychiatric conditions is currently poorly understood. 

 Dr. Eccles' conclusions are:

Through new data contained within this thesis, I provide evidence to link joint hypermobility to a set of distinct psychopathological diagnoses, including the general expression of anxiety. Additionally, I provide experimental insight into a putative underlying mind-brain-body mechanism for this association, namely the aberrant engagement and control of autonomic nervous system. While the importance of joint hypermobility, and signs and symptoms of autonomic dysfunction, to the generation and maintenance of psychopathology has been poorly appreciated, this PhD, through a systematic set of studies goes some way toward a better characterisation of this relationship and its mediation by autonomic dysfunction. This has particular relevance for increasing clinical recognition of joint hypermobility itself across different medical disciplines and opens up new possibilities for personalised medicine. 

A body of work already exists correlating psychopathologies to joint hypermobility. Dr. A. Bulbena et al have published nearly 50 papers studying psychopathology in patients who have joint hypermobility (JHM or JHS).

However, in this thesis Dr. Eccles shows for the first time that
autonomic dysfunction, particularly sympathetic activation, partially mediates the relationship between anxiety and joint hypermobility.
 Dr. Eccles attributes the relationship between hypermobility, autonomic dysfunction and the expression of anxiety to some biological mechanism that could be a consequence of abnormal peripheral vasoconstriction, consequent upon variant connective tissue, e.g., collagen within the vasculature.

Based on diagram in the thesis of Dr. J. A. Eccles

The role of autonomic dysfunction and heightened interoception has been discussed before as contributory mechanisms to psychiatric symptoms, especially anxiety in joint hypermobility syndrome [1,2]. Interested readers will also find these two papers by Dr. Marco Castori very informative:

Psychopathological Manifestations of Joint Hypermobility and Joint Hypermobility Syndrome/ Ehlers–Danlos Syndrome, Hypermobility Type: The Link Between Connective Tissue and Psychological Distress Revised


Unexpected association between joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type and obsessive–compulsive personality disorder


[1] Mallorquí-Bagué, Núria, et al. "Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility." Front Psychol 5 (2014): 1162. Link

[2] Papers by Dr. A. Bulbena et al