Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression

Abstract

The mind is embodied; thoughts and feelings interact with states of physiological arousal and physical integrity of the body. In this context, there is mounting evidence for an association between psychiatric presentations and the expression variant connective tissue, commonly recognised as joint hypermobility. Joint hypermobility is common, frequently under-recognised, significantly impacts quality of life, and can exist in isolation or as the hallmark of hypermobility spectrum disorders (encompassing joint hypermobility syndrome and hypermobile Ehlers-Danlos syndrome). In this narrative review, we appraise the current evidence linking psychiatric disorders across the lifespan, beginning with the relatively well-established connection with anxiety, to hypermobility. We next consider emerging associations with affective illnesses, eating disorders, alongside less well researched links with personality disorders, substance misuse and psychosis. We then review related findings relevant to neurodevelopmental disorders and stress-sensitive medical conditions. With growing understanding of mind-body interactions, we discuss potential aetiopathogenetic contributions of dysautonomia, aberrant interoceptive processing, immune dysregulation and proprioceptive impairments in the context of psychosocial stressors and genetic predisposition. We examine clinical implications of these evolving findings, calling for increased awareness amongst healthcare professionals of the transdiagnostic nature of hypermobility and related disorders. A role for early screening and detection of hypermobility in those presenting with mental health and somatic symptoms is further highlighted, with a view to facilitate preventative approaches alongside longer-term holistic management strategies. Finally, suggestions are offered for directions of future scientific exploration which may be key to further delineating fundamental mind-body-brain interactions.

Keywords: Joint hypermobility; Hypermobile Ehlers-Danlos syndrome; Psychopathology; Psychiatric disorders; Neurodevelopmental disorders; Mind-body relations

Core tip: The association between vulnerability to psychological or psychiatric symptoms and hypermobile joints may initially appear counterintuitive to many clinicians. However, a relationship with anxiety is consistently confirmed across multiple studies worldwide. In this narrative review, we appraise increasing evidence linking neuropsychiatric presentations to hypermobility across the lifespan, including emerging links to neurodevelopmental disorders and stress-sensitive medical conditions. We discuss pertinent mechanistic insights in the context of growing understanding of mind-body interactions. We offer direction for future research and highlight implications for clinical practice, notably roles of timely screening and detection alongside longer-term holistic management strategies.