Evidence-Based Reviews

Anxiety and joint hypermobility: An unexpected association

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Psychopathology. Ensure proper assessment and treatment not only of the anxiety disorder and its dimensions (ie, anticipatory anxiety, high loss sensitivity, depersonalization, impulse phobias, or avoidance behavior), but also of the other related conditions, such as mood disorders, substance use disorders, or eating disorders.

Behavioral dimensions. Defense mechanisms often take individuals with JHS/hEDS to the extremes of a circumflex behavioral model in which the most typical axes include the following: me/others, loss/excess of control, avoidance/invasion, fight/flight, and dependency/isolation. A rich psychotherapeutic approach that focuses on these defense mechanisms and behavioral axes is required to balance these mechanisms.

Somatosensory symptoms. Be aware of, validate, and provide understanding of the patient’s increased sensitivities, including greater pain, body perception, meteorosensitivity, and higher sensitivity to medications and adverse effects.

Additional research is needed

Future directions for exploring the link between anxiety and JHS/hEDS should include the development of new nosologic approaches, the expansion of the therapeutic dimension, and unmasking the common biologic mechanisms using evolutionary models.

Bottom Line

Recognizing the link between anxiety and joint hypermobility syndrome/Ehlers-Danlos type 3–hypermobile type (JHS/hEDS) has provided a way to better understand psychopathologic and somatic conditions. In patients who present with an anxiety disorder, clinicians should screen for JHS/hEDS to properly evaluate and treat all dimensions of the newly described “Neuroconnective phenotype.”

Related Resources

  • Bulbena A, Baeza-Velasco C, Bulbena-Cabré A, et al. Psychiatric and psychological aspects in the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):237-245.
  • The Ehlers-Danlos Society. hEDS Diagnostic Checklist. https://www.ehlers-danlos.com/heds-diagnostic-checklist/.


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