In individuals with Ehlers-Danlos syndrome (EDS), a combination of symptoms and stress from persistent pain might increase the chance of developing mental health disorders.
EDS is a term used to describe a collection of diseases that impair the connective tissue, rendering it fragile and susceptible to injury. Joints, skin, blood arteries, and organs are supported and structured by connective tissue, serving as structural support. Patients experience movement challenges and an increased risk of injury due to a weakening of the connective tissue, resulting in mental health problems.
The association between Joint Hypermobility Syndrome/hypermobile type Ehlers-Danlos syndrome (JHS/hEDS) and anxiety was discovered in 1988 at the Hospital del Mar in Barcelona. It was the first time it was described. We were intrigued by coincidence and decided to investigate the connection further. Before this study, a few scattered observations in the literature pointed in the direction of this new research. When rheumatologists Rotes-Querol and Argany studied patients with hypermobility in 1957, they discovered that they suffered from a high level of nervous stress. Inflammatory hEDS (juvenile hEDS) is a disorder linked with difficulties in the muscles, joints, and bones caused by a collagen deficit or genetic changes that influence collagen production. JHS/hEDS refers to the syndromes of joint hypermobility syndrome (JHS) and the hypermobile type of Ehlers-Danlos syndrome (hEDS) as a single entity for this article. Throughout this article, we examine the psychopathology associated with JHS/hEDS, as well as the probable reasons for such an association, as well as debates, management, and future research directions.
EDS and Mental health Relation – Psychopathology
The relationship between JHS/hEDS and anxiety disorders has been extensively researched over the past 30 years, and current research indicates a strong link between the two. According to one research study, approximately 70% of hypermobile individuals had some anxiety condition, compared to 22% of the control group. Since then, anxiety has been linked to JHS/hEDS on a number of occasions, confirming the validity of these findings. While the evidence for JHS/hEDS involvement in other illnesses is less well-established, some evidence suggests that they may be associated with mood and personality disorders and addictions, eating disorders, and psychosis, among other things.
Disorders of the Neurodevelopmental System
A growing body of evidence suggests that JHS/hEDS are associated with several neurodevelopmental problems, including attention-deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) (DCD). If you have attention deficit hyperactivity disorder (ADHD), studies have discovered that individuals with ADHD had greater rates of joint hypermobility (JH) and issues with automatic control of bodily processes (dysautonomia) than adults without ADHD. Other investigations have discovered a high prevalence of JH or EDS in conjunction with ADHD. Specifically, when it comes to DCD, children with DCD exhibit more symptoms linked with JHS/hEDS than those usually developing. The association between JH and DCD may be related to impaired positional sense in afflicted children.
Psychiatric and Psychological Treatment for hEDS
There is substantial evidence that JHS/hEDS patients take more anxiety medicines than the general population. High levels of anxiety and despair are common in JHS/hEDS patients, and it has been demonstrated that negative emotions can exacerbate the sensation of pain in these patients. Pain and bodily signals and sensations are susceptible in patients with JHS/hEDS. JHS/hEDS patients also have sensitization to pain and physical signals and feelings. These factors, associated with more excellent pain perception or lower pain tolerance, may impact the pain experience.
JH is related to the use of dysfunctional coping methods. However, no studies have investigated coping strategies in JHS/hEDS; further research into the psychological aspects of pain perception is needed to develop effective treatment programs. Cognitive-behavioral therapy (CBT) methods have been developed, with evidence suggesting that CBT is beneficial in the pain treatment of individuals with JHS/hEDS.
Possible Causes
However, while it is plausible that some mental symptoms, risk or defensive behaviors, and personality traits might result from adaptation and problems in dealing with long-term diseases, biological explanations for this relationship have been proposed. The possibility of a genetic connection between anxiety and depression should be investigated further. In addition, anatomical abnormalities in emotional-regulating brain regions and a connection between anxiety disorders and poor regulation of automatic physiological systems have been proposed as possible explanations. Anxiety is related to hypermobility, and hypermobility scores were shown to be associated with other emotional regions of the brain as well as with other physical characteristics. Different bodily inputs can have an impact on one’s ideas, feelings, and actions. Given the rising evidence of increased body awareness and sensitivity among JHS/hEDS, it is possible that an excessive amount of frightening information is received, resulting in psychological discomfort and mental disorders.
Controversies
In the context of JHS/hEDS, certain concerns are surrounding mental illnesses that need to be addressed. First and foremost, individuals suffering from long-term pain and diminished functioning frequently experience anxiety and despair, regardless of whether they have hEDS. Another item to mention is that hEDS are connected with several diseases, such as dysautonomia, which can produce a wide range of physical problems that might be mistaken for anxiety-like symptoms in some people. According to the American Heart Association, patients with rapid heart rate fluctuations may be misdiagnosed with panic episodes. The severe fatigue induced by inadequate sleep, for example, might be misinterpreted as depression in specific individuals. The ability to recognize the source of the problem is critical.
Another point of contention in hEDS is diagnosing children presenting with pain, bruises, dislocations, disorientation, and fatigue. The symptoms of hEDS might be misinterpreted as simply a mental disease in the kid or parent. In contrast, both physiological and mental symptoms frequently occur in the same individual. Individuals who conduct evaluations of hEDS patients must have appropriate training.
Management
It is necessary to investigate and correctly analyze the mental difficulties that patients are experiencing. Pain, unpleasant emotions, and poor emotional control are all common experiences. All of these considerations can aid in the development of evidence-based treatments such as cognitive-behavioral therapy (CBT). Future research directions include: (1) developing a complete condition model to understand it better. (2) More research into the underlying processes is required, particularly to identify genetic connections between the two conditions. It is necessary to investigate the relationship between pain and bodily awareness and these two factors and mental results. (3) It is necessary to design and evaluate combinations of therapies to provide improved evidence-based management. (4) It is necessary to put in place care guidelines. (5) It is necessary to test and implement preventive methods, particularly among youngsters. This may aid in the development of more specialized therapies as well as the prevention of negative consequences in maturity. However, while the relationship between JHS/hEDS and anxiety has been well established, there is minimal evidence in other mental illnesses, and these should be explored more in the future.
What types of mental health issues are prevalent among EDS patients?
Anxiety, sadness, and other mood disorders are prevalent in EDS patient groups, according to research.
Patients with EDS are more likely than the general population to suffer from somatoform diseases, defined as pain and tiredness that have no known explanation.
What factors contribute to mental health issues?
Researchers believe that genetics has a role in mental health; however, they are unsure how this is true. People’s genetic makeup may put them at risk for having mental health problems, but the environment may be responsible for the emergence of symptoms in some cases.
Pain is one of the essential elements that contribute to mental health difficulties in people with EDS. Many patients may also be concerned about the possibility of suffering dislocations while going about their everyday activities. Sleep problems may be caused by the illness, resulting in a lack of sufficient restorative sleep. In conclusion, persistent tiredness might develop or worsen mental health disorders.
What is the prevalence of mental problems in EDS?
The incidence of mental problems in classical and hypermobile EDS may be as high as 43 percent in some cases. Anxiety levels may reach as high as 25%, while depression levels may reach 26 percent.
In part due to the rarity of other forms of EDS, researchers have only done a small number of studies on the mental health and psychiatric difficulties experienced by people with these conditions.
