Suggested link between anxiety and hypermobility of the joints

June 18, 2015 8:46 AM

"Joint flexibility is an oft-coveted trait that provides a special advantage to dancers and athletes, but there can be too much of this good thing. A growing body of research suggests a surprising link between high levels of flexibility and anxiety. A study published last year in the journal Frontiers in Psychology is among the most recent to confirm the association, finding that people with hypermobile joints have heightened brain activity in anxiety regions."
posted by SeedStitch (50 comments total)

Obviously the more flexible you are, the more inevitable it feels that somebody will fold you up and pack you in a case like a ventriloquist's dummy.
posted by ardgedee at 9:02 AM on June 18, 2015 [11 favorites]

Hm, well my kiddo and I both have this, interesting to think that it could be causing us anxieties too.
posted by emjaybee at 9:15 AM on June 18, 2015 [1 favorite]

My fellow bendy peeps: get thee to a Pilates class! It helps you become aware of your body parts, and how to control them. Bonus: makes stronks! Bonus: exercise reduces anxiety!
posted by gsh at 9:17 AM on June 18, 2015 [2 favorites]

I knew it!! It was there in front of us all along!!1
posted by Trochanter at 9:21 AM on June 18, 2015

This is relevant to my interests.

Of course this is my unique, special situation, but it might be interesting.

I have hyperextensibility. I can bend all of my fingers completely backwards to lie flat on the back of my hand. I can turn my feet outwards 180 degrees so they point completely backwards. Touching toes? Big deal. I can put my hands completely flat on the ground. Feet wrapped around the back of my head. Easy. Oh, I have a lot of party tricks.

When I was in K-12, it was cool. It's not anymore. Proceeding through adulthood, my knees slipped more and more. Basic things like taking a shower and correcting for the slippery surface could find me on the floor, writhing in pain. Any kind of lateral movement risked the possibility of my legs giving out. Basic yardwork has become more and more dangerous. My shoulders and hips can pop out of joint almost anytime.

I've had nightmares about this. Mostly about my knees because of the pain.

Exercise helps. You basically strengthen the muscles around the joints.

I don't really have a point, but yeah, it sure has hell has made me anxious.
posted by nedpwolf at 9:24 AM on June 18, 2015 [18 favorites]

Wait a minute, what about those of us bunheads who suffered anxiety for not having feet like Paloma Herrera or legs like Sylvie Guillem?!

Aaaand first link up searching for Paloma's feet was www.wikifeet.com. Because the God of Google decided I needed a reminder about Internet Rule 34 today, apparently.
posted by romakimmy at 9:25 AM on June 18, 2015 [1 favorite]

Cause & effect, people. I dislocate my shoulders just by thinking about it, and it hurts like a mofo (plus it costs $5k for an ambo ride, sitting around the ER, and eventually getting drawn [but not quartered] between the stoutest interns available).

Of course I have a high level of anxiety.
posted by spacewrench at 9:30 AM on June 18, 2015 [3 favorites]

yes how surprising that my body's inability to keep my joints jointing might STRESS ME THE FUCK OUT
posted by poffin boffin at 9:34 AM on June 18, 2015 [3 favorites]

my doctor yesterday: in general we don't like necks to do that
me: i agree with the medical community that this is bad
my dr: that curve over there? it's backwards!
me: may i have pills
my dr: absolutely yes
posted by poffin boffin at 9:36 AM on June 18, 2015 [37 favorites]

also it is nice to potentially have a reason for the leg blood pooling thing which has been irritating and confounding me for many years.
posted by poffin boffin at 9:41 AM on June 18, 2015

This is my first-ever FPP, and it's fully relevant to my interests, as a hypermobile anxious person.
posted by SeedStitch at 9:50 AM on June 18, 2015 [12 favorites]

Hey, me too - thanks :)

I read about this association a bit ago, very interesting. See also

Balon et al., 2015

The common mechanisms that are involved in this association include genetics, autonomic nervous system dysfunctions and interoceptive and exteroceptive processes. Considering clinical and nonclinical data, pathophysiological mechanisms and the presented nosological status, we suggest a new Neuroconnective phenotype, which around a common core Anxiety-Collagen hyperlaxity, includes five dimensions: behavioral, psychopathology, somatic symptoms, somatosensory symptoms, and somatic illnesses. It is envisaged that new descriptions of anxiety disorders and of some psychosomatic conditions will emerge and that different nosological approaches will be required.

Gratacos et al., 2001

Garcia-Campayo et al 2011 review

Eccles' study
posted by cotton dress sock at 9:54 AM on June 18, 2015 [4 favorites]

It might be also interesting to note that I know a handful of former gymnasts. ALL of them, now in their fifties, have joint issues.

Personally, I've found that walking or running or using elliptical machines are great. I can't participate in activities like basketball (so very risky) or racquetball. I am always, always very aware when doing anything physical to make sure I'm not risking another couple months with a cane.
posted by nedpwolf at 9:58 AM on June 18, 2015

Is everyone else reading an entirely different article that says that joint flexibility causes anxiety? Because the one in this FPP says that there is a link or association.
posted by MisantropicPainforest at 10:06 AM on June 18, 2015 [4 favorites]

I'm the person that when I show up at a new chiropractor for evaluations, the entire office shows up to watch my mobility with awe and terror. I'm going to read this with deep interest. And anxiety.
posted by librarianamy at 10:11 AM on June 18, 2015

I read the article, and yes, all it says is that there is a link.

Just because correlation might not equal causation doesn't mean that correlation does not equal causation.

I think those of us with skin in the game are just speculating.
posted by nedpwolf at 10:13 AM on June 18, 2015

(whoops first link is Bulbena et al, sorry, rushing today & doing everything wrong. From that abstract, also:

The common mechanisms that are involved in this association include genetics, autonomic nervous system dysfunctions and interoceptive and exteroceptive processes)
posted by cotton dress sock at 10:13 AM on June 18, 2015 [1 favorite]

nedpwolf, thank you - reading your comments made me go, 'I've found my people!' (right down to the anxiety)

My friends don't quite understand my very strong opposition to taking any gym classes that involves too much movement like Bodycombat or Bodyjam, even if I love doing martial arts or dance. The pace is too fast, and I know (and have!) almost always nearly tripped or twisted something. Good thing I have enough fast reflexes to catch myself usually*. Most of the time if people caught me in one of my being about to trip, they thought I was dancing or something because my 'correction' makes the fall a deliberate move. On the other hand, yoga and pilates are fun and quick ego boosts for me.

*not this week - I'm nursing a massively abraded kneecap.
posted by cendawanita at 10:14 AM on June 18, 2015

I am in my early thirties and until this thread I never put together that my hypermobility might be related to my general state of klutziness.

Cotton dress sock, thanks for the additional links! This is all fascinating to me (and to my siblings, both of whom are hypermobile and only one of whom is also anxious).
posted by SeedStitch at 10:18 AM on June 18, 2015 [1 favorite]

Oh, and if anyone is interested, I have found support forums about this in the past. I don't have any links because I didn't save them. There were a lot of people saying "OMG! Me too!". Not a lot of practical, physical advice. If you google "hyperextension" or "hyperextensibility", I'm sure you can find them. Maybe they could be helpful for some.
posted by nedpwolf at 10:30 AM on June 18, 2015

I've got the anxiety but no flexibility. What the hell?!
posted by photoslob at 10:33 AM on June 18, 2015 [1 favorite]

I have tried a couple of support forums in the past and there was a bit too much "try this amazing homeopathic remedy" for me, alas.
posted by poffin boffin at 10:38 AM on June 18, 2015

I wonder if this is why movement and movement restriction (self-inflicted burritoing) helps some of the folks in my life with anxiety issues, especially the knuckle cracking.
posted by tilde at 10:44 AM on June 18, 2015

No probs, SeedStitch :) Thank you for opening up the subject :)
posted by cotton dress sock at 10:47 AM on June 18, 2015

Joint hypermobility, which affects approximately 20 percent of the population
That unsourced figure seems rather high, I wonder if they meant to write 2.0% ?

I read somewhere that hypermobility is much much more common in Women, basically the body is acting like it is going into labour all the time. But knowing that doesn't help answer the question "is hypermobility causing the anxiety or vice versa?"
posted by Lanark at 11:09 AM on June 18, 2015

I think that for everyday hypermobility, like just joints that are way too flexible for their own good, the 20% sounds okay. If we're talking actual hypermobile-type EDS then yeah, 20% sounds like crazy talk.
posted by poffin boffin at 11:15 AM on June 18, 2015

I learned in MetaChat several years ago that hypermobility is also associated with the anaesthesia at the dentist's office not working right.
posted by aniola at 11:21 AM on June 18, 2015 [3 favorites]

Well this explains my life. I always thought being bendy was a good thing, but I should've known it was too good to be true.
posted by winna at 11:30 AM on June 18, 2015 [1 favorite]

On the plus side, grossing out your friends by having them push your fingers backwards and feeling no resistance at all is a nice little pick-me-up on an anxious day.
posted by jason_steakums at 11:45 AM on June 18, 2015 [1 favorite]

I think there is a pretty simple explanation for this which has nothing to do with any anxiety the condition itself might produce, but my presence on Metafilter is right now too marginal to contain it, I'm afraid.

But in addition to the question of a physiological mechanism, why, in spite of the many problems hyperflexibiity gives rise to, do we see it at such relatively high levels in the population? Is there some factor in the environment that has selected for it the way malaria selects for sickle cell?

I'd guess the answer is yes, and that the factor in question is probably the mumps.

Because if a male gets the mumps after puberty, it tends to attack the testicles and cause them to swell, and in that event the normally tough and relatively inflexible collagen covering of the testes causes internal pressure to rise so high that there's lots of tissue damage; and then the male victim is often sterilized and has very low sex hormone levels for the rest of his life -- which is exactly what happened to P G Wodehouse among many others.

But some people apparently get the mumps and their testicles swell alarmingly (one man I knew as a kid told my father and me that his got way bigger than softballs), but they then recover and are fine -- and I'd have to think hyperflexible collagen would dramatically increase the chances of such an outcome.
posted by jamjam at 11:56 AM on June 18, 2015 [2 favorites]

but my presence on Metafilter is right now too marginal to contain it, I'm afraid.

What on Earth does this mean? If you're saying that the opinion is too inflammatory, then why make this vague allusion to it in the first place?
posted by tonycpsu at 11:59 AM on June 18, 2015

It was a joking reference to Fermat, but the vehemence of your response makes me wonder whether it's truer than I realized.
posted by jamjam at 12:05 PM on June 18, 2015 [4 favorites]

Wow, I suffer from hypermobility and also deal with anxiety attacks. Hmm.
posted by Windigo at 12:26 PM on June 18, 2015

the rest of us got it, jamjam.

That's a really clever just-so story. It's almost certainly wrong (do testicles even contain collagen?), as most such stories are, but it'd make a great TED Talk.
posted by leotrotsky at 12:47 PM on June 18, 2015 [1 favorite]

This is completely speculative on my part but I feel like this has to relate to TGF-beta signaling somehow. On looking at one of the original papers I guess they looked at the prevalence of mitral valve prolapse which was my first thought for a mechanism of causing anxiety, and that would support a role for TGF-beta, but it seems like MVP didn't matter in their dataset (though they also didn't recover an association between MVP and anxiety at all, and other groups have suggested that I think? Not my field!).
posted by en forme de poire at 12:48 PM on June 18, 2015

So are we just talking about parlor trick flexibility here, or something like EDS? Or both?
posted by fiercecupcake at 1:10 PM on June 18, 2015

So are we just talking about parlor trick flexibility here, or something like EDS?

I wondered that, too. A friend who developed a bad alcohol problem by treating her crippling anxiety with booze has Ehlers-Danlos syndrome. Her teenage son died suddenly from what turned out to be undiagnosed vascular Ehlers-Danlos. Not surprisingly, she got more anxious and drank more. So sad.

Anecdata, of course.
posted by 4shortlegs at 1:33 PM on June 18, 2015

I can kind-of follow a bit of the bio stuff, but not super well (especially not the gene stuff). But to me, it makes a kind of sense that having a strong vasovagal response (if that's related to some of the hypermobility-related physiology; maybe the weird collagen factor has CV system implications even outside of MVP) and e.g. heightened sensitivity to interoceptive signals might a) lead to varied subjective interpretations of those signs (it's notable I think that there's a particularly strong association with panic disorder, which is all about freaking out that your body's freaking out) and b) a more or less distinctive amygdala (as a consequence of the continual freaking out etc). One of those papers also talks about the other issues that are often comorbid with anxiety - IBS and various pain syndromes. I can see a wonky signalling system playing a role there too.
posted by cotton dress sock at 1:33 PM on June 18, 2015

So are we just talking about parlor trick flexibility here, or something like EDS? Or both?

I think, according to some of the stuff above, that some now think that benign hypermobility syndrome may be a mild expression of EDS-III.
posted by cotton dress sock at 1:34 PM on June 18, 2015 [1 favorite]

As a complete layperson, my understanding is that EDS is an extreme example, a mutation, with similar symptoms to the more common hypermobility.

It's a complete outlier. My bendy friends and I can do simple things like the splits or twisting our arms behind our heads. Like you say, parlor tricks. I think EDS is something else altogether.

I read a couple articles about it a few years ago, so I am obviously an expert on the subject.
posted by nedpwolf at 1:36 PM on June 18, 2015

Mod note: A few comments deleted. Let's pass on having a little flamewar over evolutionary theory; if you guys need to argue you can do that elsewhere than in this thread.
posted by LobsterMitten (staff) at 1:53 PM on June 18, 2015 [3 favorites]

I have EDS hypermobility type and it has completely upended my life. Constant pain, can't work, taking a shower is very difficult. All my joint surgeries have failed so that is no longer an option. AAAAAANNNDDDD I can't find a pain management doctor in my area that takes my insurance. Oh, there are 2 that are over an hour away but I can't even imagine making the trip w/o pain meds.

Anxiety? Yup! No panic attacks though. I have always had low grade anxiety that spikes occasionally but it seemed normal given my situation.
posted by futz at 2:25 PM on June 18, 2015 [1 favorite]

The people here (nedpwolf) talking about slipping knees and dislocating shoulders frequently should get screened for Ehlers Danlos syndrome. I suspect this level of laxity is associated with EDS rather than simple laxity. It's a rare genetic disease and there is no cure (much rarer than the 20% of the population claimed to have loose joints in this article), but there are resources available to help make life much more bearable.

I have a mild case and, basically, I have learned that you have to do most of the work to make yourself feel better, because even most M.D.s only vaguely recall it from school, and almost all physical therapists and yoga instructors will give you exercises that will make things worse.

Purchase a copy of the Joint Hypermobility Handbook by Brad Tinkle.

It is a systemic disease whose symptoms can extend beyond joint laxity into many other parts of the body.

Anyone who lives in the Boston area feel free to PM me for resources. There is a physical therapist I found who actually has EDS herself and is better than anyone I've ever been to.

As far as the link between anxiety and laxity, well, I've seen some numbers that make me curious as to whether the link extends beyond just the idea that the anxiety is caused by the constant stress of dislocations and pain of existence.
posted by Halogenhat at 4:00 PM on June 18, 2015 [2 favorites]

Joint hypermobility, which affects approximately 20 percent of the population
That unsourced figure seems rather high, I wonder if they meant to write 2.0% ?

Yeah, it seems like the 20% must refer to anyone with some hypermobility, not just those with hypermobility severe enough to be a problem. I'm in the first category - my wrists/fingers and ankles are flexible enough to freak people out, but the rest of my joints are normal.

I wish the article was more clear about whether the entire 20% has an increased chance of also having anxiety or just those with a problematic level of hypermobility.
posted by insectosaurus at 4:23 PM on June 18, 2015

almost all physical therapists and yoga instructors will give you exercises that will make things worse

YES it's so frustrating to see yoga instructors recommend hot yoga classes for joint pain when they have NO IDEA what the cause of that joint pain is. Hot yoga classes are incredibly dangerous for me because my muscles get so loose and relaxed that they don't want to hold things in place anymore and then my shoulder Does A Thing and everyone gets upset.
posted by poffin boffin at 5:22 PM on June 18, 2015 [2 favorites]

Hypermobility + Ulcerative Colitis Inflammation Tag-Team Buttfucking Anecdata Point:

Sitting here in my apartment (alone because the stress and emotional burden of all this caused my wife to leave for good) writing emails to clients about why I can't deliver what I promised this week, and apologizing to friends for not being able to hang out last night. It's almost time to pop my 3x-daily Motrin and Tylenol horse-pills, because I couldn't get my insurance company to cover Humira, and it's like $3000 a month, so I have to switch carriers (and HMO doctors) for the 4th time in 3 years, so it's impossible to progress with any long-term treatment. Steroids turned me into an obese basketcase for a few months, so the cheap option is a no-go.

Reaching over to the keyboard to type the rest of this, my shoulder started to slip out, I winced and clenched it back in, and kept typing. That's going to hurt like a FUCKER later. This is life every day.

At this point I'm not sure if I will die first of kidney/liver failure, or suicide. (no immediate crisis, I just can't take much more of this, and am starting to doubt that I'll ever escape constant, crippling agony, or sleep through the night without smoking an eighth of weed)

Anxiety indeed. Please hurry up, science. I need more life. I'm keeping your kids entertained on their video game systems, it's the least you can do.

Time to drive down to E3 and meet famous people and smile and crack jokes :D
posted by jake at 6:00 PM on June 18, 2015 [4 favorites]

I hear you jake. Feel free to memail me. I can tell you how I finally got my very crappy low income health insurance to listen to me.
posted by futz at 6:32 PM on June 18, 2015

I was going to complain about having anxiety and not flexibility, but if hypermobility is causing all these problems, at least that's one less thing to be anxious about.
posted by Rangi at 6:44 PM on June 18, 2015

Hypermobility and anxiety also gets its own paragraph in this thorough overview from 2010 that I just wandered across.
posted by aniola at 7:36 PM on July 14, 2015 [3 favorites]

aniola - thanks for thank link! Reading through it was like a checklist - any item that didn't apply to me personally applied to one of my two siblings or to one of my parents. I am fascinated by this.
posted by SeedStitch at 12:30 PM on July 16, 2015