Ehlers–Danlos Syndrome and Anorexia Nervosa: A Dangerous Combination?

Miles, Stacia C.; Robinson, D. Paul; M.D., Judith L. Miles

doi:10.1111/j.1525-1470.2007.00382.x

Cited by 10 publications

(8 citation statements)

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“…Most studies seem to point toward a relationship between ectomorph somatotype (linear, thin, and usually tall) and JHS/hEDS [Bulbena et al, ], with higher rates of restrictive or compensatory eating disorders such as anorexia or bulimia. Some case reports described a co‐occurrence of EDS and eating disorders such as anorexia nervosa (AN) [Al‐Mufty and Bevan, ; Miles et al, ], although the type of EDS was not specified in the reports. Goh et al [] hypothesized that since there is symptom overlap seen AN and JH such as gastrointestinal symptoms, orthostatic intolerance, and fatigue associated syndromes, JH is a possible indicator of a familial disorder of connective tissue elasticity which potentially plays a causal role in the development of the eating disorder.…”

Section: Literature Reviewmentioning

confidence: 99%

Psychiatric and psychological aspects in the Ehlers–Danlos syndromes

Bulbena¹,

Baeza-Velasco²,

Bulbena-Cabré³

et al. 2017

American J of Med Genetics Pt C

109

104

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There is increasing amount of evidence pointing toward a high prevalence of psychiatric conditions among individuals with hypermobile type of Ehlers-Danlos syndrome (JHS/hEDS). A literature review confirms a strong association between anxiety disorders and JHSh/hEDS, and there is also limited but growing evidence that JHSh/ hEDS is also associated with depression, eating, and neuro-developmental disorders as well as alcohol and tobacco misuse. The underlying mechanisms behind this association include genetic risks, autonomic nervous system dysfunction, increased exteroceptive and interoceptive mechanisms and decreased proprioception. Recent neuroimaging studies have also shown an increase response in emotion processing brain areas which could explain the high affective reactivity seen in JHS/hEDS. Management of these patients should include psychiatric and psychological approaches, not only to relieve the clinical conditions but also to improve abilities to cope through proper drug treatment, psychotherapy, and psychological rehabilitation adequately coupled with modern physiotherapy. A multidimensional approach to this "neuroconnective phenotype" should be implemented to ensure proper assessment and to guide for more specific treatments. Future lines of research should further explore the full dimension of the psychopathology associated with JHS/hEDS to define the nature of the relationship. © 2017 Wiley Periodicals, Inc.KEY WORDS: joint hypermobility; anxiety; psychopathology; neuroconnective phenotype; hypermobile Ehlers-Danlos syndrome Professor Antonio Bulbena, M.D., M.Sc, Ph.D., is the Chair of the Department of Psychiatry at the Autonoma University of Barcelona with clinical, academic, and administrative contributions particularly in the area of psychosomatic medicine and anxiety disorders, dementia, chocolate and carbohydrates, clinical measurement in psychiatry, phobias, seasonality, and biometeorology. Has recently developed the Neuroconnective Phenotype and has published numerous books, book chapters, and scientific articles in peer-reviewed journals.Carolina Baeza-Velasco, Ph.D., is a clinical psychology at the Paris Descartes University, with important contributions in the area of psychological assessment and treatment of patients with comorbid anxiety disorders and joint hypermobility among other conditions. Has published several articles about the psychological factors of EDS and related conditions. Andrea Bulbena-Cabre, M.D., M.Sc., is a Psychiatry Research Fellow at the Icahn School of Medicine at Mount Sinai/J. J. Peters Bronx VA Hospital. She has specialized in psychosomatic medicine and is currently studying the anxiety-joint hypermobility phenomena in bipolar and psychotic spectrum disorders. Other research interests include substance abuse, especially in synthetic cannabis and psychosis.Guillem Pailhez, M.D., Ph.D., is an Assistant Professor at the Department of Psychiatry at the Autonoma University of Barcelona, has devoted his career in the study of the interactions between mind and body ...

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Section: Literature Reviewmentioning

confidence: 99%

Psychiatric and psychological aspects in the Ehlers–Danlos syndromes

Bulbena¹,

Baeza-Velasco²,

Bulbena-Cabré³

et al. 2017

American J of Med Genetics Pt C

109

104

View full text Add to dashboard Cite

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“…Ehlers–Danlos syndrome (EDS) is a heritable connective tissue disorder in which patients also complain of a constellation of GI symptoms, including abdominal pain (81%), bloating (57%), nausea (57%), reflux (48%), vomiting (43%), constipation (38%), and diarrhea (14%); delayed gastric emptying is frequently evident as well (71%), and these individuals often receive a diagnosis of an FGID (Zarate et al, 2010). There are several case reports of EDS accompanying AN, with EDS being the suspected cause and/or maintaining factor for on‐going disordered eating (Baeza‐Velasco et al, 2016; Lee & Strand, 2018; Miles et al, 2007) (Table 6). In a sample of 106 individuals diagnosed with EDS, nearly 60% complained of GI symptoms and two (1.9%) were found to have AN (Hershenfeld et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

Gibson

Watters

Mehler

2021

Intl J Eating Disorders

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Objective Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers–Danlos syndrome contribute toward disordered eating. Methods Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were used to structure and complete the review. Results A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. Discussion Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers–Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.

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“…Thus, in patients with a connective tissue disorder (of which JHM is a hallmark) long-term amenorrhea and bone mass loss may lead to serious fractures. In addition, in more severe cases of heritable disorders of connective tissue (e.g., Ehlers-Danlos syndromes), there may be a risk of visceral perforation in patients with significant weight loss combined with intense physical exercise ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Joint Hypermobility and Clinical Correlates in a Group of Patients With Eating Disorders

et al. 2022

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Background: The ability to move joints beyond the normal range of motion is called Joint Hypermobility (JHM). JHM has been associated with a plethora of physical problems and is a frequent sign of hereditary disorders of connective tissue. Neuropsychiatric conditions such as eating disorders (ED) have also been related to JHM. However, little is known about the clinical profile of people with ED and JHM. The aim of this study was to explore JHM in patients with ED and to compare the clinical characteristics of hypermobile ED patients with non-hypermobile ED patients.Method: Fifty-three outpatients diagnosed with ED were assessed using the Beighton score for JHM, the Eating Disorders Inventory 2, the Eating Disorder Examination, and the Detail and Flexibility Questionnaire. Information relating to patients' psychiatric and somatic comorbidities/symptoms was also collected.Results: Using the traditional Beighton score's cutoff of ≥4, 41.5% of the sample presented with JHM. Our results indicate that compared with non-hypermobile ED patients, those with JHM are significantly younger, suffer at a greater extent from joint pain and easy bruising, have a shorter duration of the ED, and have lower scores for cognitive rigidity. In addition, for those with anorexia nervosa, the restricting subtype represents a significantly lower proportion of hypermobile ED patients compared to non-hypermobile ED patients. Multivariate analyses showed that cognitive rigidity, age, and duration of the ED could predict the JHM status in this sample.Conclusion: These results suggest that JHM is frequent in patients with ED and is accompanied by signs of tissue fragility. Patients with ED and JHM seem to present a specific profile characterized by less cognitive rigidity and restricting behavior in the case of anorexia nervosa. Further research is needed in order to confirm these results.

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Ehlers–Danlos Syndrome and Anorexia Nervosa: A Dangerous Combination?

Cited by 10 publications

References 16 publications

Psychiatric and psychological aspects in the Ehlers–Danlos syndromes

Psychiatric and psychological aspects in the Ehlers–Danlos syndromes

The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

Joint Hypermobility and Clinical Correlates in a Group of Patients With Eating Disorders

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