Generalized joint hypermobility (GJH) and anxiety; the impact on daily functioning, societal and sport participation in adolescents and young adults

Generalized Joint Hypermobility (GJH) is a condition characterized by the ability to move joints beyond the “normal” range of motion. While some may have GJH without significant issues, others may develop musculoskeletal and systemic problems, leading to disability when injured. Perceived disability and clinical presentations may change over time and recognizing GJH and its associated symptoms are critical particularly in differentiating from Hereditary Connective Tissue Diseases. The frequent experience of pain in hypermobile Ehlers Danlos Syndrome, symptomatic GJH, can induce pain-related fear and anxiety and may lead to avoidance, discomfort and disuse. Alongside physical problems, anxiety and fear could play a significant role in worsening disability. Whether this is also the case for adolescents and young adults with asymptomatic GJH is currently unknown. This thesis aimed to study the relation between anxiety and GJH in adolescents and young adults and demonstrated the disabling impact of GJH combined with anxiety. While anxiety in symptomatic GJH align with established patterns of pain-related fear, anxiety in asymptomatic GJH may pre-exist. While GJH-related anxiety is present in asymptomatic GJH, fear of failure, and performance anxiety appear to have a greater influence on physical behaviour. This thesis emphasizes the importance of screening for anxiety and changes in all types of GJH and acknowledges the barriers adolescents and young adults may face in expressing anxiety symptoms. It recommends screening of anxiety in high performing individuals with GJH, regardless of whether they have complaints, and support an interdisciplinary approach for those who do.