Psychiatric disorders in Ehlers-Danlos syndrome are frequent, diverse and strongly associated with pain

Rheumatol Int. 2016 Mar;36(3):341-8. doi: 10.1007/s00296-015-3375-1. Epub 2015 Oct 3.


Ehlers-Danlos syndromes (EDS) are a heterogeneous group of hereditary connective tissue disorders characterized by joint hypermobility, widespread musculoskeletal pain and tissue fragility. Psychiatric disorders and psychosocial impairment are common, yet poorly characterized, findings in EDS patients. We investigated the frequency and types of psychiatric disorders and their relationship to systemic manifestations in a cohort of 106 classic and hypermobility type EDS patients. In this retrospective study, extensive medical chart review was performed for patients referred at two genetics clinics who were diagnosed with EDS. Statistical analysis was undertaken to determine the frequency of psychiatric disorders and association with systemic findings. Psychiatric disorders were found in 42.5% of the EDS cohort, with 22.7% of patients affected with 2 or more psychiatric diagnoses. Anxiety and depression were most commonly reported, with frequencies of 23.6 and 25.5%, respectively. A variety of other psychiatric diagnoses were also identified. Abdominal pain [odds ratio (OR) 7.38], neuropathic pain (OR 4.07), migraines (OR 5.21), joint pain (OR 2.85) and fatigue (OR 5.55) were significantly associated with the presence of a psychiatric disorder. The presence of any pain symptom was significantly associated with having a psychiatric disorder (OR 9.68). Muscle pain (OR 2.79), abdominal pain (OR 5.78), neuropathic pain (OR 3.91), migraines (OR 2.63) and fatigue (OR 3.78) were significantly associated with having an anxiety or mood disorder. Joint hypermobility and the classic dermatological features of EDS showed no significant association with having a psychiatric disorder. Our findings demonstrate a high frequency of psychiatric disorders and an association with pain symptoms in EDS.

Keywords: Anxiety; Connective tissue disorders; Depression; Ehlers–Danlos syndrome; Pain; Psychiatric disorders.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / epidemiology*
  • Abdominal Pain / psychology
  • Adult
  • Arthralgia / diagnosis
  • Arthralgia / epidemiology*
  • Arthralgia / psychology
  • Comorbidity
  • Ehlers-Danlos Syndrome / diagnosis
  • Ehlers-Danlos Syndrome / epidemiology*
  • Ehlers-Danlos Syndrome / psychology
  • Female
  • Humans
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Migraine Disorders / diagnosis
  • Migraine Disorders / epidemiology*
  • Migraine Disorders / psychology
  • Neuralgia / diagnosis
  • Neuralgia / epidemiology*
  • Neuralgia / psychology
  • Odds Ratio
  • Ontario / epidemiology
  • Pain Measurement
  • Psychiatric Status Rating Scales
  • Retrospective Studies
  • Risk Factors
  • Young Adult