Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility

Objective: Anxiety is associated with increased physiological reactivity and also increased “interoceptive” sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Methods: Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. Results: We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Conclusions: Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen.

• Publication year

  2014

• Venue

  Frontiers in Psychology

• Publication date

  2014-10-14

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.3389/fpsyg.2014.01162PMID 25352818PMCID 4196473
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Multidimensional Assessment of Interoceptive Awareness

  2016cited by this paper
• Plos One

  2015cited by this paper
• The relationship between benign joint hypermobility syndrome and psychological distress: a systematic review and meta-analysis.

  2014influential reference
• Emotional reactivity and regulation in panic disorder: insights from a functional magnetic resonance imaging study of cognitive behavioral therapy.

  2013cited by this paper
• Keeping the body in mind: Insula functional organization and functional connectivity integrate interoceptive, exteroceptive, and emotional awareness

  2013cited by this paper
• Exploring the Relationship Between Mindfulness and Cardiac Perception

  2013cited by this paper
• Visceral influences on brain and behavior.

  2013cited by this paper
• Anterior insular cortex mediates bodily sensibility and social anxiety.

  2013cited by this paper
• Interoception, emotion and brain: new insights link internal physiology to social behaviour. Commentary on:: "Anterior insular cortex mediates bodily sensibility and social anxiety" by Terasawa et al. (2012).

  2013cited by this paper
• Postural tachycardia syndrome—current experience and concepts

  2012cited by this paper
• Brain systems for baroreflex suppression during stress in humans

  2012cited by this paper
• Mindfulness

  2012cited by this paper
• Brain structure and joint hypermobility: relevance to the expression of psychiatric symptoms

  2012influential reference
• The Multidimensional Assessment of Interoceptive Awareness (MAIA)

  2012cited by this paper
• Anxiety and joint hypermobility association: a systematic review.

  2012cited by this paper
• Joint Hypermobility and Anxiety: The State of the Art

  2011cited by this paper
• Neuroimaging in anxiety disorders

  2011cited by this paper
• Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome

  2011cited by this paper
• Joint hypermobility syndrome is a risk factor trait for anxiety disorders: a 15-year follow-up cohort study.

  2011influential reference
• Joint hypermobility syndrome

  2011cited by this paper
• EASILY MISSED? Joint hypermobility syndrome

  2011cited by this paper
• Interoceptive sensitivity in anxiety and anxiety disorders: an overview and integration of neurobiological findings.

  2010influential reference
• The role of anterior insular cortex in social emotions

  2010cited by this paper
• Current status of brain imaging in anxiety disorders

  2009influential reference
• Neural bases of social anxiety disorder: emotional reactivity and cognitive regulation during social and physical threat.

  2009cited by this paper
• Heart rate response after emotional picture presentation is modulated by interoceptive awareness.

  2007influential reference
• Interoceptive awareness mediates the relationship between anxiety and the intensity of unpleasant feelings.

  2007influential reference
• Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure.

  2006cited by this paper
• An insular view of anxiety.

  2006cited by this paper
• Argonaute—a database for gene regulation by mammalian microRNAs

  2005cited by this paper
• Emotional category data on images from the international affective picture system

  2005cited by this paper
• Visual memory and visual perception recruit common neural substrates.

  2004influential reference
• Self-focused attention and negative affect: a meta-analysis.

  2002influential reference
• Nonconscious Fear Conditioning, Visceral Perception, and the Development of Gut Feelings

  2001influential reference
• Quadratic trend analysis and heartbeat detection.

  2001cited by this paper
• The neurobiology of social cognition.

  2001cited by this paper
• REV NEUROL

  2001cited by this paper
• Heartbeat detection and the experience of emotions

  2000influential reference
• Descartes' Error: Emotion, Reason and the Human Brain

  1995influential reference
• Looking at pictures: affective, facial, visceral, and behavioral reactions.

  1993cited by this paper
• [Hypermobility of the joints].

  1989cited by this paper
• Joint hypermobility syndrome and anxiety disorders.

  1988cited by this paper
• The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

  1986cited by this paper
• Heart beat perception and emotional experience.

  1981cited by this paper
• Letter: Clonidine overdose.

  1976cited by this paper
• Manual for the State-Trait Anxiety Inventory

  1970cited by this paper
• STAI manual for the State-trait anxiety inventory ("self-evaluation questionnaire")

  1970cited by this paper

• An Online Pilates Program for People with Hypermobility: A Pragmatic Clinical Trial Looking at Function, Interoception, Kinesiophobia, and Physical Activity Levels.

  2026cites this paper
• Prevalence and management of mental health comorbidities in a German cohort of patients with Ehlers-Danlos syndromes and a generalized hypermobility spectrum disorder

  2026cites this paper
• The role of interoceptive awareness in social anxiety disorder – results of an internet-based CBT-manualized therapist delivered group-treatment

  2025influential citation
• Association between interoception and self-care in individuals with cardiovascular disease.

  2025cites this paper
• Interplay Between Cortical and Neurocardiac Interoceptive Processes and its Association with Self-Reported Interoceptive Sensibility

  2025cites this paper
• No significant links between somatognosia, stereognosia, and hypermobility: sensory processing unlikely to drive common complaints in hypermobile population

  2025cites this paper
• Body listening in the link between symptoms and self-care management in cardiovascular disease: A cross-sectional correlational descriptive study.

  2024cites this paper
• The Relationship Between Interoceptive Awareness, Emotion Regulation and Clinical Symptoms Severity of Depression, Anxiety and Somatization

  2024cites this paper
• Trauma, early life stress, and mindfulness in adulthood

  2024cites this paper
• A new conceptual model for anorexia nervosa: A role for connective tissue?

  2024cites this paper
• Physical and Psychosocial Outcomes of a Weekend Retreat for People Living with Hypermobile Ehlers-Danlos Syndrome

  2024cites this paper
• The importance of body perception in the relationship between physical activity and self-esteem in adolescents

  2024cites this paper
• Meditation and interoception: a conceptual framework for the narrative and experiential self

  2024cites this paper
• Neural processes linking joint hypermobility and anxiety: key roles for the amygdala and insular cortex

  2024influential citation
• A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility

  2024cites this paper
• Validation of the neuroconnective endophenotype questionnaire (NEQ): a new clinical tool for medicine and psychiatry resulting from the contribution of Ehlers–Danlos syndrome

  2023cites this paper
• A narrative review of the literature on illness uncertainty in hypermobile ehlers-danlos syndrome: implications for research and clinical practice

  2023influential citation
• Within-Person Modulation of Neural Networks following Interoceptive Awareness Training through Mindful Awareness in Body-Oriented Therapy (MABT): A Pilot Study

  2023cites this paper
• Sensing the body matters: profiles of interoceptive sensibility in chronic pain adjustment.

  2023cites this paper
• Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review

  2023cites this paper
• Characterization of Migraine in Children and Adolescents With Generalized Joint Hypermobility: A Case-Control Study.

  2023cites this paper
• Interoceptive Sensibility Mediates Anxiety Changes Induced by Mindfulness-Based Tai Chi Chuan Movement Intervention

  2023cites this paper
• The Neural Correlates of Autonomic Interoception: Perceptual Mismatch and Clinical Implications

  2023influential citation
• Efficacy of the myofascial approach as a manual therapy technique in patients with clinical anxiety: A randomized controlled clinical trial.

  2023cites this paper
• Development of a Scale to Examine Responses to Bodily Sensations

  2022cites this paper
• Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study

  2022cites this paper
• The relationship between brain neural correlates, self-objectification, and interoceptive sensibility.

  2022cites this paper
• Development and Initial Validation of an Experience Sampling Method of Interoceptive Attention

  2022cites this paper
• Going beyond the DSM in predicting, diagnosing, and treating autism spectrum disorder with covarying alexithymia and OCD: A structural equation model and process-based predictive coding account

  2022cites this paper
• Hypermobile spectrum disorders symptoms in patients with functional neurological disorders and autism spectrum disorders: A preliminary study

  2022cites this paper
• An investigation of body awareness, fatigue, physical fitness, and musculoskeletal problems in young adults with hypermobility spectrum disorder.

  2022cites this paper
• Embodied Feelings - A Meta-Analysis on the Relation of Emotion Intensity Perception and Interoceptive Accuracy.

  2022cites this paper
• The association between anxiety and cardiac interoceptive accuracy: A systematic review and meta-analysis.

  2022cites this paper
• Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management

  2022cites this paper
• Hypermobility in patients with functional seizures: Toward a pathobiological understanding of complex conditions.

  2022cites this paper
• Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain

  2022cites this paper
• PHYSICAL ACTIVITY, HEALTH AND EXERCISE Rebooting in sport training and competitions: Athletes’ perceived stress levels and the role of interoceptive awareness

  2022cites this paper
• meta / contrib-group / affiliation / aff " parastyle " Affiliation " Interoceptive attention regulation in Ehlers – Danlos syndromes : associations between pain and psychiatric symptom severity

  2021influential citation
• Diseases, Disorders, and Comorbidities of Interoception.

  2021cites this paper
• Interoception, Pain Tolerance, and Self-Injurious Behaviors: A Multidimensional Assessment.

  2021cites this paper
• Disrupted dorsal mid-insula activation during interoception across psychiatric disorders

  2021cites this paper
• The interplay of interoceptive accuracy, facets of interoceptive sensibility, and trait anxiety: A network analysis

  2021cites this paper
• Place de la pleine conscience dans la prise en charge

  2021cites this paper
• Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression

  2021cites this paper
• Variant connective tissue (joint hypermobility) and dysautonomia are associated with multimorbidity at the intersection between physical and psychological health

  2021cites this paper
• Interoceptive attention regulation in Ehlers-Danlos syndromes: associations between pain and psychiatric symptom severity.

  2021cites this paper
• Title: The Effect of Hypermobility on the Incidence of Injury in Professional Football: a multi-site cohort study

  2021cites this paper
• Title: The Effect of Hypermobility on the Incidence of Injury in Professional Football: a multi-site cohort study

  2021cites this paper
• Introduction to the thematic issue on stress, pain and the brain

  2020cites this paper
• Two Measures of Interoceptive Sensibility and the Relationship With Introversion and Neuroticism in an Adult Population

  2020influential citation
• Do interoceptive accuracy and interoceptive sensibility predict emotion regulation?

  2020cites this paper
• Do interoceptive accuracy and interoceptive sensibility predict emotion regulation?

  2020cites this paper
• The relationship between heartbeat counting and heartbeat discrimination: a meta-analysis.

  2020cites this paper
• Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain

  2020cites this paper
• Perception of atrial fibrillation in dependence of neuroticism.

  2020cites this paper
• Examining the Factor Structure and Validity of the Multidimensional Assessment of Interoceptive Awareness

  2020cites this paper
• Discovery and Proteomics Analysis of Effective Compounds in Valeriana jatamansi Jones for the Treatment of Anxiety.

  2020cites this paper
• Joint hypermobility is a marker for anxiety in children

  2019cites this paper
• Immediate biomechanical, systemic, and interoceptive effects of myofascial release on the thoracic spine: A randomised controlled trial.

  2019cites this paper
• Mindfulness, Interoception, and the Body: A Contemporary Perspective

  2019cites this paper
• Joint hypermobility is a marker for anxiety in children.

  2019cites this paper
• Immediate effects and associations between interoceptive accuracy and range of motion after a HVLA thrust on the thoracolumbar junction: A randomised controlled trial.

  2019cites this paper
• First evidence for an association between joint hypermobility and excitability in a non-human species, the domestic dog

  2019cites this paper
• Atypical bodily self-awareness in vicarious pain responders

  2019cites this paper
• Interoception is associated with heartbeat-evoked brain potentials (HEPs) in adolescents.

  2018cites this paper
• Low- and high-anxious hypermobile Ehlers–Danlos syndrome patients: comparison of psychosocial and health variables

  2018cites this paper
• Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome.

  2018cites this paper
• Joint hypermobility and its relevance to common mental illness in adolescents: a population-based longitudinal study

  2018cites this paper
• Randomized Controlled Trial Immediate biomechanical , systemic , and interoceptive effects of myofascial release on the thoracic spine : A randomised controlled trial

  2018cites this paper
• The Immediate Effect of Therapeutic Touch and Deep Touch Pressure on Range of Motion, Interoceptive Accuracy and Heart Rate Variability: A Randomized Controlled Trial With Moderation Analysis

  2018cites this paper
• Joint Hypermobility Classes in 9-Year-Old Children from the General Population and Anxiety Symptoms

  2018cites this paper
• Examination of interoception along the suicidality continuum.

  2018cites this paper
• Joint hypermobility is also associated with anxiety disorders in the elderly population

  2018cites this paper
• Joint Hypermobility Classes in 9-year-old Children from the General Population

  2018cites this paper
• Attention-deficit/hyperactivity disorder, joint hypermobility-related disorders and pain: expanding body-mind connections to the developmental age

  2018cites this paper
• Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire‐Short Form (BPQ‐SF)

  2018cites this paper
• Both anxiety and joint laxity determine the olfactory features in panic disorder.

  2017cites this paper
• Psychiatric and psychological aspects in the Ehlers–Danlos syndromes

  2017cites this paper
• Brain responses and self-reported indices of interoception: Heartbeat evoked potentials are inversely associated with worrying about body sensations.

  2017cites this paper
• A connective tissue disorder may underlie ESSENCE problems in childhood.

  2017cites this paper
• Body perception in a sample of nonclinical youngsters with joint hypermobility

  2017influential citation
• Understanding Anxiety in Borderline Personality Disorder

  2017cites this paper
• Experience‐dependent modulation of right anterior insula and sensorimotor regions as a function of noise‐masked auditory feedback in singers and nonsingers

  2017cites this paper
• Generalised joint hypermobility and neurodevelopmental traits in a non-clinical adult population

  2017cites this paper
• Holding the body in mind: Interoceptive awareness, dispositional mindfulness and psychological well-being.

  2017cites this paper
• Mind-Body Interactions in Anxiety and Somatic Symptoms

  2016cites this paper
• Title : The Effect of Hypermobility on the Incidence of Injury in Professional Football : a multi-site cohort study

  2016cites this paper
• Syndrome d’Ehlers-Danlos hypermobile : considérations psychologiques

  2016cites this paper
• Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility

  2016cites this paper
• Hypermobility and autonomic hyperactivity : relevance for the expression of psychiatric symptoms

  2016cites this paper
• The effect of hypermobility on the incidence of injury in professional football: A multi-site cohort study.

  2016cites this paper
• Joint Hypermobility, Anxiety, and Psychosomatics — The New Neuroconnective Phenotype

  2015cites this paper
• Neurovisceral phenotypes in the expression of psychiatric symptoms

  2015cites this paper
• Emotion processing in joint hypermobility: A potential link to the neural bases of anxiety and related somatic symptoms in collagen anomalies

  2015cites this paper
• Ehlers–Danlos syndrome(s) mimicking child abuse: Is there an impact on clinical practice?

  2015cites this paper
• Computational dissection of human episodic memory reveals mental process-specific genetic profiles

  2015cites this paper
• Interoception, contemplative practice, and health

  2015cites this paper
• Psychopathological manifestations of joint hypermobility and joint hypermobility syndrome/ Ehlers–Danlos syndrome, hypermobility type: The link between connective tissue and psychological distress revised

  2015cites this paper
• Evidence for Enhanced Interoceptive Accuracy in Professional Musicians

  2015cites this paper
• Neuroscience and Biobehavioral Reviews Discussion Dopamine and Anorexia Nervosa

  year unknowncites this paper