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Embracing Complexity: Connecting Bipolar Affective Disorder, Joint Hypermobility, and Neurodivergence
28 Pages Posted: 12 Sep 2024
More...Abstract
Background: Neurodivergence encompasses neurodevelopmental conditions including autism, attention deficit hyperactivity disorder (ADHD), and Tourette syndrome. Particular physical traits, notably those linked to joint hypermobility, have an established association with both neurodivergence and bipolar affective disorder. This case-control study tested how presence of joint hypermobility and neurodivergent characteristics interact in relation to the expression of bipolar affective disorder.
Methods: Data was collected from 52 participants with bipolar affective disorder and from a comparison group of 54 participants without bipolar affective disorder. All participants were assessed on screening instruments for autism (Ritvo Autism Asperger Diagnostic Scale; RAADS-R), ADHD (Wender Utah Rating Scale; WURS), and joint hypermobility. Group differences were explored, and odds ratios calculated. A mediation analysis was performed to determine the contribution of neurodivergent characteristics to the relationship between joint hypermobility and bipolar affective disorder.
Outcomes: The presence of joint hypermobility significantly predicted the presence of bipolar disorder (OR 5·1; 95% CI = [2·1, 12·4]). In the bipolar affective disorder group, the prevalence of likely autism and ADHD was greater (84·6% and 65·4% respectively) than in the comparison group (22·2% and 3·7% respectively). OR for a diagnosis of bipolar affective disorder was 18·2 (CI 95% = [6·70, 49·41]) in those meeting threshold for likely autism; and 46·89 (95% CI = [9·96, 220·74]) in participants meeting threshold for likely ADHD. Mediation analysis showed that autistic, ADHD and pooled neurodivergent characteristics mediated the link between joint hypermobility and bipolar affective disorder.
Interpretation: This study reveals how neurodivergent characteristics underpin vulnerability to bipolar affective disorder in individuals with joint hypermobility. The appreciation of interacting physical and neurodivergent traits to the expression of psychiatric illness has implications for diagnostic formulation, personalised medicine, and service design.
Funding: Brighton and Sussex Medical School. JAE was supported through a MQ transforming mental health/Versus Arthritis Fellowship (MQF17-19).
Declaration of Interest: Authors declare no competing interests.
Ethical Approval: Ethical approval was granted by the Brighton and Sussex Medical School RGEC (ER/BSMS99VB/1).
Keywords: Joint Hypermobility, EDS, Autism, ADHD, Bipolar Affective Disorder
Suggested Citation: Suggested Citation