It started when neuropsychiatrist Antonio Bulbena, MD, PhD, noticed a strange pattern in his patients at the Hospital del Mar in Barcelona, Spain. Many with anxiety shared the same rubber stamp in their files: “joint hypermobility.” Bulbena called the doctor behind the stamps — a rheumatologist named Juan Carlos Duró. The two combed through patient files and discovered that those with hypermobility were four times more likely than those without hypermobility to have panic disorder. They published the results in 1988 in The Lancet.

Since then, many studies — “hundreds,” by Bulbena’s estimation — have supported the anxiety-hypermobility link. Research suggests that those with vs without hypermobility are four times more likely to have anxiety and depression, five times more likely to have agoraphobia, and seven times more likely to have panic disorder. Despite the evidence, these connections remain largely unrecognized by both doctors and their patients.

“There’s so many people affected, but it doesn’t seem to have cracked into the mainstream at all,” said Jessica Eccles, MD, PhD, a neurodevelopmental psychiatrist at Brighton and Sussex Medical School in Brighton, England.

Between 10% and 15% of people have joint hypermobility, commonly known as being double-jointed. Whether you’re one of them can be quickly assessed with a few simple tests that add up to a Beighton score: Can you bend your pinky finger back beyond 90 degrees? When you stand with knees locked, do your legs bend backward? For many people, the condition is benign or even beneficial: Professional ballet dancers are 11 times more likely to have hypermobility. Yet for others, their double-jointed fingers and limbs spell trouble: chronic joint pain, back pain, recurrent sprains. In rare cases, hypermobility signals a serious heritable connective tissue disorder, such as Ehlers-Danlos syndrome or Marfan syndrome. These conditions bring cardiovascular complications and characteristic looks: slender build, disproportionately long arms and fingers (like the “demon violinist,” Niccolò Paganini).

A 2026 study by Eccles found five times the risk for bipolar disorder in people with hypermobility, though the data are “not very strong yet,” Bulbena said. Another study by Bulbena and colleagues showed that after the massive 2015 earthquakes in Nepal, children and teenagers with hypermobility had more severe posttraumatic stress disorder than those without hypermobility. “It’s unexpected, but it’s there,” Bulbena said. These findings reflect what Bulbena calls the neuroconnective phenotype — the idea that some people are born with a particular body-brain combination that requires a different approach to care.

Hypermobility and Mental Health: Understanding the Link

Scientists are only starting to disentangle the connection between hypermobility and mental health. The pains and injuries that plague bendy bodies could be to blame, along with diagnostic delays. “Many people go and see lots of doctors about lots of different problems throughout the body, and many times they are not believed,” Eccles said.

But research suggests there’s more to the story. Evidence from Bulbena’s study on dogs found that canines with hip hypermobility were quicker to bark or yelp at minor disturbances and had a harder time calming down. To Bulbena, this indicates that the hypermobility-anxiety link has evolutionary roots.

Behind extreme flexibility are changes in collagen — the body’s main structural protein that supports and strengthens the skin, muscles, bones, and connective tissue. “Hypermobility is kind of a red herring for an overarching problem in the body, which is variant connective tissue,” said Lisa Quadt, PhD, a cognitive neuroscientist at the Brighton and Sussex Medical School. “That connective tissue is everywhere in the body and has a lot of jobs to do. It covers our nerves, it holds our organs in place, it makes up our skin, it holds our joints in place — or it doesn’t, if it’s too loose.” In humans, a deficiency in Tenascin-X (a key protein in maintaining the structure of connective tissue) causes a rare form of Ehlers-Danlos syndrome. Genetically engineered mice that don’t produce Tenascin-X have very stretchy skin low in collagen. They’re also highly anxious, even as mice go.

Another link may lie in a dysfunctional autonomic nervous system, the part that regulates processes outside our conscious control, such as heart rate. One condition associated with both anxiety and hypermobility is postural orthostatic tachycardia syndrome. When standing up from lying down, people with postural orthostatic tachycardia syndrome experience a faster-than-normal heartbeat, lightheadedness, and dizziness. In hypermobility, this could be explained by the presence of abnormal collagen in the veins, which may make it harder for the heart to pump blood. In recent experiments, most people with hypermobility (82%) couldn’t go from lying to standing without showing symptoms, such as drops in blood pressure and abnormal heart rate. And if you feel lightheaded and your heart is racing, you may interpret these signals as anxiety, Eccles said. “Seemingly randomly, you’re having an odd physiological fight-or-flight response,” she said. “For most people, they don’t know why that is. They’re just like, ‘I feel weird. What is going on?’” 

Inside the Brains of Bendy People

Double-jointed people may have trouble with interoception, or the ability to perceive and accurately interpret body sensations. People with anxiety tend to pay close attention to their bodies and catastrophize what they perceive (My pulse is racing! I’m having a heart attack!). In their research, Bulbena and Eccles found that faulty interoception could explain some of the links between hypermobility and anxiety.

Neuroimaging studies by Eccles and her colleagues show structural and functional differences in the brains of people with hypermobility, particularly in regions responsible for sensory processing and fear, such as the insula and amygdala. For their 2026 study, the scientists scanned the brains of dozens of healthy participants and participants with generalized anxiety disorder. They also evaluated participants for hypermobility. Volunteers looked at images of faces showing emotions, from anger to fear. In every participant, the insula and amygdala lit up in response — but people with both hypermobility and anxiety experienced the strongest activation in these regions. Double-jointed volunteers also had stronger functional connections between the amygdala and the precuneus, the hub of sensory processing. The explanation for such brain differences could again come down to abnormal collagen. “Is there any collagen in the brain? Yes, there is,” Bulbena said. Unfortunately, no research exists yet on how brain collagen might differ in people with hypermobility.

Future Direction and Potential Treatments

More research on hypermobility and mental health is vital for proper patient care, Quadt said. Cognitive-behavioral therapy and medication can leave “torturous” bodily symptoms untouched, she said. Interoceptive training could be an option. Quadt’s research shows it can improve anxiety in adults with autism, a condition that may overlap with hypermobility. The program in her study involved having participants gauge their heartbeat during light physical activities and tasks, with experts providing feedback on their judgments. The training made interoception more automatic and less effortful, teaching people to be “more accurate in their unconscious processing of internal signals.” Eccles and her colleagues also designed a therapy that targets catastrophizing of internal sensations, using biobehavioral training — such as learning to correctly estimate their own heartbeat — to get better at judging changes in their cardiovascular system. Neurofeedback could work, too, and so might yoga, according to an unpublished study from Bulbena.

“Hypermobility is a bit in the extremes: of emotion, of physical limits,” Eccles said. Her advice: “Capitalize on your strengths and support your challenges.” 

The experts cited in this article reported having no relevant disclosures.