Comorbidity of ehlers–danlos syndrome and obsessive-compulsive disorder: clinical case
CLINICAL CASE
Abstract
Comorbidity of Ehlers–Danlos syndrome with various psychiatric disorders is a topical scientific issue. Some authors note that patients with this disorder often have obsessive-compulsive disorder (OCD). In addition, scientific data highlight the impact of fatigue on the quality of life of patients with Ehlers–Danlos syndrome. The presented clinical case describes a case of comorbidity of OCD and Ehlers–Danlos syndrome against the background of the so-called “broad spectrum autism phenotype”. Differential diagnostics were carried out with recurrent depression, ASD, anxiety-depressive disorder, OCD and anankastic personality disorder, accompanied by asthenic syndrome. A detailed collection of childhood and adolescent anamnesis, clinical attention to the somatic anamnesis allowed us to assess the described complaints within the asthenic and anankastic circle, and also to assume a rheumatological condition, which was later confirmed by a rheumatologist. The therapy prescribed by the psychiatrist focused on obsessive-compulsive symptoms, escitalopram and cognitive-behavioral therapy were prescribed. Asthenic syndrome was position as the second target, the therapy of which was carried out with courses of neurometabolic drugs. The therapeutic measures carried out for six months led to an improvement in the patient's condition and quality of life. The patient continues to be monitored by a rheumatologist and other somatic specialists regarding concomitant pathology, continues psychotherapy. Asthenic background has traditionally been considered as a factor in the unfavorable course of mental disorders and therapeutic incurability. Therefore, the identification of heteronomous symptoms that do not fit into the overall picture of a particular psychiatric diagnosis is an important task for a practicing clinician. The issue of comorbidity of Ehlers–Danlos syndrome and various mental illnesses, including OCD, is poorly understood and requires further research. Current knowledge of rheumatological pathology (in this case, Ehlers–Danlos syndrome) should be considered when diagnosing mental disorders, which allows for a holistic assessment of the patient's condition, correcting drug therapy, and competently constructing prognostic and psychoeducational work with patients.
References
1. Stein T., Collins S., St Louis J. The prevalence of hypermobile Ehlers–Danlos syndrome at a gender-affirming primary care clinic. SAGE Open Med. 2025;13. https://doi.org/10.1177/20503121251315021.
2. Isaev M.R., Batalin V.A., Galin P.Yu., Batalina M.V., Yorov N., Mironchev O.V., Nikonova E.N., Atashova D.M., Napol’nova A.V., Artem’eva A.V., Ovcharova K.I., Zenina I.A. On some hypermobility spectrum disorders among young people. Orenburg Medical Herald. 2021;9(35):25–30. EDN: HHIIRZ.
3. Baleva L.S., Zotova S.A., Semyachkina A.N., Nikolaeva E.A., Bondarenko N.A., Sipyagina A.E. Ehlers–Danlos syndrome in children from radocontaminated territory. Almanac of Clinical Medicine. 2006;10:3–9. EDN: HZKRMX.
4. Clark N.L., Johnson M., Rangan A., Kottam L., Swainston K. The biopsychosocial impact of hypermobility spectrum disorders in adults: a scoping review. Rheumatol Int. 2023;43(6):985–1014. https://doi.org/10.1007/s00296-023-05298-2.
5. Slepian P.M., Axenova K., Mc Carthy M., Siegal R., Gobin K., Weinrib A., Buryk-Iggers S., Santa Mina D., Mc Gillis L., Mittal N., Katz J., Clarke H. Rates of mental health concerns among individuals assessed at the Good Hope Ehlers–Danlos Syndrome Clinic. Orphanet J Rare Dis. 2025;20(1):75. https://doi.org/10.1186/s13023-025-03550-5.
6. Ishiguro H., Yagasaki H., Horiuchi Y. Ehlers–Danlos Syndrome in the Field of Psychiatry: A Review. Front Psychiatry. 2022;12. https://doi.org/10.3389/fpsyt.2021.803898.
7. Sokol O.E., Biggs E.E., Berger A.S., Simons L.E., Bhandari R.P. The Relationship Between Fatigue, Pain Interference, Pain-Related Distress, and Avoidance in Pediatric Hypermobile Ehlers–Danlos Syndrome. Children. 2025;12(2):170. https://doi.org/10.3390/children12020170.
8. Udugampolage N., Taurino J., Bassotti A., Pini A., Caruso R., Callus E. et al. Exploring fatigue in Marfan and hypermobile Ehlers–Danlos syndromes: an analytical cross-sectional study in two Italian healthcare centres. BMJ Open. 2025;15(1):e087298. https://doi.org/10.1136/bmjopen-2024-087298.
9. Rocchetti M., Bassotti A., Corradi J., Damiani S., Pasta G., Annunziata S. et al. Is the Pain Just Physical? The Role of Psychological Distress, Quality of Life, and Autistic Traits in Ehlers–Danlos Syndrome, an Internet-Based Survey in Italy. Healthcare (Basel). 2021;9(11):1472. https://doi.org/10.3390/healthcare9111472.
10. Gensemer C., Burks R., Kautz S., Judge D.P., Lavallee M., Norris R.A. Hypermobile Ehlers–Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes. Dev Dyn. 2021;250(3):318–344. https://doi.org/10.1002/dvdy.220.
11. Sucksmith E., Roth I., Hoekstra R.A. Autistic traits below the clinical threshold: re-examining the broader autism phenotype in the 21st century. Neuropsychol Rev. 2011;21(4):360–389. https://doi.org/10.1007/s11065-011-9183-9.
12. Pasquini M., Celletti C., Berardelli I., Roselli V., Mastroeni S., Castori M. et al. Unexpected association between joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type and obsessive-compulsive personality disorder. Rheumatol Int. 2014;34(5):631–636. https://doi.org/10.1007/s00296-013-2901-2.
