title: Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility.
abstract: 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.
authors.affiliation: Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autonoma de Barcelona Barcelona, Spain ; Department of Psychiatry, Psychology and Psychosomatics, Hospital Universitari Quirón Dexeus Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Mallorquí-Bagué
authors.affiliation: Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Mood and Anxiety Research in Sussex (MARS), Sussex Partnership NHS Foundation Trust Sussex, UK ; Sackler Centre for Consciousness Science, University of Sussex Falmer, UK.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Garfinkel
authors.affiliation: Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University Maastricht, Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Engels
authors.affiliation: Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Mood and Anxiety Research in Sussex (MARS), Sussex Partnership NHS Foundation Trust Sussex, UK.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Eccles
authors.affiliation: Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autonoma de Barcelona Barcelona, Spain ; Anxiety Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Universitat Autònoma de Barcelona Barcelona, Spain ; Hospital del Mar Medical Research Institute Barcelona, Spain.
authors.forename: Guillem
authors.initials: G
authors.lastname: Pailhez
authors.affiliation: Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autonoma de Barcelona Barcelona, Spain ; Anxiety Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Universitat Autònoma de Barcelona Barcelona, Spain ; Hospital del Mar Medical Research Institute Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bulbena
authors.affiliation: Psychiatry, Brighton and Sussex Medical School, University of Sussex Falmer, UK ; Mood and Anxiety Research in Sussex (MARS), Sussex Partnership NHS Foundation Trust Sussex, UK ; Sackler Centre for Consciousness Science, University of Sussex Falmer, UK.
authors.forename: Hugo D
authors.initials: HD
authors.lastname: Critchley
keywords: anxiety; emotion; functional magnetic resonance imaging (fMRI); interoception; joint hypermobility; psychology