Chronic musculoskeletal pain is an increasingly frequent feature in young people. Many exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population. The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS-R score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations. Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 63.4%, 40.6% and 43.7% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was significantly associated with autistic traits, with dysautonomia a stronger predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia. This is the first community study to provide evidence for a direct association between fibromyalgia and autistic traits. Although self-selected, the findings in our predominantly young female population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile.

https://www.lidsen.com/journals/neurobiology/neurobiology-07-01-155/obm.neurobiol.2301155.pdf

Autistic Traits Correlate with Chronic Musculoskeletal Pain: A Self-Selected Population Based Survey

INTRODUCTION Chronic musculoskeletal pain is now a common feature among younger women. Many such women exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population. METHODS The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS-R score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations. RESULTS Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 63.4%, 40.6% and 43.7% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was significantly associated with autistic traits, with dysautonomia a stronger predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia. DISCUSSION This is the first community study to provide evidence for a direct association between fibromyalgia and neurodivergent traits. Although self-selected, the findings in our predominantly young population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile. 

Neurodivergent Traits Correlate With Chronic Musculoskeletal Pain: A Self-Selected Population Based Survey

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is underrecognised and underdiagnosed in females. As a result, females often navigate years of symptoms without appropriate support, sometimes contributing to adverse outcomes for them and for those who try to support them. This review describes the experience of females with ADHD and explores and explains the main challenges they face. Methods: We distilled the most common themes expressed in the available literature on ADHD in females and used these to develop topic headings for a literature review. We then explored therapeutic options and identified future priorities for clinical research and development. Results: The commonest issues identified and explored related to the following topics: emotional development, friendships and relationships, handling conflict, self-harm and suicidality, creativity and hyperfocus, hypersensitivity, cognition and coordination, physical, psychological, and psychiatric comorbidity, and the effects of masking. We specifically considered the implications for serious self-harm, conflict, and criminal conviction among ADHD females, and explored how these risks may be mitigated with treatment. Discussion: Females with ADHD are both under-diagnosed and undersupported, despite the serious psychosocial consequences of this condition. Given that many of these carry potentially serious complications, recognition of these issues and the provision of appropriate support and intervention is of paramount importance if those who care for them professionally and/or personally are to respond effectively. Treatment mitigates adverse outcomes for many females with ADHD. 

Review of the Psychosocial Consequences of Attention Deficit Hyperactivity Disorder (ADHD) in Females

Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are the most common joint hypermobility conditions encountered by physicians, with hypermobile and classical EDS accounting for >90% of all cases. Hypermobility has been detected in up to 30-57% of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, postural orthostatic tachycardia syndrome (POTS), and long COVID (LC) compared to the general population. Extrapulmonary symptoms, including musculoskeletal pain, dysautonomia disorders, cognitive disorders, and fatigue, are seen in both LC and HSD. Additionally, ME/CFS has overlapping symptoms with those seen in HSD. Mast cell activation and degranulation occurring in both LC and ME/CFS may result in hyperinflammation and damage to connective tissue in these patients, thereby inducing hypermobility. Persistent inflammation may result in the development or worsening of HSD. Hence, screening for hypermobility and other related conditions including fibromyalgia, POTS, ME/CFS, chronic pain conditions, joint pain, and myalgia is essential for individuals experiencing LC. Pharmacological treatments should be symptom-focused and geared to a patient's presentation. Paced exercise, massage, yoga, and meditation may also provide benefits. 

Long COVID and hypermobility spectrum disorders have shared pathophysiology

People experience life and interact with others in many ways. The term ‘neurodivergence’ refers to variations from what is considered typical. Research and education into neurodivergent conditions in women and girls is essential to inform a timely reassessment of clinicians’ approaches to those who present with multiple symptoms. Neurodivergence may influence a person’s style of communication, learning, attitudes, and behaviour, and they may experience inequity and rejection. A formal diagnosis improves access to support services and helps them and their family better understand themselves and the challenges they face. Neurodivergent females are very prone to developing many physical and psychological health issues, and it is important that clinicians learn to recognise and respond to these. This narrative review highlights the huge burden of co-occurring conditions carried by neurodivergent women and girls and suggests how clinicians might increase their awareness of diagnosis and management of these to mutual benefit. 

pdf/commentary-recognising-and-responding-to-physical-and-mental-2vvfpi2kte.pdf

[Commentary] Recognising and Responding to Physical and Mental Health Issues in Neurodivergent Women

Fibromyalgia and joint hypermobility are common coexisting conditions among younger females that are often accompanied with additional features of autonomic dysfunction. Mental health is frequently impacted with these conditions and an association with neurodivergence has been recently established. Neurodivergence is also prevalent among close relatives. Reasons for this association are poorly understood, although genetics, adverse early life experiences and autoimmunity all contribute. Pharmacological responses may differ in neurodivergence, while psychological support requires adaptation for individual sensitivities. Screening patients with fibromyalgia and hypermobility for neurodivergent traits and vice versa may facilitate diagnosis and management.

/pdf/the-links-between-fibromyalgia-hypermobility-and-13pypq6t.pdf

The Links Between Fibromyalgia, Hypermobility and Neurodivergence

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The Links Between Fibromyalgia, Hypermobility and Neurodivergence