A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

About the autistic author marker

Eccles, J. A., Quadt, L., Garfinkel, S. N., & Critchley, H. D. (2024). A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility. Philosophical Transactions of the Royal Society B: Biological Sciences, 379(1908), 20230247-20230247. https://doi.org/10.1098/rstb.2023.0247

Journal or book title
Philosophical Transactions of the Royal Society B Biological Sciences
Publisher
The Royal Society
Volume
379
Issue
1908
Pages
20230247-20230247
Article number
20230247
Publication date: 15 Jul 2024 Added to AutiHub: 25 Sep 2026 Type: Article Article language: English

This publication is integrated into AutiHub through:

Authors

Publication authors
4
Publication authors identified as autistic
1 / 4 (25.0%)

Abstract

Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation. In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation. We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals. We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people. This article is part of the theme issue ‘Sensing and feeling: an integrative approach to sensory processing and emotional experience’.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 3 Oct 2026 08:20.

Cited references
50
With a DOI
46
Without a DOI, from raw bibliography text
3
10 / 50 (20.0%) cited references include at least one author identified as autistic.
References with data to complete
0 / 50 (0.0%)
References with detected author names
50 / 50 (100.0%)
Without detected author names
0
Without a structured title
0
Without a stable identifier
1
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
391
From DOI or external metadata
391
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
118 / 391 (30.2%) names are linked to an author already present in AutiHub. 273 / 391 (69.8%) names are not yet linked.
Names linked to a person identified as autistic
23 / 391 (5.9%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 23 / 118 (19.5%). Distinct people identified as autistic: 14 / 336 (4.2%).
  1. Andrew F. Hayes (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach .
    Type: Book OpenAlex: https://openalex.org/W1849190772
    OpenAlex
  2. Antonio Damasio , Gil B. Carvalho (2013). The nature of feelings: evolutionary and neurobiological origins . Nature Reviews Neuroscience, 14(2), 143-152. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1038/nrn3403 OpenAlex: https://openalex.org/W2022333848
    Crossref OpenAlex OpenCitations
  3. Hugo G. Beigel (1952). The influence of body position on mental processes . Journal of Clinical Psychology, 8(2), 193-199. Wiley.
    Crossref OpenAlex OpenCitations
  4. Hugo D. Critchley , Jessica A. Eccles , Sarah N. Garfinkel (2013). Interaction between cognition, emotion, and the autonomic nervous system . In Handbook of Clinical Neurology (pp. 59-77). Elsevier.
    Crossref OpenAlex OpenCitations
  5. Peter J. Lang (1994). The varieties of emotional experience: A meditation on James-Lange theory. Psychological Review, 101(2), 211-221. American Psychological Association (APA).
    Crossref OpenAlex OpenCitations
  6. González Moreno, Andrés Santiago (2013). Diagnostic and statistical manual of mental disorders . American Psychiatric Association.
    Crossref OpenAlex OpenCitations
  7. Bill J. Yates , Philip S. Bolton , Vaughan G. Macefield (2014). Vestibulo‐Sympathetic Responses . Comprehensive Physiology, 4(2), 851-887. Wiley.
    Crossref OpenAlex OpenCitations
  8. Martin P. Paulus , Murray B. Stein (2006). An Insular View of Anxiety . Biological Psychiatry, 60(4), 383-387. Elsevier BV.
    Crossref OpenAlex OpenCitations
  9. Thomas Parr , Giovanni Pezzulo , Karl J. Friston (2022). Active Inference . The MIT Press.
    Crossref OpenAlex OpenCitations
  10. Sahib S. Khalsa , Ralph Adolphs , Oliver G. Cameron , Hugo D. Critchley , Paul W. Davenport , Justin S. Feinstein et al. (2018). Interoception and mental health: A roadmap . Biological Psychiatry Cognitive Neuroscience and Neuroimaging, 3(6), 501. Elsevier BV.
    Crossref OpenAlex
  11. Jenny L. L. Csecs , Nicholas G. Dowell , Georgia Savage , Valeria Iodice , Christopher J. Mathias , Hugo D. Critchley et al. (2021). Variant connective tissue (joint hypermobility) and dysautonomia are associated with multimorbidity at the intersection between physical and psychological health . American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 187(4), 500-509. Wiley.
    Crossref OpenAlex OpenCitations
  12. Hugo D. Critchley , Sarah N. Garfinkel (2017). Interoception and emotion . Current Opinion in Psychology, 17, 7-14. Elsevier BV.
    Crossref OpenAlex OpenCitations
  13. Beatrice de Gelder (2006). Towards the neurobiology of emotional body language . Nature Reviews Neuroscience, 7(3), 242-249. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1038/nrn1872 OpenAlex: https://openalex.org/W2012758188
    Crossref OpenAlex OpenCitations
  14. Meng-Chuan Lai , Caroline Kassee , Richard Besney , Sarah Bonato , Laura Hull , Will Mandy et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis . Lancet Psychiatry, 6(10), 819. Elsevier BV.
    Crossref OpenAlex OpenCitations
  15. Turgay Akay , Andrew J. Murray (2021). Relative Contribution of Proprioceptive and Vestibular Sensory Systems to Locomotion: Opportunities for Discovery in the Age of Molecular Science . International Journal of Molecular Sciences, 22(3), 1467. MDPI AG.
    Crossref OpenAlex OpenCitations
  16. Núria Mallorquí-Bagué , Sarah N. Garfinkel , Miriam Engels , Jessica A. Eccles , Guillem Pailhez , Antonio Bulbena et al. (2014). Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility . Frontiers in Psychology, 5, 1162. Frontiers Media SA.
    Crossref OpenAlex
  17. Sue Fletcher-Watson , Francesca Happé (2019). Autism . Routledge.
    Crossref OpenAlex OpenCitations
  18. S.B. Sanches , F.L. Osório , P. Louzada-Junior , D. Moraes , J.A.S. Crippa , R. Martín-Santos (2014). Association between joint hypermobility and anxiety in Brazilian university students: Gender-related differences . Journal of Psychosomatic Research, 77(6), 558-561. Elsevier BV.
    Crossref OpenAlex OpenCitations
  19. Harriet Emma Clare Sharp , Hugo D. Critchley , Jessica A. Eccles (2021). Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression . World Journal of Psychiatry, 11(10), 805-820. Baishideng Publishing Group Inc..
    Crossref OpenAlex OpenCitations
  20. Christopher Gillberg (2010). The ESSENCE in child psychiatry: Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations . Research in Developmental Disabilities, 31(6), 1543-1551. Elsevier BV.
    Crossref OpenAlex OpenCitations
  21. Carolina Baeza-Velasco , Lorenzo Sinibaldi , Marco Castori (2018). Attention-deficit/hyperactivity disorder, joint hypermobility-related disorders and pain: expanding body-mind connections to the developmental age . ADHD Attention Deficit and Hyperactivity Disorders, 10(3), 163-175. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  22. Matthew R. Mulvey , Gary J. Macfarlane , Marcus Beasley , Deborah P. M. Symmons , Karina Lovell , Philip Keeley et al. (2013). Modest Association of Joint Hypermobility With Disabling and Limiting Musculoskeletal Pain: Results From a Large‐Scale General Population–Based Survey . Arthritis Care & Research, 65(8), 1325-1333. Wiley.
    Crossref OpenAlex OpenCitations
  23. Themistoklis Pantazakos (2025). Neurodiversity and psychotherapy—Connections and ways forward . Counselling and Psychotherapy Research, 25(1). Wiley.
    Crossref OpenAlex OpenCitations
  24. Christoph Best , Annegret Eckhardt-Henn , Regine Tschan , Marianne Dieterich (2009). Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes . Journal of Neurology, 256(1), 58-65. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  25. Sarah N. Garfinkel , Claire Tiley , Stephanie O'Keeffe , Neil A Harrison , Anil K. Seth , Hugo D. Critchley (2016). Discrepancies between dimensions of interoception in autism: Implications for emotion and anxiety . Biological Psychology, 114, 117-126. Elsevier BV.
    Crossref OpenAlex OpenCitations
  26. Tal Shafir (2016). Using Movement to Regulate Emotion: Neurophysiological Findings and Their Application in Psychotherapy . Frontiers in Psychology, 7, 1451-1451. Frontiers Media SA.
    Crossref OpenAlex OpenCitations
  27. Jessica A. Eccles , F. D. C. Beacher , M. A. Gray , C. L. Jones , L. Minati , Neil A Harrison et al. (2012). Brain structure and joint hypermobility: Relevance to the expression of psychiatric symptoms . British Journal of Psychiatry, 200(6), 508-509. Royal College of Psychiatrists.
    Crossref OpenAlex OpenCitations
  28. Sahib S. Khalsa , Ralph Adolphs , Oliver G. Cameron , Hugo D. Critchley , Paul W. Davenport , Justin S. Feinstein et al. (2018). Interoception and Mental Health: A Roadmap . Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501-513. Elsevier BV.
    OpenCitations
  29. Jing Li , Wenchen Wang , Jia Cheng , Haimei Li , Lei Feng , Yuanchun Ren et al. (2023). Relationships between sensory integration and the core symptoms of attention-deficit/hyperactivity disorder: the mediating effect of executive function . European Child & Adolescent Psychiatry, 32(11), 2235-2246. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  30. Thierry Lelard , John Stins , Harold Mouras (2019). Postural responses to emotional visual stimuli . Neurophysiologie Clinique, 49(2), 109-114. Elsevier BV.
    Crossref OpenAlex OpenCitations
  31. Carolina Baeza-Velasco , David Cohen , Claude Hamonet , Elodie Vlamynck , Lautaro Diaz , Cora Cravero et al. (2018). Autism, Joint Hypermobility-Related Disorders and Pain . Frontiers in Psychiatry, 9, 1. Frontiers Media SA.
    Crossref OpenAlex OpenCitations
  32. M F Ward , P H Wender , F W Reimherr (1993). The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder . JAMA Psychiatry, 150(6), 885. American Psychiatric Association Publishing.
    Crossref OpenAlex
  33. Marco Castori , Brad Tinkle , Howard Levy , Rodney Grahame , Fransiska Malfait , Alan J. Hakim (2017). A framework for the classification of joint hypermobility and related conditions . American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 148-157. Wiley.
    Crossref OpenAlex OpenCitations
  34. Mahnaz Daman , Farideh Shiravani , Ladan Hemmati , Shohreh Taghizadeh (2019). The effect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial . Journal of Bodywork and Movement Therapies, 23(1), 202-205. Elsevier BV.
    Crossref OpenAlex OpenCitations
  35. Eve B. Carlson , Frank W. Putnam (1993). An update on the dissociative experiences scale . Dissociation, 6, 16.
    Type: Article OpenAlex: https://openalex.org/W2779225231
    Crossref OpenAlex
  36. AJ Hakim , R Grahame (2003). A SIMPLE QUESTIONNAIRE TO DETECT HYPERMOBILITY: AN ADJUNCT TO THE ASSESSMENT OF PATIENTS WITH DIFFUSE MUSCULOSKELETAL PAIN . International Journal of Clinical Practice, 57(3), 163-166. Wiley.
    Crossref OpenAlex OpenCitations
  37. Lisa Feldman Barrett (2017). How emotions are made: The secret life of the brain.
    Type: Book OpenAlex: https://openalex.org/W2908473373
    Crossref OpenAlex
  38. Ashley Robertson , David R. Simmons (2019). Glasgow Sensory Questionnaire (GSQ) . In Encyclopedia of Autism Spectrum Disorders (pp. 1-3). Springer New York.
    Crossref OpenAlex OpenCitations
  39. Hayes AF (2017). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach . Introduction to mediation, moderation, and conditional process analysis: a regression-based approach.
    Type: Other
    Crossref
  40. Colin M.E. Halverson , Heather L. Penwell , Clair A. Francomano (2023). Clinician-associated traumatization from difficult medical encounters: results from a qualitative interview study on the Ehlers-Danlos syndromes . Qual. Res. Health, 3, 100237. Elsevier BV.
    Crossref OpenAlex