Told You’re “Too Sensitive”? It Might Be ADHD, Autism, and Hypermobility with Jessica Eccles (Ep 194)

Transcripts are autogenerated and may contain errors

Dr. Jessica Eccles: [00:00:00] When you don't have that knowledge, when people haven't explained these words to you, you think, you know, "What fresh hell is next in terms of random weirdnesses?"

Dr. Linda Bluestein: Welcome back, every bendy body to the Bendy Bodies podcast. I'm your host, Dr. Linda Bluestein, the Hypermobility MD, a Mayo Clinic-trained expert in Ehlers-Danlos syndromes, dedicated to helping you navigate hypermobility and live your best life. I am so excited to speak with Dr. Jessica Eckles today. Dr.

Eckles is an award-winning neurodevelopmental psychiatrist and researcher specializing in the links between the brain and the body, and particularly joint hypermobility. Dr. Eckles is a wealth of information, so I know you're really going to [00:01:00] enjoy this episode today. As always, this information is for educational purposes only and is not a substitute for personalized medical advice.

Stick around until the very end so you don't miss any of our special hypermobility hacks. Here we go.

Thank you so much for listening to Bendy Bodies. We really appreciate your support. It really helps the podcast when you like, subscribe and comment on YouTube and follow, rate and review on all audio platforms. This helps us reach so many more people and spread the information to everyone. Thank you so much again and enjoy the rest of the episode.

I'm so excited to be here today with Dr. Jessica Eckles, who is an incredible expert in the space of hypermobility, connective tissue variance, neurodiversity, so many amazing topics that are so critical to this audience. And this is our third conversation with Dr. Eckles, and I know that the first couple of conversations were, at least for a very long time, some of the absolute most [00:02:00] popular episodes of the Bendy Bodies podcast.

So it's, it's a real honor to have you back. 

Dr. Jessica Eccles: Oh, it's a, it's a real pleasure to be back. Thank you so much. 

Dr. Linda Bluestein: Of course, of course. So I have to say, in preparation for this episode, I was looking at more recent articles that you've published. Oh my gosh, you're, you're talking about so many different fascinating things, right?

And I'm like, wow, we're talking about, of course, neurodivergence, hypermobility, chronic pain, fatigue, you know, all these things where people are being told that it's all in their head and the difference between things in the body, things in the, in the brain. And it was also really interesting because, um, I will be soon interviewing Dr.

David Nutt and- 

Dr. Jessica Eccles: Oh, 

Dr. Linda Bluestein: wow ... um, and, and Lucy Stafford and so it was funny 'cause I was preparing for both interviews at the same time and I'm gonna talk to them about psychedelics. 

Dr. Jessica Eccles: Yes, because, um, sorry, uh, Lucy was my, um, um, master's student, and she was working with David Nutt [00:03:00] on, um, medical cannabis for EDS.

She's now our PhD student at Brighton and Sussex Medical School, and she's working on a, um, a technique called microneurography to look at single nerves, uh, as a measure of autonomic nervous system function in postural tachycardia syndrome and hypermobility. 

Dr. Linda Bluestein: Wow, that's amazing. Well, well, it was funny 'cause I didn't think there was necessarily any connection between the three of you.

I knew there was between the two of them 'cause he suggested that she be also a, you know, a guest on the same show. Uh, but then I found an article that the three of you published together, so, so that was cool on, on medical cannabis. So you are doing so many great things and it's like, okay, well, where do we start?

Maybe we start talking about people being so misunderstood and the distress that they experience, and I feel like this is just so common. It's kind of a common thread through the work that you're doing. People are often [00:04:00] misunderstood when their distress is intense, embodied, or hard to categorize. Do you see that as one of the central issues for people with c- you know, connective tissue variance?

I love how you call it connective tissue variance, postural orthostatic tachycardia syndrome, et cetera. 

Dr. Jessica Eccles: I think that this is absolutely pivotal, really. So there was the, um, Halverson paper a couple of years ago about clinician-associated traumatization in EDS, and I have given-- I give a fair number of talks.

I think in fact, last year I might have given 50. And one of the, one of my, uh, new talk styles is to talk about, um, some of the things that I was interested in before I became interested in, um, psychiatry. So in medical school in the United Kingdom, it's different to in the United States. So I think in the United States, you do an undergraduate degree, and then you do medicine afterwards.

Here in the UK, we go into medical school when [00:05:00] we are 18, and it's an undergraduate degree, but it lasts kind of six years. And one of the, um, one of the things that certain medical schools do is they let you do a little mini degree in the middle. So I did one in a relatively unusual, uh, topic you would think, called the History and Philosophy of Science.

This was back when I was at Cambridge University, and I found an old essay that I had written back in those days, uh, of being a slightly pretentious undergraduate, and it was about the social construction of healing. And it basically said that for a coherent doctor-patient relationship, for healing, which I kind of use in a grand sense To happen, you need to have a shared narrative, a shared framework.

And I think for so many hypermobile people, [00:06:00] this is what they do not get. So they go and see a doctor, they go and see any number of, uh, professionals or educationalists, and many of them, unfortunately, basically hear back, "I don't understand your story, therefore, it cannot be real. Um, uh, this must be somehow in your head, this must be somehow anxiety, um, or functional neurological disorder."

And that what is so transformative and what I hope the research that we're doing, particularly at Brighton and Sussex Medical School, is helping, is to provide a framework that both seems coherent and makes sense to patients and also by doing this research and by trying to educate other doctors and clinicians and the public, there is a shared narrative.

[00:07:00] And I think, I think that that is really important because without that sense of trust, of being listened to and being believed, I don't think you get very far in, um, in medicine. You need to be-- You need to at least have some sense of what we would say is singing from the same hymn sheet. We-- You need to, um...

That there needs to be a, a, a shared, a shared framework and a shared language, and this is why hypermobility and variant connective tissue are so interesting, is because they involve both the body and the brain, and the work that we're doing is kind of connecting all sorts of things that seem in some ways quite disparate, you know, anxiety, chronic fatigue, ADHD.

You might think, "Well, how are these all interrelated?" But actually, by providing this framework, you are able to say to patients, and I [00:08:00] am a patient myself, that you, um, you haven't actually got ten, 12 different perplexing problems that no one understands, seems to be random, you might be making up. In fact, there is this unifying framework.

You are built differently, and by being built differently, you may be more likely to be able to do certain things, you know, like dancing, or you may be able to be particularly good at playing certain piano pieces. But at the same time as having those sort of strengths, you're also more likely to have a particular constellation Of challenges.

And what we are really realizing is that there is so much more we need to know, because I think the work that we're doing, uh, is really just the tip of the iceberg. 

Dr. Linda Bluestein: Yes. Yes, I agree. And I interviewed Dr. Halverson [00:09:00] for the podcast, so we're gonna link that, and we'll also link that paper in the show notes that you just mentioned, 'cause that's, that's a really important paper.

I've used that quite a bit in my presentations as well. It's, uh, it's important for people to be a-aware of and, and know that for better or for worse, they're not alone in having had these traumatic e-encounters and, and if we can really improve that, I think that's gonna be something really helpful for so many people.

And you've published on some interesting topics like rejection sensitivity, masking chronic pain, fatigue, autism, and borderline personality disorder, and I'm curious what ties those together for you. 

Dr. Jessica Eccles: Ah, well, what ties them together... Now, I must caveat the idea of borderline personality disorder as a sort of somewhat contentious construct that I don't necessarily agree with, but it is a, it's a diagnostic terminology.

All of those things are linked, as I think almost everything is, [00:10:00] with variant connective tissue. So rejection sensitivity is a very interesting topic in that it almost seems to be-- Well, it's really exploded on social media. There's lots and lots of people talking about it on social media. I remember first reading it i-- about it in, um, is it Hallowell's book, Delivered From Distraction, which was a book about ADHD.

In the book, he describes one of his patients, um, uh, you know, basically kind of waiting for, you know, what fresh horror is gonna happen next that's gonna basically take the, uh, the rug out from underneath my feet and make me feel awful, and that this is me living every day. And when we started looking into rejection sensitivity, it actually turns out that rejection sensitivity is not specific to ADHD.

The previous research looks at rejection [00:11:00] sensitivity in autism as well, and also in, um, self-esteem issues and in depression. I do not think rejection sensitivity is specific to ADHD. But for people with ADHD and neurodivergent people, uh, one... people describe typically that one of the things that is hardest for them is emotion regulation.

So even though we think of ADHD as a difficulty in focusing, when in fact actually it's a difficulty in switching focus, it's not necessarily a difficulty in focusing One of the things that adults in particular would like to change the most about ADHD if they could, is this sort of roller coaster of emotions.

And, uh, when-- again, it kind of takes me back to what I was saying about the shared framework, is when you talk to patients about rejection sensitivity, whatever their diagnosis, and also it could be related to [00:12:00] trauma, it could be related to self-esteem problems, it is something that patients really seem, some of them, to identify with.

So this, this feeling of feeling profoundly upset, disturbed, depressed by the thought of actual rejection or perceived rejection. And so when we started looking into it, we noticed that actually, although lots and lots of people are talking about rejection sensitivity, there is very little understood about it.

So we, in parallel, have been doing two projects, one of which is now published by Annabelle Smith and Beth Sutton and Lisa Quat, our qualitative exploration of rejection sensitivity. But with, um, Rebecca Gazett and, uh, Lisa Quat, we are doing some quantitative work as well, which is also very interesting.

But the big finding that we found [00:13:00] in the, um, in the rejection sensitivity paper, the one that I, I found most interesting was that this experience of rejection sensitivity is basically an embodied experience. So the people that we talk to, or Annabelle talked to whilst I was there, they said that this feeling of rejection was like a punch in the chest, that it was like having a chair pulled out from them.

And it just goes to show that what we think of as a psychological construct, difficulties related to self-esteem and relating to other people, is we cannot separate that from the, um, from the bodily experience. And this links to how the work that we've been doing in hypermobility, the very early work that we did in hypermobility and anxiety and autonomic dysfunction, so you know, what you might see in postural tachycardia syndrome, [00:14:00] is that a hypermobile person may be more likely to be neurodivergent.

A neurodivergent person, for a number of reasons, may be more likely to be traumatized. And a-- this hypermobile neurodivergent brain body, because of the reactivity of the autonomic nervous system, may well then process trauma differently, more acutely, leading to this embodied phenomenon. The reason why I think this is important Is that especially for a lot of people who have difficult relationships with their bodies and their bodies and their brains.

So there's this, this idea of in, uh, neurodivergence of... Well, not in neurodivergence. Uh, there is an idea in neurodivergence of alexithymia, which is this difficulty recognizing and understanding emotions. And there is also, we've been working for many years, particularly, um, Hugo [00:15:00] Critchley and Sarah Garfinkel and Lisa Quod, on this idea of interoception, the inner sense of what is happening in your body.

And, um, for those of us who have complicated relationships with our bodies, you know, they're prone to, um, do things they shouldn't and, uh, let you down. Um, uh, actually, sometimes the body might be the way in to integrating the brain and the body. So if you are very, you know, in a rejection sensitive moment or in a traumatized moment or a triggered moment, you will potentially become dysregulated and distressed.

And when you're dysregulated and distressed, actually talking about it doesn't necessarily help. It seems, you know, you think, "Oh, we've gotta let it out. We've gotta talk it out." But what may help is getting in, in tune with the body [00:16:00] through sort of the senses may get you into a sort of a zone of, um, a window of tolerance, a zone of regulation that means that you can begin to do some work that calms and settles the, um, both the brain and the body.

So I think that the rejection sensitivity work, the embodied nature of the rejection sensitivity, it ties up with my other, I think-- I'm not sure if it was last year or the year before. I think it was last year. My favorite paper that we have published, not supposed to really have favorites, is, I think it was called "The Proprioceptive Impact of, of Neurodivergence on Emotion Regulation and the Relationship with Joint Hypermobility."

It's a bit of a long title, but essentially what we showed was that if you had neurodivergent characteristics, you were more likely to experience emotion regulation difficulties, and that emotion regulation [00:17:00] difficulties were related to this sense of uncertainty about where you were in space. We called it proprioceptive surprise.

But that relationship linking the brain and the body in terms of emotion regulation was, in fact, twice as powerful in, uh, people with joint hypermobility. So this is, um, this is the sort of paradox that we see in hypermobility is like, you know, dancers who might bump into walls, that this sense of uncertainty about where we are in space May in fact be contributing to mental uncertainty, and that if weee, and this is just a hypothesis on the basis of this data, is that if we were able to improve our proprioception, uh, quite simply sometimes, you know, I don't know, wobble boards, uh, resistance bands, arch supports, you know, just feedback.

It might be that by [00:18:00] improving our sense of certainty about where we are in space could in fact improve our emotion regulation, which I don't know, somehow that, that really, uh, I love that idea because we know, and I'm a psychiatrist, that conventional medication strategies and, um, conventional psychological approaches, they don't work for everyone.

And this basically just gives us, uh, something more, another tool in our toolkit, and opens up an entire avenue of, um, brain, body research and possible interventions that I don't think we'd necessarily been thinking about before, or if we had been thinking about, we didn't have evidence to necessarily support.

Dr. Linda Bluestein: I love that because I totally see your point, and my personal and professional experience also, uh, is completely consistent with what you're saying about emotional [00:19:00] dysregulation and that in that setting, talk therapy may or may not be that effective. And I'm also thinking about the rejection sensitivity and that that might help explain why so many of us are subject to gaslighting ourselves.

So we go to the doctor, and we get this rejection by the doctor. The doctor says, "No, no, no, there's nothing wrong with you. You're perfectly fine. I did some lab tests. I did an X-ray. You're fine." So then we, we sense that rejection, but we internalize it, and if we have problems with emotional regulation, that can really set us on a bad path that maybe some other people, it just wouldn't phase them as much.

Dr. Jessica Eccles: No, absolutely. And I think that's the interesting thing about rejection sensitivity is, um, that it manifests in different way for different people. So for some people, just as you've described, it can-- you can internalize it. But I think rejection sensitivity can also be externalized as anger, as rage. Some people may withdraw into [00:20:00] themselves, and other people may move towards other people.

And I-- what though is really hard, I think when I speak to my patients in our neurodivergent brain body clinic we have in our NHS service in Sussex, the world's first neurodivergent brain body clinic, um, is that that feeling of rejection, that feeling of being misunderstood, that feeling of being let down Or means almost like a feeling of learned hopelessness and helplessness, and that there are many patients that I talk to who have all sorts of issues who actually don't want to put themselves through the, the fear of going to see the doctor or a healthcare professional because they are worried, very worried about being misunderstood.

And not [00:21:00] only is that leading to this sort of sense of hopelessness and helplessness, it could actually be really dangerous in terms of not seeking, not seeking help when you need it. I mean, we know obviously that, uh, there's lots of, um, problems associated with hypermobility and with, um, things like postural tachycardia syndrome, but that in the main, apart from for the genetic causes of Ehlers-Danlos syndrome, they don't tend to be life-limiting conditions.

And, you know, postural tachycardia syndrome is not a problem of the structure or function of the heart. But not being believed may mean that you end up not seeking help for something that is actually understood or more widely understood, you know, like the signs of a, of a cancer or heart disease, and it is...

That is really, [00:22:00] really sad. The other thing I just wanted to say there about, uh, rejection sensitivity, and we don't have a really good construct for it yet, and I really don't think there has been much research, but one of the papers that we just have published only a few weeks ago actually, was about the relationship between hypermobility and bipolar disorder and neurodivergence.

And this was something that these Swedish studies, we've got, you know, these whole population databases. They, um, I will have talked about this before on the, uh, Bendy Bodies podcast about how the Swedish data showed that if you were hypermobile, diagnosis of hypermobility, you were seven times more likely to be autistic, five times more likely to have ADHD, but also three times more likely to have bipolar, and unfortunately, twice as likely to have attempted suicide.

And we showed in a group of patients with a bipolar diagnosis that they were more likely to be hypermobile and that the relationship [00:23:00] between hypermobility and these altered mood states was partly driven by neurodivergent characteristics. And if we think of, um, rejection sensitivity as a sort of a gateway or a driver into depressed or low mood or dysphoria or burnout We must also think of the opposite.

You know how, uh, neurodivergent people can get quite excited, busy, a sort of a glimmer. Uh, I think we talk about things that give you joy, uh, that there is also this, um, the converse to rejection sensitivity, recognition sensitive euphoria. So this, uh, overarching idea that of all of these paradoxes, that you basically you don't want to be overstimulated, you don't want to be under stimulated, you don't want...

You know, you of trying to live in, in, in this, you know, this sort of sweet spot, uh, [00:24:00] which I refer to one of the very first books about-- by a patient about hypermobility that I read, oof, back in, I don't know, twen- two thousand and ten, eleven, was called Bending Without Breaking by Isabel Knight. And I really, um, I don't know, like that analogy.

As a hypermobile person, how do you learn to bend physically, mentally without breaking? How do we, um, how do we live within our-- how do we live well within our limits? 

Dr. Linda Bluestein: Yeah, that's obviously really challenging for, for a lot of us, and that's really interesting what you said about the recognition sensitivity euphoria.

That's super interesting. I've never heard that term before, so that's, that's fascinating. And a lot of people who you just mentioned about the Swedish study, which I l- find fascinating, or the [00:25:00] database that they collected, and we talked a little bit about autism and how much more common that is. Can you talk a little bit about masking and- Oh, yeah

what should clin- yeah, what should clinicians know about masking, and what should patients know? When is it protective? When is it harmful? 

Dr. Jessica Eccles: Well, the, this is, this is a really interesting point, and that's also cropped up in the rejection sensitivity business, was, um, this idea of masking as an important defense mechanism.

So masking, we often think 'cause, um, when I was at medical school, long time ago now, I'm told, you know, that, uh, autism and ADHD affected, uh, males nine times more than females. And we now know that that difference is, is probably minimal and may not even exist at all in terms of the, um, of the gender differences But one of the ideas that is put forward is that women in particular, though not necessarily just women, are [00:26:00] not picked up as being autistic or having ADHD because they learn to have a mask of, you know, maybe social competence, so have a social script, uh, they're sort of performing in social situations, or that they can, can be in social situations, but they actually find them quite draining or exhausting and will have to spend a lot of time recovering.

That people may be, you know, naturally quite hyperactive and fidgety, but they will mask that and suppress that. And to a degree, we do need to, in certain ways, to mask a little to, um, get through the world. But at the same time, masking may come at a considerable cost. So it may be energy-draining. It may also be, I don't know, it sounds like a strong word, [00:27:00] soul-draining.

It may, um, it may take not only a toll in terms of energy, but it may kind of take a toll in terms of its identity-- of your identity. Who am I? What is, what is underneath the mask? But at the same time, masking, masking may have a function, and I did talk on this other podcast, the ADHD Chatter podcast, about, about ballet as an analogy in some ways for this.

I know, uh, you're very interested in, uh, dancing, and I actually, you know, I can't dance to, uh, save my life. But you have this beautiful performance of, uh, dancers and, you know, in some ways that is a mask. Under, underneath that beautiful performance, poor dancer's toenails are like prob- probably dropping off and, um, uh, you know, really dealing with very difficult injuries and [00:28:00] problems.

But, you know, the show has gone on and... But that takes its toll. But at the same time, it's kind of, it's all jumbled up. And one of the interesting things, though, is I'm the patron of a, a charity called CEDS Connective, and its founder, which is a charity particularly for hypermobile neurodivergent people.

And, uh, when, um, I was talking with Jane Green, the founder, and she said she wasn't quite sure about this masking business in neurodivergence, but what she really knew and understood in a kind of bodily level was that as a hypermobile person, she had gone through her life basically masking pain, which I don't think people actually talk, uh, enough about.

We talk about masking a lot in autism and ADHD, possibly other neurodivergences. But this, um, this idea of being in a body that is unreliable [00:29:00] and going to let you down, and she talks in-- we-- I have a YouTube channel, Bendy Brain, and we interview her for, um, uh, episode three, and she talks about how she'd go to the doctor, and one time it'd be like her left leg that was out of whack, and then one time it'd be her right leg, and they'd be like, "Have you even forgotten?"

And she's like, "No, no, I've just... I'm being affected on different sides at different times," and that when you're so disbelieved or you have to keep functioning, you know, she was talking about having to, you know, look after her children, uh, that you, um, you end up, you end up masking that. And I, I kinda had a, a strange realization myself.

Uh, I'm forty-three. I have a condition that is associated with hypermobility. Used to be called congenital dislocation of the hip. It's now called developmental dysplasia. So I had a, um, you know, improperly formed, well, absent, uh, hip socket and, um, lots of surgeries when I was younger [00:30:00] and probably started experiencing pain from early onset arthritis when I was about nine or ten years old.

And that pain, uh, didn't really, um... Well, obviously it didn't go. It just got worse and worse. But it did leave when I was thirty-six and had a hip replacement. And, um, unfortunately, in the last, um, I don't know, just over a year, I have had a, um, a lumbar disc prolapse, multiple ankle ligament ruptures, and some problems with my right hip and, uh, uh, some trochanteric bursitis.

So I've been plunged into a terrible state of my wings clipped, can't really mobilize well, and awful pain. And I realized, of course I'd experienced all of that before, but I kind of put it away and forgotten it. And actually, having a taste of that again made me realize that to have got [00:31:00] to where I am, sitting here talking to you now with all of these research papers and stuff, getting through medical school, well, getting through school, getting through medical school, getting through, you know, I think you call it residency and all of those things, all of the bits that you have to do to end up proper, fully fledged consultant, that I must have, you know, in order to have done all of that, the only way of surviving it was to, um, pretend it wasn't happening or not to show it to other people.

So I'm not... I, I agree with Jane in some ways that I don't think we talk enough about masking, but also that if you are a hypermobile person whose body is always letting them down and has let them down, possibly since before they could talk You, um, you might not even realize that that's what you're doing because, um, you think that must be like that for everyone else.

And that is such a common experience when I talk to my patients. You know, you say, "Do you get dizzy when you stand up? Do you [00:32:00] have to lie down after a hot bath?" And they say, "Well, but doesn't everyone?" Like, "No." And same thing with, um, a number of patients recently with, uh, a quite unusual phenomenon, an immunological phenomenon called cold urticaria, which is where you kind of get hives and pain when you're in the cold.

Uh, and sometimes people's, you know, throat swell up, but you also get this really painful sensation when you put your hands in cold water. And I've s-- and bizarrely, I've had a run of patients, uh, with this particular problem recently, and they're like, "But doesn't everyone feel like that in the cold?" And you're like, "No, it is not normal to have your throat, uh, swell up, uh, just because it is cold."

And there is this degree to which hypermobile people really end up putting up with experiencing so many medical [00:33:00] strangenesses but have no idea that these are, these are not everyday experience, particularly because hypermobile people tend to have hypermobile family members, and, uh, so it's sort of accepted as, um, this is, um, this is typical.

Dr. Linda Bluestein: Yeah. And, and as you're talking about that, I'm thinking about how so many of these things occur on a spectrum, and if you're talking to somebody and you ask, "Oh, how are you doing?" So often we say, "Fine." Right? You know, we're-- Masking, I think, is, is also, to me, as you're talking about this, probably on a spectrum.

Like pretty much everyone has to mask when they're in medical school. I mean, you... Or doing like, like you said, dance is a perfect example. You, you're trying to make it look so effortless, but it's really, you're in pain. It's really hard. So I love those examples. It sounds like what you're saying, though, is that people who have hypermobility, chronic pain, all of these other things, cold-induced urticaria, vibration-induced urticaria, like these, you know- Yes, exactly

Dr. Jessica Eccles: again, [00:34:00] 

Dr. Linda Bluestein: yeah, we don't know what other people's bodies are like, and so we just kind of are trying to fit in, and so we just kind of like pretend like it's not happening. Mm. 

Dr. Jessica Eccles: But I also think that it is, um... But making sense of that, and it brings me back to what I was saying about this, um, narrative framework, is when you think, "Oh God, actually all of those things could potentially be linked," and that these unusual experiences, which I didn't necessarily think were unusual, are all connected.

Although that doesn't make it in-necessarily any easier to experience them. It, having a unifying framework, I think- Has a sort of sense of, of validation and a sense of meaning that you don't have if you have... if you haven't got a explanation. 

Dr. Linda Bluestein: Yeah, no, that, that makes perfectly good sense. And the fact [00:35:00] that people, again, don't know what other people's joints feel like, so they don't realize that their joints are unstable sometimes because if they're getting more subluxations than dislocations, they might not realize that other people walking around don't have to deal with that and d- and aren't, um, coping with that.

Um, we are gonna take a quick break, and when we come back, I really want to explore your fascinating work on autism and borderline personality disorder. I really wanna talk about that 'cause it's something that I think is not talked about often enough, and I know there's a lot of stigma attached to both of those, but you talked in one of your papers about that, and I think it's a really fascinating topic.

So we're gonna take a quick break, and we will be right back with Dr. Eccles.

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So we're back with Dr. Jessica Eccles, and right before the break, we were talking about vibration-induced urticaria, and I was taking an exercise class this morning, and they brought in these, uh, you know, vibration plates, power plates. And I immediately, when I was standing [00:37:00] on it and doing the exercises, I immediately started itching.

But I think you have a even better example of vibration-induced urticaria. 

Dr. Jessica Eccles: So I was, um, I was talking to a patient just a few days ago who had no idea that it was not typical to come out in a rash, so hives, and go red from... This is a-- or from pressure, vibration pressure. So she found that clapping brought on hives, and, uh, she has a child, and you can imagine how often children want to clap and clap back And how many times at, I don't know, primary school or elementary school that you end up having to clap and-- But if you-- I think this also, it really feeds into this framework that we talk about in terms of prediction error and mismatch.

So if you knew, Linda, when that you, [00:38:00] when you, um, well, you obviously knew that you come out all itchy and stuff because of the vibration. But if that happens to you and you perceive it to be random, just as, you know, you have heart rate spikes, and you don't realize that's because you've changed posture or you've had a, um, hot bath or you've had a large meal, those physiological signals are troublesome, overwhelming, scary, confusing, and in and of itself, that uncertainty and randomness is going to feel or even generate anxiety because it's so unpredictable.

But once you have a framework for it, so you had the framework, but not many people have that framework, you're able to say, "Actually, I need to step away from this, uh, vibration plate," or, you know, seek medical advice about antihistamines or something. But, you know, that means that it's slightly less scary.

[00:39:00] But when you don't have that knowledge, when people haven't explained these quirks to you, you think, you know, "What fresh hell is next in terms of random weirdnesses?" 

Dr. Linda Bluestein: What fresh hell is next? That we're, we're gonna have to for sure use that as one of our, as one of our promotional pieces because I think so many people can relate to that.

What fresh hell is next? Yes, the uncertainty gets... You know, there's enough uncertainty in life, right, especially now. But having all that un-uncertainty in your body and not being able to count on your body being able to do certain things, um, is incredibly stressful and incredibly anxiety-provoking. 

Dr. Jessica Eccles: And also when you don't realize, yeah, that, you know, just as you were saying, that this isn't like that for everyone.

So I had another patient, and it sort of sounds embarrassing, and I, I don't know what the, uh, cooking situation is in, in, um, in the United States of America. But in, uh, in the [00:40:00] UK and Europe, there is a sort of luxury brand of saucepans that are made of, um, very pretty, uh, painted cast iron called Le Creuset, and these are high-end saucepans.

Um, I was talking to a patient and I said, "What would happen if you had to, uh, pick up a, um, a Le Creuset saucepan?" And they said, "Well, I would really struggle because they're too heavy for my wrists." And, and I, I think this could be, you know, a new medical sign in the textbooks, the Le Creuset sign. But, uh, uh- I-- my brother bought me one of these, um, 

Dr. Linda Bluestein: yeah, 

Dr. Jessica Eccles: well, a griddle pan made by this same company.

Very beautiful, powder blue. Beautiful. Can I use it? No, I can't, because my wrists are too weak to lift it up. And when you talk to patients and say, "You know, when you come home from the supermarket with your [00:41:00] shopping, does it feel like your, um, arms are gonna come out of your shoulder sockets?" And they're like, "Yes, yes."

But does this happen to everybody? No. Quite a few people are able to carry their groceries home without feeling physically on the brink of, of subluxation. 

Dr. Linda Bluestein: Yeah, no, it's hard if they've... Just everyday tasks cause you to get injured. I remember when I first read about kinesiophobia, and I was writing my first paper about pain and pain, uh, medicine for people with joint hypermobility, and I came across the word kinesiophobia, and I realized, oh my gosh, that's what's happened to me, because I kept getting hurt doing little everyday things.

And so it has been very helpful for me. I f- I'm very fortunate that I've been able to build more muscle mass, which is protective, of course. But yeah, when you don't have that confidence in your body that you're not gonna get hurt doing little things, that's incredibly, [00:42:00] um, challenging. I wanna go on and talk about autism and borderline personality disorder.

So there's so much stigma around borderline personality disorder, but there also is around autism, and I know you wrote a really interesting paper about this recently. Can you talk to us about the overlap b- between these, why it's important for this population especially, what we might want to look at in order to distinguish which diagnosis is more appropriate, and what we can do about it?

And that, I know that was a lot all rolled into one. No, 

Dr. Jessica Eccles: but I think I, I, I got the gist. So yes, with colleagues Sebastian Shaw, uh, and I supervised a, another, a psychiatrist called Bruce Tamelson, who conducted a number of interviews on, I think, mainly women. I'd have to go back and check the methods. I'm, I'm pretty sure, uh- I think it was women ...and these, these people had all previously received a [00:43:00] diagnosis of, uh, it's called, considered in the DSM as borderline personality disorder in, in Europe under the ICD, ICD-11 classifications.

This might also be called emotionally unstable personality disorder. And what it meant to them to later be given or confirmed as having an autism diagnosis, and what the sort of the bottom line, and it brings us back to what I was saying at the beginning about the framework, is that they felt the autism diagnosis Made sense to them in a way that the personality disorder diagnosis did not.

That it, uh, that it provided a framework for understanding themselves that they had not previously had in connection to the personality disorder diagnosis. [00:44:00] Now, this brings up a huge number of questions. I mean, the very first question also brings us back, uh, to the, um, history and philosophy of science, is how do we know what we know?

And in psychiatry, we have a lot of labels. We don't have markers in the same way as you might have in, um, other areas of medicine. But you must caveat, in other areas of medicine which do have biomarkers, those biomarkers and the definitions of those biomarkers and those ranges are constantly changing.

So you know what people considered to be high blood pressure twenty years ago is completely different now. We know, for example, things like CRP, uh, what we considered to be a normal CRP when I first was a junior doctor is now not the same as what we consider to be a normal CRP now. So biomarkers in and of [00:45:00] themselves are a slight fallacy in terms of this is knowable and solid, is that psychiatric labels-- Uh, I remember, uh, going to a lecture years ago, someone was describing the DSM.

It's basically a Chinese menu. You pick a bit of A, a bit of B, and then, uh, there is, uh, criteria C. Um, and that's not... You know, this is the same thing in, uh, physical health, in lots of syndromes. You know, you have major and minor criteria, and these diagnostic criteria have, for want of a better word, the great and good have sat around a table and sort of decided what they are.

And are these diagnostic categories-- Well, are they actually consistent? They probably are in that, you know, thinking about things like ADHD and autism, uh, as we understand it now. I don't know, uh, if people are familiar with "Anne of Green Gables," but you only have to read "Anne of [00:46:00] Green Gables," Canadian novel about an orphan, uh, to realize that, um, all ADHD has been there forever, that we've been describing this sort of thing in literature.

You only have to read Shakespeare to understand that people have experienced depression for a very-- ever since, uh, people have been writing. But some labels seem a better fit than others. And I think that the thing about a neurodivergence description is that it captures things that a personality disorder diagnosis may not.

So one of the, um, one of the big issues for neurodivergent people is sensory sensitivities. So, you know, feeling, um, feeling, uh, strange when your clothes don't fit you right, when there's funny smells, being overwhelmed by loud noises or, um, or, or there [00:47:00] not being enough noise. I like to go to a café sometimes to concentrate because, uh, a bit of noise, background noise is actually helpful.

We're all different in terms of our sensory profile, but the emotionally unstable-- the borderline personality disorder label or construct doesn't include any of those things. It doesn't have a sensory element. It has a interpersonal element, and it has a harming, often, you know, self-harm element. And I think it's, it's important to recognize that some forms of, and it's difficult to talk about, uh, some forms of self-harm may be actually attempts to regulate, you know, a dysregulated nervous system.

And if you're hypermobile and neurodivergent, you may be more likely to have a dysregulated nervous system. The other interesting thing is that the diagnostic categories, they [00:48:00] lump things together. So they put things like, you know, autism in a, in a round, they put depression in a round, put personality disorder in a round, and they put, I don't know, psychosis in a thing.

But actually, all of these rounds are made up of sort of star shapes and spiky bits that are actually quite common in all of those things. So there are elements, for example, ADHD, bipolar disorder, and, uh, what you consider emotionally unstable personality disorder, are all associated with problems with impulsivity and emotion regulation.

And would we not be better to focus on characterizing the differences and responding treatment-wise or intervention-wise to those core kind of [00:49:00] neurological, uh, you know, the neural construct of what is driving impulsivity and emotion regulation issues than necessarily having these particular labels?

And the problem for me with the EUPD or the borderline, uh, label is that it's a bit like a functional neurological disorder in that these patterns may well exist, but that the label itself has become a form-- has become pejorative Even if it never was intended to be in the first place. I mean, people may not know, but the term borderline personality disorder actually originated back in a time in psychiatry when we were much more focused on a psychoanalytic approach to understanding, um, people.

Was there was an idea that there were some people who were neurotic, so they had anxiety [00:50:00] problems, they had depression problems, and then there were some people who ha- were psychotic, who had delusions and hallucinations, and that borderline in borderline personality disorder is, um, the border between psychotic and neurotic.

But people, um, when they hear the word borderline personality disorder, they do not think, "Oh, this is the history of the difference between neurosis and psychosis." They think this is a stigmatizing label that-- and now this sounds possibly of a stretch, but it is mainly made by men on women, so male doctors to describe a set of things in women that they find potentially problematic.

So for the people who took part in our study, they basically were saying that a autism diagnosis [00:51:00] provided a more coherent and less stigmatizing account of their differences and difficulties than the previous personality disorder diagnosis. Now, what I, um, am grappling with conceptually in a quite a big way, is it one or the other in the world?

Is it either/or, or is it both and? And I think we have to bear in mind, bearing in mind the caveats about what are labels anyway, what are our diagnostic constructs, is it is possible, just like people didn't think you could diagnose autism if someone had trauma, it is possible to, um, for more than one thing to be going on at once.

And we have to, um, we have to really, uh, formulate and integrate all of the different elements of, of a person and their brain/body [00:52:00] interactions. And I think helpfully, conceptually, I hope the term borderline personality disorder or emotionally unstable personality disorder is more into this idea of complex post-traumatic stress, uh, disorder.

And again, when I speak to patients, many of them, they find the idea of complex PTSD resonates in a way that a personality disorder diagnosis does not. But it's perfectly possible to-- in fact, it's almost certainly more likely to be neurodivergent and also to have experienced complex trauma. There's a very, um...

I'm looking forward soon, some excellent colleagues from Glasgow, which is in Scotland, are coming to, um, brainstorm, uh, uh, some work that we've been doing about the [00:53:00] intersection between neurodivergence and trauma. And as I was saying, you know, uh, we know from, um, Helen Minnis and Ruchika Gajwani's work that if you are, if you are, if you have experienced trauma, you are actually also more likely to be neurodivergent, and neurodivergent people are more likely to experience trauma.

So I don't think, I don't think we can get away from the idea that it's either one thing or another, but I think that neurodivergence can provide a, a framework that is, is helpful. It also, by understanding, you know, what I was talking about in terms of sensory things, it provides a way, and this goes back to the proprioceptive uncertainty, it provides an opportunity and an avenue for regulation.

So if you give someone a label of EUPD, that doesn't necessarily give you the tools to, to work with it. But when you [00:54:00] understand about a spiky profile and your sensory differences, you can, you can kind of work-- you can move into understanding yourself better. But interestingly, uh, there are a couple of techniques that are used, particularly in dialectical behavior therapy, which is, um, being used for, uh, um, um, people with complex emotional needs, is this idea of putting something cold on your face.

I don't know if you've heard about this, but I remember one of my patients saying that they'd been on a, uh, program, um, called the Steps Program, which is something that's quite common in the UK, and, um, that they, um, they'd been told, you know, if you're feeling dysregulated, that you could, you could kind of put your face in some water.

They said they didn't wanna do that because they had a fear of drowning. But what they had worked out was that if they put frozen peas on their face, that did the same job. [00:55:00] And my dear-- my PhD supervisor and mentor, Hugo Critchley, he is very interested in autonomics and also reflexes. And what you are describing when-- what the patient was describing about the soothing impact of peas on-- frozen peas on the face is, uh, something called the diving reflex.

So that activates, um, a parasympathetic response that reduces heart rate So that helps regulate because you, um, you are kind of, you are calming your autonomic nervous system down. So I don't think we should always necessarily throw the baby out with the bathwater. There are elements of, of interventions for personal- what we call personality disorders that are helpful for regulation, but I do think that we have [00:56:00] to strongly consider what are-- on what basis do we, do we have these labels, and are we better actually just describing a series of, of patterns.

And that-- But I also think it's interesting 'cause I'm speaking at this from a perspective from Europe, from the UK, where I think autism is still a very stigmatized label. But my feeling is, is that there is more stigma perhaps in the US, that Europe... Well, uh, the, in the UK there is a more neurodiversity affirmative approach, but I could be speaking in overgeneralizations.

But it is very interesting, hierarchies of stigma, 'cause we think of stigma as a sort of stigma is stigma. But I remember when I was first a very junior researcher, I was researching, uh, and again, this was actually brain body stuff. At the time, [00:57:00] people who had a condition called hepatitis C, which is a, a liver condition, uh, were given a inflammatory cytokine called interferon as a treatment.

And this was, this was a really-- it's, um, it's now an outdated treatment. There's something much easier and, uh, less tricky, uh, is used. But at the time, interferon made... Had to take it for months and months and months, and it would make you, um, make half of the people who took it depressed or cause real, um, psychological difficulties.

So we were looking at why some people might be more likely to experience interferon-induced depression if they had hepatitis C. And I had a-- I was junior researcher, I was like, you know, twenty-seven or something, had a little poster at, at a hepatitis conference, and the person next to me was presenting about stigma in people who had both HIV and hepatitis C, and that in that particular cohort of people, it was [00:58:00] perceived to be more stigmatizing to have hepatitis C than it was to have HIV.

Now, that was just, that was that particular, in that particular group of people, and that was a real eye-opener to me that there were these, um, yeah, different levels of, different levels of stigma and that they are fluctuating and change in different social contexts and, uh, across the lifespan. And I, yeah, I think, uh, we...

And that, that is also the same thing a bit. So we talk about autism, that paper was about autism, but we know that autism and ADHD occur just as often together as they occur alone. But for different people in different contexts, attitudes towards autism may be completely different towards attitudes towards ADHD.

And, um, [00:59:00] it is, it's a bit of a minefield, uh, really in terms of, of stigma and of, of understanding. And I think, you know, things will... We already, our understanding of autism has changed substantially since the last DSM. Who, um, who knows what the next one will bring? But it's also important to understand, uh, the history of the DSM, going back to the history all the time.

Homosexuality was in the DSM until the late '80s, and it is obviously no longer in the DSM. 

Dr. Linda Bluestein: Yeah. That's, that's so interesting what you said about biomarkers and how they change, because of course, right now we're approaching the, you know, the road to 2026, the evolution of the diagnostic criteria for hypermobile EDS, and that's causing a lot of stress in the community, a lot of angst, totally understandably.

Um, but it's so helpful what you were saying about labels and how they're constantly [01:00:00] changing, these biomarkers are changing, um, and that really at the end of the day, what we should be looking at is how can we help people feel better, function better, and, and things like that, and try... Even though labels are important, labels are very important 'cause they give us access to things like more physical therapy sessions, more specialists and, and things like that.

So labels are, are still important. 

Dr. Jessica Eccles: But, uh- No, they, they absolutely are. We need labels to count things, and we also need them to, um, to, you, you need them to code them in your insurance system so that they can be paid for. And you need them, sometimes they're a gateway. You can only, um, uh, we can only really, uh, prescribe ADHD medicine, uh, if you have a ADHD diagnosis.

They do serve a function, but people are so much more than their labels, and labels are always, always changing. But the pattern isn't, as I said, you can see that pattern in, um... There's this wonderful description in Shakespeare of, uh, I think it's in Hamlet, where he says, uh, "Wherefore I know not I have lost all my mirth," which [01:01:00] means I've lost all my happiness.

And that, that is a... And it's like what, you know, sterile promontory, this earth, this quintessence of dust. And that is, you know, a real description of, um, anhedonia, which is one of the things that we conceptualize as a, a core feature of depression. And, um, that's been around in literature forever The-- I am sure the pattern of neurodivergence and also the pattern of hypermobility have been around forever.

They will have no doubt, and I think some people have certainly written about this in terms of ADHD and autism. I don't know if they've ever written about it in terms of hypermobility, but there will have been an evolutionary advantage to, um, uh, being the type of person who could reach the berries on strange trees or the type of person whose physicality meant they could run, you know, a particular distance.

So that there will have been an evolutionary advantage to, uh, being built differently and to be [01:02:00] thinking differently. And, um, these patterns have always been there. It's just that we have called them different things over different times. So Linda, one of the things that really came to mind when thinking about the sort of neurodivergence personality disorder overlap is the Scandinavians.

They're, uh, in a, um, meta-analysis. So meta-analysis are where you kind of pool, um, lots of data from different sources. A, um, paper looked at all of the medicines that are used by psychiatrists for the treatment of borderline or emotionally unstable personality disorder. And, um, the interesting finding was that ADHD medicine was the most effective.

So could be ADHD medicine e-effective in treating emotionally unstable personality disorder, could be that a lot [01:03:00] of people who have a diagnosis of emotionally unstable personality disorder actually have ADHD, or it could be that, as I said about, you know, ADHD, EUPD, and, um, bipolar, that, um, impulsivity and emotion regulation difficulties are the core features, and those are amenable to stimulants.

Dr. Linda Bluestein: That's so fascinating. And when I think of stimulants, I think of them helping people with focus, but does it also help with the emotional dysregulation and impulsivity? 

Dr. Jessica Eccles: Yes, it really does, uh, seem to be a significant benefit. And also, interestingly, some people, obviously this is with the appropriate medical advice, some centers use stimulants in the treatment of postural tachycardia syndrome because of the vasoconstrictive effects of stimulant.

So yeah, we're always learning new things and we-- there's been a big... [01:04:00] I mean, in the moment in the UK, there's a bit of controversies about, um, you know, what are the-- what is the prevalence of ADHD and autism? Why are there so-- why is there so much demand for diagnostic assessments? How can our healthcare system cope with this demand?

And one of the really interest-- and there's a lot of chatter about this idea of over-diagnosis, which I think is not helpful. But really important thing is there was this study published last year in the BMJ by Zheng et al., who showed that ADHD medicine reduced, this is particularly stimulants, reduced death by suicide, criminality, substance misuse by about twenty percent across the board.

So ADHD medicine is generally safe. I mean, loads of studies that suggest that. And, uh, its effectiveness is [01:05:00] hard to beat amongst other... I mean, you can't do direct head-to-head comparisons, but in terms of the interventions that exist in medicine, I think we published in a paper called, um, The Elephant in the Room: Neurodivergence in Psychiatry, that the number of people needed to treat with ADHD medicine is three, which in the grand scheme of medicine is actually a very good number.

And we-- Yeah, the tools, I'm not saying ADHD medicine or stimulant medicine is for everyone, but it is-- it can. Supporting people with ADHD and neurodivergent people can really save lives, and it's important not to trivialize the difficulties associated with ADHD and autism. 

Dr. Linda Bluestein: I really appreciate you sharing that because I feel like there is, speaking of stigma, a lot of [01:06:00] stigma about the treatment and taking stimulants and, you know, do you really need that?

And I mean, I'm guilty of it, that actually my-myself with family members at, at times will, you know, "Do you know that you still need that?" So I really appreciate you sharing that, uh, very important information, and we'll find that, um, Yang et al. paper and, and link that in the show notes. Also, about the stimulants and POTS.

So many people think of POTS, Postural Orthostatic Tachycardia Syndrome, as like the tachycardia being the problem. So a stimulant would make the tachycardia worse. But, uh, that's fascinating that it actually can be beneficial in this group of people that suffer from fatigue and chronic pain and so many other things.

It's, we know it's a dysfunction of the autonomic nervous system and not just a cardiovascular problem. 

Dr. Jessica Eccles: I mean, and obviously, you must talk to your, uh, medical professionals, but there are, you know, there are also... That's the other thing about medicines. They're not anti-anxiety medicines or anti-ADHD medicines.

They all have these biological pathways that have [01:07:00] all sorts of downstream effects, and, um, they don't all work for everyone. But working out who benefits from what is really, really important. 

Dr. Linda Bluestein: Yeah. That's great And we are going to definitely have a part two of this conversation because we got about halfway through my questions that I wanted to ask.

So we're gonna come back and talk about some of the other things that you've spoken about, chronic pain, fatigue, self-harm, which you alluded to, but I wanna talk about that more for sure. Before we get to the hypermobility hack, which is how we end every episode, I just wanna ask, um, I love that you talked about the diving reflex and cold on the face, and so that we can leave people with something that they can try.

So you talked about proprioception, working on proprioception as a way to reduce that, uh, you know, uncertainty in the body and that proprioceptive surprise if they-- we can use things like compression garments or exercising in the water or, like you said, any kind of tactile cues that way. Do you think also that other things that stimulate the vagus nerve can help with that emotional [01:08:00] dysregulation?

So like humming, gargling, singing, are those things that might help as well? 

Dr. Jessica Eccles: I, I, I, I think humming, humming probably does. I am a little wary of all of, you know, when you're scrolling, uh, your phone, there are all these, uh, things that claim to be hacking your vagus nerve, and I think we have to be, you know, pretty evidence-based when thinking about these things.

But yes, absolutely, using your own autonomic nervous system to regulate is, is really important. And one of the other things that Hugo, uh, and I were discussing, he was telling me about the diving reflex, is you wouldn't realize it, but there's another reflex, I can't remember exactly what it's called, but basically menthol helps you concentrate.

And, um, that is not my hypermobility hack, but it is, it is food for thought. My hypermobility hack is, uh, as I mentioned, I'm experiencing a lot of, uh, musculoskeletal problems at [01:09:00] present. One of the things that I tell my patients and I tell myself is do not underestimate the importance of arch support. So a lot of hypermobile people have flat feet, and having flat feet can have a huge knock-on effect throughout the body.

And something simple like an insole with arch support can actually make a huge difference to neck pain, back pain, hip pain, and a general feeling of stability. So my hypermobility hack, which is keeping me going at the moment, is a combination of arch support insoles and incredibly strappy high top trainers to, uh, keep my, um, ankles together.

Dr. Linda Bluestein: I love that hack. And I pulled off my shoe because I am wearing these Oofos, [01:10:00] which it might not look like that much arch support, but it's enough that it makes all the difference. I had so much trouble with my feet. I was actually Went on a family trip a number of years ago, and I was in a wheelchair because I couldn't walk enough for, for the activities that we were gonna do, which were not that much by the way.

And so my family was pushing me around on a wheelchair because I had so much difficulty with my feet, and now I'm doing so much better from a variety of things. But yes, love that about the arch support and really paying attention to your footwear, your ankle support, and everything. That's great. I love that hack.

Before we go, can you tell people where they can learn more about your amazing work? 

Dr. Jessica Eccles: Uh, yes. So, um, I am, uh, Dr. Jessica Reckles, and you can find out more about my work or our work, because this is a huge team of people who are involved in this, on my Linktree, Bendy Brain, and also YouTube channel, Bendy Brain, and I'm on Instagram as Dr.

[01:11:00] Bendy Brain. So please try and keep the Linktree regularly updated. You can subscribe for alerts. And yes, do, do check out the YouTube Bendy Brain and Instagram, Dr. Bendy Brain. And also I'm on LinkedIn as well. But, um, I'm really looking forward to speaking to you, um, again soon, Linda. And, uh, I still have fond memories of meeting you in person at that IADMS conference in, uh, was it Ohio in, uh, 2023?

Dr. Linda Bluestein: Oh, yes, it was. You know, I was telling somebody that it was Montreal, but no, you're right, it was Oh- it was Ohio. Montreal was in 2019. It was Ohio. It was Ohio. Yeah. Yes. Yes. You, Jennifer Milner, and I all had dinner together, which was wonderful. Jennifer Milner was my co-host for the first like four seasons of the podcast, and now I still do lots of other activities with her.

So she co-hosted when we interviewed you both times, I believe. And so, yeah, we had a great, [01:12:00] great dinner. Fascinating. I just love everything that you're doing, and I'm so grateful to you for taking the time to, to talk with me. And I love how we had a-- we have a picture together. In fact, we should... I'm gonna have to share that with the social media team so that they can use that.

Yes. 

Dr. Jessica Eccles: Yeah, we have with both of... I think I've got a zebra jacket, and you've got a zebra- Yes ... uh, yes. Yes. Yes, we've got- Yes ... we've got that photo. Yes. 

Dr. Linda Bluestein: Yeah. We're side by side. You're wearing a zebra jacket. I'm wearing zebra pants. Together we have a zebra suit. Yeah. And I'm Bendy Bodies, and you're Bendy Brain, so it's perfect.

Dr. Jessica Eccles: Exactly. 

Dr. Linda Bluestein: Wonderful. Wonderful. Well, thank you so much. I know that you're super busy, and you're doing such fantastic work, and I love how it just ties so many different things together that impact and touch so many lives. I mean, if you think about between the diagnosis of, you know, borderline personality, autism, joint hypermobility.

If you think about all the different thing, anxiety, all the different areas that you're touching, this is like most of the population of the world. So you really- 

Dr. Jessica Eccles: Oh, yes ... yeah. And, um, um, and [01:13:00] I, I do really want to be clear that although we're talking about what you think of as psychological Phenomena, I do think there's a brain body basis to all of these things.

Yeah. And yeah, that the biggest-- one of the biggest problems is not only finding the right framework in order to be li- to be believed, is also bridging that gap between the brain and the body. 

Dr. Linda Bluestein: That was the opening question 'cause you used Slido at the IADMS conference, and you, your opening question, I believe was, you know, do you think that the brain and the body are, are really separate or that the, or that the conditions should be considered separate?

Something like that. You asked a really- Yes. 

Dr. Jessica Eccles: Yeah, yeah, 

Dr. Linda Bluestein: yeah ... great opening question. Yeah. 

Dr. Jessica Eccles: Yeah. Yeah. The big idea. Yeah. 

Dr. Linda Bluestein: Yeah. The big idea. Okay. Well, thank you again, and I look forward to chatting with you next time. 

Dr. Jessica Eccles: Thank you, Linda. 

Dr. Linda Bluestein: I'm super excited to tell you about the Bendy Bodies Boutique. I am so proud of our fierce [01:14:00] styles and flexible designs.

These are created by hypermobile artists for hypermobile shoppers. There are so many fun items from clothing, accessories, home goods, and my favorite are the bags. I especially love the Weekender tote with one of the EDS Tough designs. Whether you're shopping for yourself or someone you love, there's so many options to choose from.

A portion of the proceeds goes to support EDS nonprofit organizations. For more information, please visit bendybodiesboutique.com. Thank you so much for listening to this week's episode of the Bendy Bodies Podcast. If you'd like to go deeper, I share additional education, clinical insights, and resources in my newsletter, the Bendy Bulletin, which you can find on Substack at hypermobilitymd.substack.com.

You can also help us spread the word about connective tissue disorders by leaving a review, sharing this episode, or sending it to someone who needs it. These small actions truly make a difference in raising awareness about conditions that are still widely misunderstood. And don't forget, full video episodes are available every week on YouTube at Bendy Bodies [01:15:00] Podcast.

As many of you know, I offer one-on-one coaching and mentorship for both individuals living with connective tissue disorders and people caring for them. You can learn more about these options on the services page at hypermobilitymd.com. You can find me, Dr. Linda Bluestein, on Instagram, Facebook, TikTok, X, and LinkedIn, all at Hypermobility MD.

As part of our collaboration with the UVA Ehlers-Danlos Syndrome Center, we also want to share some of their helpful resources. For questions or appointment inquiries, you can contact the UVA EDS Center at ruvaedscenteratuvahealth.org. Again, that's the letter R as in Robert, uvaedscenteratuvahealth.org.

You can find answers to common questions at uvahealth.com/support/eds/faq. Our incredible production team is Human Content. You can find them on TikTok and Instagram at Human Content Pods. As you know, we love bringing on guests with unique perspectives to share. However, these unscripted discussions do [01:16:00] not necessarily reflect the views or opinions held by me or the Bendy Bodies team.

Although we may share healthcare perspectives on the podcast, no statements made on Bendy Bodies should be considered medical advice. Please always consult a qualified healthcare provider regarding your own care. For more information about the Bendy Bodies program disclaimer and ethics policy, submission verification and licensing terms, HIPAA release terms, or to get in touch with us, please visit bendybodiespodcast.com.

Bendy Bodies Podcast is a Human Content production. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.

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