orax deformity, joint hypermobility, and anxiety disorders Murat Gulsun, MD, Mehmet B. Yilmaz, MD, Murat Pinar, MD, Murat Tonbul, MD, Cemil Celik, MD, Barbaros Ozdemir, MD, Kemal Dumlu, MD, Mevlut Erbas, MD. S everal studies have suggested an association between mitral valve prolapse (MVP) and/or joint hypermobility and anxiety disorders, mainly panic disorder, 1-8 and the contradictory results obtained have made this field controversial and well suited to further research. Several studies have highlighted the relation between thorax deformities and MVP. 9-11 However, we were unable to find any study concerning the association between thorax deformities and panic disorder. e association between thoracic skeletal abnormality and MVP may be a manifestation of a single connective tissue defect during embryonic development of the bony thoracic cage and the atrioventricular valves. 12 Pectus excavatum appears soon after birth and is occasionally associated with kyphosis, scoliosis, or MVP. is may be familial or associated with Marfan, or Ehlers-Danlos syndromes, or with isolated hyper flexibility of the joints. According to some reports, thoracic deformity may be the cause of psychosocial problems due to esthetic worries. is malformation affects an individual’s psychosocial development, causing embarrassment, feelings of stigma, social anxiety, and even depression. 13 In the same way, pectus deformities and atypical costal anomalies are congenital thoracic wall defects that can cause a marked cosmetic defect with psychological trauma. e presence of anxiety disorder has been reported to be 3 times higher in patients with joint hypermobility and MVP, compared with patients who were non-concomitant with MVP. Joint hypermobility syndrome is a genetic condition characterized 1840 ABSTRACT Objective: To evaluate the association between thorax deformities, panic disorder, and joint hypermobility. Method: e study includes 52 males diagnosed with thorax deformity, and 40 healthy male controls without thorax deformity, in Tatvan Bitlis and Isparta, Turkey. e study was carried out from 2004 to 2006. e teleradiographic and thoracic lateral images of the subjects were evaluated to obtain the Beighton scores; subjects’ psychiatric conditions were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), and the Hamilton Anxiety Scale (HAM-A) was applied in order to determine the anxiety levels. Both the subjects and controls were compared in sociodemographic, anxiety levels, and joint mobility levels. In addition, males with joint hypermobility and thorax deformity were compared to the group with thorax deformity without joint hypermobility. Results: A significant difference in HAM-A scores was found between the groups with thorax deformity and without. In addition, 21 subjects with thorax deformity met the joint hypermobility criteria in the group with thorax deformity, and 7 subjects without thorax deformity met the joint hypermobility criteria in the group without thorax deformity, according to Beighton scoring. e Beighton scores of the subjects with thorax deformity were significantly different from those of the group without deformity. Additionally, anxiety scores of the males with thorax deformity and joint hypermobility were found higher than males with thorax deformity without joint hypermobility. Conclusions: Anxiety disorders, particularly panic disorder, have a significantly higher distribution in male subjects with thorax deformity compared to the healthy control group. In addition, the anxiety level of males with thorax deformity and joint hypermobility is higher than males with thorax deformity without joint hypermobility. Saudi Med J 2007; Vol. 28 (12): 1840-1844 From the Departments of Psychiatry (Gulsun, Dumlu), and Internal Medicine (Erbas), Isparta Military Hospital, Isparta, Department of Cardiology (Yilmaz), Cumhuriyet University, Sivas, Department of Internal Medicine (Pinar), Tatvan Military Hospital, Tatvan Bitlis, Sb Okmeydani Hospital (Tonbul), Istanbul, Maresal Fevzi Cakmak Military Hospital (Celik), Erzurum, and Erzincan Military Hospital (Ozdemir), Erzincan, Turkey. Received 30th January 2007. Accepted 18th June 2007. Address correspondence and reprint request to: Dr. Murat Gulsun, Department of Psychiatry, Isparta Military Hospital, Isparta, Turkey. Tel. +90 (246) 2241165. Fax. +90 (246) 2241314. E-mail: mgulsun@gmail.com