ALPIM Anxiety-Laxity-Pain-Immune-Mood

Many of us living with mental illness have other chronic illnesses. Often we are not treated for our “physical” illnesses, as many doctors dismiss them as psychosomatic. “Mental” illnesses ARE “physical” illnesses, and “physical” illnesses affect our “mental” illnesses. We are not just our brains, just our bodies, just our minds, just our feelings, or just our souls. The more we learn, the more we understand interconnectedness and comorbidities.

The ALPIM Spectrum

In the Spring 2015 issue of the Journal of Neuropsychiatry and Clinical Neurosciences, researchers proposed The ALPIM Spectrum:

  • A = Anxiety disorder (mostly panic disorder);
  • L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
  • P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
  • I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
  • M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).

Study Conclusion

We conclude that patients with ALPIM syndrome possess a probable genetic propensity that underlies a biological diathesis for the development of the spectrum of disorders. Viewing patients as sharing a psychological propensity toward somatizing behavior essentially denies patients access to care for the diagnosable medical conditions with which they present.

– J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132

Download the Study

Should you want to read the journal article, I purchased the pdf version: A Novel Anxiety and Affective Spectrum Disorder of Mind and Body—The ALPIM (Anxiety-Laxity-Pain-Immune-Mood) Syndrome: A Preliminary Report (J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132). No copyright infringement intended.

Associations in ALPIM Domains

ALPIM SYNDROME FIGURE 5. A Schema Demonstrating Significant Associations Within and Between ALPIM Domains. Anxiety - Pain Attacks (included in Phenotype). Laxity - Joint Laxity Syndrome (Beighton), Mitral Valve Prolapse. Hernias. Scoliosis. Double-Jointedness. Easy Bruising. Pain - Fibromyalgia (included in Phenotype), Headache, Prostatitis and Cystitis. Immune - Asthma, Rhinitis, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, Hypothyroidism. Mood - Major Depressive Episode (included in Phenotype), Bipolar II Disorder, Bipolar III Disorder, Tachyphylaxis. This schematic diagram depicts, via line connections, significant associations within and between the ALPIM domains (see the Results for a description). Table 2 repors corresponding significant probability levels, odds ratios, confidence intervals, and Wald statistics. ALPIM, anxiety, laxity, pain, immune, mood.
J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132

Diagram of Comorbidities

FIGURE 7. The ALPIM Syndrome: A Neuropsychosomatic Spectrum Disorder. Schematic Venn diagram showing the hypothesized spectrum of comorbidity in patients having a core anxiety disorder with laxity, pain, immune, and mood disorders. The overlapping circles demonstrate that comorbidities exist along a spectrum, in which a patient might have anywhere from just one disorder under one domain to multiple disorders under multiple overlapping domains. ALPIM, anxiety, laxity, pain, immune, mood.
J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132
Bipolar III is cyclothymia, a “milder” form of bipolar than bipolar II.


23 responses to “ALPIM Anxiety-Laxity-Pain-Immune-Mood”

  1. Frustrating to have symptoms and illnesses dismissed as psychosomatic. Diagnosable anxiety is not just feeling of anxiety. It is a physical illness which interacts with and may be connected to other physical illnesses. When doctors do not treat those of us with “mental” illnesses for our other very real symptoms, they do us a disservice.

  2. I love this post, thanks for sharing. My Dr said my IBS and endometriosis is because of anxiety. I feel like anxiety gets blamed for everything happening in my body

  3. Thank you so much!!

  4. Thank you. My mother in law and a best friend have MS. Wish you the best.

  5. This was very interesting and helpful information. I have had MS for 16 years and there is a lot of instabilities in my family. You are very insightful. I just started following your blog and just started my own about a month ago. I am very excited to read more of your posts. Take Care!!

  6. Here is Alzheimer’s Association’s information on PREVENTION AND RISK OF ALZHEIMER’S AND DEMENTIA.

  7. Jennifer Avatar

    well wasn’t to scared until now. I fit every slot on that spectrum. I do not drink though. I have often been scared of this because I forget a lot and forget in mid sentence. I was told by a KAISER doc there was no connection. well I guess I will wait and see. What can be done to stop any such progression into dementia??

  8. Thank you for commenting, Mark. So sorry you live with many challenges and we’re abused as a child. Environmental factors, including abuse, affect our health, both mental and physical, in so many ways.

  9. I think that they are genetically connected, not connected causally.

  10. i get your blog.i am disabled i have m.e. ibs, asperger syndrome.long list health issues. as a child i was abused sexually
    people do not see the every day effects,i am alive.if you would like to reply pleas do.i do a blog:
    i am from England

  11. Absolutely right. What a great figure and diagram. Analyzing “Anxiety” in a different context. The other comorbidity disorders associated with anxiety is a result of transformation occuring within the body. It is a tough situation to overcome. Hope this is more appropriate to your post.

  12. Thanks for the link. Not sure that it directly applies, but I love the Brain & Behavior Research Foundation.

  13. I’m so glad you persisted and found a doctor who helped you. We are just beginning to understand how to treat complex comorbid disorders. Improved treatments will no doubt eventually be the result of current research.

  14. You’re welcome. We’re learning so much. Look forward to improved treatments down the road, for our kids and their kids if not in our lifetimes.

  15. Awesome read!
    I’ve dealt with psychogenic pain in the past and have recently had a relapse. Even morphine can’t kill the pain, a high dose of anxiety meds help me, tho.
    When it first happened to me 11 years ago. All Drs thought I was nuts and wanted to give me morphine. I refused, and figured out the anxiety issue through a physical therapist by accident.
    Thank goodness things have changed. My doctor has changed my meds accordingly and I’m trying Cymbalta now, along with other meds. I’m not out of the woods yet, but the meds are mostly keeping me pain free, however very tired. ??

  16. Good Post. Thanks, Kitt. More than clinical assessments may help provide a better diagnosis with defined biotypes from a recent research article provided by BBRF New Biotypes Classify Psychosis Cases According to Measurable Biological Features.

  17. Fascinating study! Thank you so much for bringing it to our attention!

  18. […] via ALPIM Anxiety-Laxity-Pain-Immune-Mood — Kitt O’Malley […]

  19. I’d be grateful – a couple lines from you would be fantastic!

  20. That reminds me, still have to email them…

  21. Glad you downloaded the PDF. The more we know, the better.

  22. I love how you always share the latest research with us. How I wish you were the editor of the magazine I’ve been so caught up with lately because you would know what’s important and what’s just filler! 😉

  23. Yes, some doctors have this ‘thing’ where they label something and run away Kitt. It is good that more studies are being done.
    I’ve downloaded the pdf for a further read, thank you 🙂

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