TABLE 3.

Causal attributions of hEDS/HSD symptoms in pediatric and adolescent population

	Causal beliefs summary
	N (n = 39)	%	Illustrative quotes
Intrinsic factors	37	95
Genes	33	84.6	“genetic predisposition’’
Puberty/development	6	15.4	“puberty started moving my bones around as I grew, and if feels like they’ll never to back to not feeling like they’re stabbing me.”
Family history	2	5.1	“my mom has it”
Specific physical characteristics	2	5.1	“Weak joints”
Extrinsic factors	20	51.3
Too much physical activity	8	20.5	“overuse of joints during dance and other activities”
Too little physical activity	1	2.6	“to much time in bed [sic]”
Viral/postviral illness	6	15.4	“viral illness in 2009”
Delay in diagnosis/treatment	3	7.7	“Going undiagnosed for more than 17 years”
Psychosocial factors	2	5.1	“attitude”
Comorbidities	2	5.1

Note. hEDS, hypermobile Ehlers-Danlos syndrome; HSD, hypermobility spectrum disorder.

Responses were completed by 39 patient participants as part of the Brief Illness Perception Questionnaire as free text, which was coded; codes were not mutually exclusive.