Psychogenic dizziness

Psychogenic dizziness better referred to as somatoform dizziness makes up a large number of the complex vertigo syndromes. It is divided into a primary and a secondary form. The primary form develops without any preceding organic vertigo condition. The secondary form develops in response to a preceding organic vertigo condition, for instance after a vestibular neuritis.

Psychogenic dizziness

Psychogenic dizziness

There is also a link between organic vestibular conditions, especially Meniere’s disease and vestibular migraine, and psychiatric disorders. This can be as high as 60%.  It is known that “stress” is a trigger for attacks in Meniere’s disease. The most common psychiatric conditions include anxiety, phobia, depression, conversion and somatoform disorders.

Until medical science reaches a point where all the parts of the inner ear can be thoroughly assessed, one should be very careful to label dizziness as psychogenic or psychological. It is known that patients with the same inner ear problem and deficit in function may experience symptoms differently.  This  “catastrophization” by some patients as described by David Pothier from Toronto, Canada, should be acknowledged.

Persistent postural-perceptual dizziness (PPPD), chronic subjective dizziness (CSD) and phobic postural vertigo (PPV) are all mentioned in the literature. Considered to be a spectrum of disorders, different sides of the same coin as to speak, they all recognize the existence of somatoform dizziness.  PPV is common in young patients with normal balance function. In this conditions patients become unnecessarily over cautious with their balance function and develop a fear for falling and injury. Although symptomatic they will usually not be bothered when partaking in sport such as swimming or riding a bicycle.  It is common to develop avoidance behavior for certain places or situations.  Injury and falling does not occur but for the often obsessive-compulsive and perfectionistic patient, re-assurance alone is not enough. Intense counseling, psychotherapy and medication may be required. Needless to say that real organic disorders should be ruled out first.