Psychiatric Dizziness

Psychiatric dizziness is defined as dizziness that occurs in combination with other symptoms as part of a recognized psychiatric disorder or symptom complex that is not related to known vestibular disorders. Although such dizziness has been characterized as nonvertiginous dizziness in the past, it is now recognized that patients with certain psychiatric disorders can present with true vertigo as part of their presenting symptoms. Dizziness is the second most common symptom reported by patients with panic disorder. In addition, a large percentage of patients with dizziness meet the criteria for panic or mood disorder. A majority of patients with panic disorder have objective abnormalities on testing of vestibular function. The strongest correlation is with patients who suffer from agoraphobia. Such patients suffer from what is known as "space and motion discomfort" (SMD). SMD is defined as comprising uncomfortable symptoms such as dizziness, imbalance, and anxiety occurring in situations delineated by certain spatial or motion characteristics. Generally, these are complex visual environments such as shopping malls. Agoraphobia may develop as a way to combat the symptoms.13

Psychiatric dizziness should not be confused with the phenomenon of psychogenic overlay. In the latter, the patient may manifest some symptoms of neurootologic disease, but illness behavior is augmented by the presence of psychiatric conditions. These include hypochondriasis and personality disorders. Patients who are withdrawn from serotonin reuptake inhibitors used on a long-term basis may experience nonvertiginous dizziness, along with gastrointestinal and flu-like symptoms, sleep deprivation, altered sensations, anxiety, and irritability. 14

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