Are you among the 3 million Americans who is always dizzy?
Recent studies show that about 60 percent — almost 2 million — of chronically dizzy people also have an Anxiety Disorder. In fact, the Anxiety Disorder causes the dizziness!
If you are among these numbers, you may have what is called Chronic Subjective Dizziness. It’s a condition in which there are no physical reasons for the dizziness. You may have suffered from this condition for years without knowing what or why it was. New research from the University of Pennsylvania now has answers for you!
This post details this new research and explains why it is important to you or someone you know who is always dizzy. The subject is explored under these topics:
- What is Chronic subjective dizziness?
- Research on Chronic Subjective Dizziness and Anxiety Disorders
- The results of the study shows 60 percent had Anxiety Disorders
- The relationship of migraines, Anxiety Disorders and Chronic Subjective Dizziness
- The significance of this study on Chronic Subjective Dizziness
- Treating Chronic Subjective Dizziness
What is Chronic Subjective Dizziness?
A medical condition with persistent dizziness
Chronic subjective dizziness is a medical condition in which a person has a persistent dizziness that cannot be explained by medical conditions. It is not related to vertigo, the feeling of whirling that is usually linked with inner ear problems.
People who have Chronic Subjective Dizziness feel dizzy, off-kilter, imbalanced, and are very sensitive to motion stimuli, such as crowded environments or heavy traffic. Jeffrey Staab says, ”
The best way to understand this … is to shake your head back and forth 20 times. When you are done, that is the feeling these people feel.
When people with Chronic Subjective Dizziness enter an environment filled with visual stimuli, such as having to drive in the rain or navigate through a busy grocery store, the dizziness gets worse. “Too much sensation is coming into the brain,” Staab says of the condition, which can be disabling.
Briefly, Chronic Subjective Dizziness is diagnosed by the following physical symptoms and examination findings:
- Persistent sensations of dizziness for a duration of 3 months. Lightheadedness, heavy-headedness, or subjective imbalance present on most days. There is no vertigo.
- Chronic (duration of 3 months) hypersensitivity to one’s own motion, which is not direction specific, and to the movements of objects in the environment.
- Symptoms are made worse in settings with complex visual stimuli such as grocery stores or shopping malls or when performing precision visual tasks such as reading or using a computer.
- Absence of other physical illnesses, medications or factors that might cause the dizziness.
- Radiographic imaging of the brain shows no abnormalities that could cause the dizziness.
- Findings from balance function tests that show no balance problems.
Research on Chronic Subjective Dizziness and Anxiety Disorders
A large-scale study over 6 years
Psychiatrist Jeffrey Staab, M.D., M.S., and neurotologist Michael Ruckenstein, M.D., of the Balance Center at the University of Pennsylvania Health system in Philadelphia studied adult patients with Chronic Subjective Dizziness from 1998 to 2004. They started off with an initial group of about 2,400 patients with a variety of vertigo, dizziness, and imbalance complaints. The results of their study was published in the February, 2007 issue of the Archives of Otolaryngology-Head and Neck Surgery.
The study group was narrowed down to 345 subjects after clinicians diagnosed most of the 2,400 patients as having medical conditions that would explain their dizziness. The 345 patients had persistent dizziness, but didn’t have the familiar spinning sensation that typifies vertigo caused by inner-ear problems. The diagnosis for these patients was Chronic Subjective Dizziness.
Besides meeting the criteria for Chronic Subjective Dizziness listed above, Staab and Ruckenstein found that many of these patients had poor concentration and difficulties in their family or work lives. They had experienced dizziness for an average of four years before entering the study.
The results of the study shows 60 percent had Anxiety Disorders
Anxiety Disorders associated with dizziness
Of the 345 subjects in the study, 206 — nearly 60 percent — had Anxiety Disorders associated with their Chronic Subjective Dizziness, and 115 — 33 percent — of the subjects with psychogenic dizziness (dizziness caused by psychological problems) had a primary psychiatric diagnosis with no physical reasons for it. The 115 subjects with no physical causes for their dizziness were diagnosed with the following Anxiety Disorders:
- Panic attacks, Panic Disorder or Social Phobia (65)
- Generalized Anxiety (25)
- Other minor Anxiety Disorders (25)
The remaining 91 subjects had some accompanying medical conditions, but also had Anxiety Disorders. They were:
- Panic attacks, Panic Disorder or Social Phobia (34)
- Generalized Anxiety (35)
- Other minor Anxiety Disorders (19)
The relationship of migraines, Anxiety Disorders and Chronic Subjective Dizziness
Migraines associated with Anxiety Disorders
Interestingly, the rate of Anxiety Disorders among patients in the study with migraine was four times higher than the population average. Epidemiological (population) studies have found that 18 percent of Americans have an Anxiety Disorder, but 77 percent of the migraine patients in Staab and Ruckenstein’s study had clinically significant Anxiety. The 57 subjects with migraine were diagnosed as follows:
- Panic or Social Phobia (21)
- Generalized Anxiety (10)
- Other minor Anxiety Disorders (13)
Joseph Furman, MD, PhD, is a neurologist and professor of otolaryngology at the University of Pittsburgh and a veteran researcher on the topic. Citing this research, his own research and others’ research, he says,
If you take a close look at people who are dizzy without a diagnosis of disease, the two main things you are going to come up with are anxiety and migraine.
The significance of this study on Chronic Subjective Dizziness
Anxiety Disorder and Chronic Subjective Dizziness connection proven
The idea that Anxiety Disorders or migraines are associated with Chronic Subjective Dizziness is not new. What is new is a large study lasting for a long time that definitively proves the connection. Previously, doctors could go on hunches, but did not have anything definitive to work with. Staab says,
Often, doctors evaluate patients like this for inner-ear problems, treat them, and then if treatment fails, just assume it’s ‘psychogenic’ [having a psychological cause]. … Now we can tell patients that this is not a mystery. We can explain just what causes their symptoms.
Treating Chronic Subjective Dizziness
No specific treatments yet
Treatment choices remain undefined. No big, randomized, controlled trials of treatment for Chronic Subjective Dizziness have been conducted. Some small, open trials have researched treatment in three directions, however:
- Selective serotonin reuptake inhibitors (SSRI antidepressants) have shown some utility in reducing Anxiety Disorders and lessening dizzy symptoms.
- Cognitive-behavioral therapy (CBT) has been tried in small numbers of patients, so far without conclusive data.
- A form of physical therapy, vestibular balance rehabilitation therapy, is also under investigation.
What do you think?
The case for a strong link between physical and mental illnesses keeps growing stronger. It is well known that the Anxiety Disorders can increase the risk of heart failure, affect the gastro-intestinal system, and can hamper the recovery from cancer and other diseases. Now this new study proves the connection between Chronic Subjective Dizziness and Anxiety Disorders. As time goes on, it is certain that other medical problems will be associated with the Anxiety Disorders.
- Do you experience dizziness? Do you also have a history of having an Anxiety Disorder as well?
- Do you know of anyone who has been diagnosed with Chronic Subjective Dizziness?
- What is your opinion of the link between physical and mental illnesses?
As always, your comments are welcome!
©2008 Anxiety, Panic & Health. All rights reserved.
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Resources used in this post:
Doheny, Kathleen. (2007, February 20). New Clues to Chronic Dizziness. Retrieved November 9, 2008 from MedicineNet web site: http://www.medicinenet.com/script/main/art.asp?articlekey=79520
Levin, Aaron. (2007, March 16). Anxiety Disorders Often Accompany Chronic, Nonspecific Dizziness. Retrieved November 9, 2008 from Psychiatric News web site: http://pn.psychiatryonline.org/cgi/content/full/42/6/16
Nauert, Rick. (2007, February 20). Anxiety Can Cause Chronic Dizziness. Retrieved November 9, 2008 from Psych Central web site: http://psychcentral.com/news/2007/02/20/anxiety-can-cause-chronic-dizziness/
Osterweil, Neil. (2007, February 19). New Spin on Chronic Dizziness. Retrieved November 9, 2008 from Medpage Today web site: http://www.medpagetoday.com/Surgery/Otolaryngology/5085
Staab, Jeffrey; Ruckenstein, Michael. (2005). Chronic Dizziness and Anxiety: Effect of Course of Illness on Treatment Outcome. Retrieved November 9, 2008 from Migraine-Associated Vertigo Forums web site (PDF): http://www.mvertigo.org/articles/chronic.dizziness.and.anxiety.05.pdf
Staab, Jeffrey; Ruckenstein, Michael. (2007). Expanding the Differential Diagnosis of Chronic Dizziness. Retrieved November 9, 2008 from Archives of Otolaryngology — Head & Neck Surgery web site (PDF): http://archotol.ama-assn.org/cgi/reprint/133/2/170?maxtoshow=&HITS=25&hits=25&RESULTFORMAT=&searchid=1&FIRSTINDEX=1625&resourcetype=HWFIG
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Dear Sir,
Your comments about anxiety disorder are excellent. Recently due to some personal problems I worried a lot and the same leaded to suffer from anxiety disorder and during that time I felt severe dizziness/lightheadedness and many anxiety symptoms. Then I searched in websites and get to know about anxiety and its symptoms. Now a days I’m not worrying or not feeling anxity but still some time I feel slight dizziness/lightheadedness and I become tired and worried. Please advice if one had anxiety in his history, dizzy spells will continue to occur?
Siva, thank you for your comment!
I’m not a psychological professional, so I cannot give you a definitive diagnosis. But I can give you some information, and the benefit of my own experience.
Although your major problems with Anxiety have passed, it seems that you are still suffering from some of its symptoms. Anxiety can cause dizziness even without other symptoms, especially when you are tired and/or stressed.
But I recommend that you check if you have any inner ear problems, as well. It could be that your dizziness is being caused by a medical condition.
I have had severe inner ear problems in the past, as well as suffering from several Anxiety Disorders. I can tell when the dizziness is Anxiety-related by checking my Anxiety level. I have learned to do this through the knowledge I gained in therapy.
And Anxiety can cause symptoms even when you’re not feeling particularly Anxious. I have developed a pursing of my lips and clicking my teeth which is continual, even when I don’t feel Anxious. I thought it was caused by one of my medications. But just this week I spoke to my psychiatrist about it, and she said it was caused by Anxiety and stress.
So, get your ears checked to make sure you don’t have a medical problem. And I would recommend seeing a mental health care professional for some therapy to help you control and manage your symptoms. It doesn’t take long, and it can last you the rest of your life!
I was so glad to find this article. I have suffered from dizziness for a long time and this past year, more often than normal. I have been diagnosed with depression, anxiety, and OCD (not a very bad case). My anxiety seems to be the worst. I take Wellbutrin, Lexapro and my xanax is a very small dose PRN. I have touches of GAD, social anxiety, and separation anxiety. I know that my dizziness has to do with my anxiety b/c it’s at times the start of panic. I have learned to take my anxiety meds when I feel it. There was however, a time where I thought something was physically wrong. When I’m walking into work at times, I’ll feel like I’m going to fall over, I have horrible balance and hate the thought of others looking at me. Your articles are so great and make me feel so much better that I’m not alone out here! ;)
Maria
Thanks for your comment, Maria! And again, thanks for the compliments!
Some years ago I had a serious ear infection that left me with a permanent balance problem. On top of that my Anxiety disorders would sometimes make me very dizzy. And on top of that, at least half of my medications say they might make me dizzy!
So I can really empathize with you. You seem to be very aware of what’s going on and are able to head off some of the symptoms.
I for years have been doing balance exercises I learned when I was having such inner ear problems. They really help. I just Googled “balance exercises” and came up with some likely looking sites, especially the NIH and the Mayo Clinic. You might want to try some of these to improve your balance so that when you do get dizzy, you’ll be better equipped to deal with it.
Hi there.
First of all, let me start by apologizing for my bad English, I’m from Portugal.
I’m 36 years old, and I have dizziness from anxiety since I was 18 years old.
When I was 18 years old, I had a major panic attack following my first (and only) smoke of hashish. It was my first panic attack, I thought I was gonna die, my heart was racing, and felt like I was going to faint or die.
Two days later, the same thing happened while I was at home (no drugs this time).
So I spent one week at the hospital taking exams, and nothing was found.
But since that time, I experienced severe dizziness and there was no physical reason for it, so I consulted a psychiatrist. He said it was anxiety and treated me.
For the last 18 years I’ve been taking medicines (Bromazepam) to control my dizziness (with success). If I stop taking them, the dizziness gets worse.
On the other hand, there are periods of time (sometimes years) where I can take little doses of bromazepam and feel great.
For some reason, there are other times where the doses have to come up (I’m in one of these times right now), as I feel more anxiety, specially (but not only) in the form of dizziness.
Just so you can have a more precise idea, a few months ago I was at a musical concert (seated) and started to feel dizzy, with my heart racing and felt like I was going to faint.
I got up, and I was still very dizzy and nervous.
I got out of that building, and 30 seconds after I was without any of those dizziness symptoms, besides the remaining anxiety from the (bad) experience.
My otorhinolaryngologist says that I don’t have any symptom of real balance disorder, that if it was physical, I couldn’t be dizzy one minute, and almost perfect the next minute, just because I left the building.
Hope this helps anyone feeling the same way.
Rogério
Thank You for the post.
Im a 31 year old male. I had psycho/emotional trauma as a child. I have lots of job stress and two young children.
I experienced my first panic attack about two years ago in metro traffic. I was convinced of my imminent death and called an ambulance from my cell where I pulled over on the highway.
I’ve been experiencing these same imbalance/dizzy symptoms for about 8 months now. I have been diagnosed with Anxiety/Depression. I have taken Zoloft for about a year off and on. It seems to help with the feelings of imbalance and dizzyness, and certainly with the stress and anxiety symptoms.
However, during periods of time when I try to “go it alone” (without meds because I don’t want to feel like I have to live with meds for the rest of my life), the dizzyness returns, along with tension headaches, stress and anxiety.
It also leads me to hypochondriasis. I find myself fearing a brain disorder, or severe heart disorder as an explanation for my dizzyness and balance problems. This of course plays right back into the Anxiety and shuts me down.
I can even stand in one place and move my head even close my eyes to prove my own stability, but when I walk or work at the computer, or have to focus on multiple depths, I feel very unbalanced, like I’ll miss a stair or tip over, though I never do.
Any further advice?
Thanks for the info. It is so nice to not feel completely crazy.
Wow! It’s absolutly incredible to hear from people who have the same issues that I do! I’ve always heard you are never alone in your suffering, but I thought I was. I had never met, or heard from anyone who has the same persistant, lightheaded, foggy, dizzy feelings that I have had for the past 11 years. On a day to day basis it is tolerable, but I have had some prety roughf days. I take paxil and have for years. It helps tremendously with my anxiety,and panic. In fact it all but iliminates it. But this dizzy feeling is something I have accepted as part of me, as so many Doctors have told me there is nothing wrong with me. Ha! I said! I wish you could see the world though my eyes for a moment! I’ve always had a scale for the “weird feeling” 1 being a slight annoyance, 10 being I cant believe I’m still functioning, or, I should probly pull over! Fatigue definatly makes it worse. 6 weeks after I had my daughter I would be in the grocery store and be genuinly concerned that I was going to fall over from being so overwhelmed by all the products, and the people walking about. It was scary. I had no anxiety at the time and thought to my self, there is no reason a health person should feel this disabled! There was nothing vauge about it. I felt like I was in a fun house.I was recently diagnosed with Migranious Syndrome. Eye migraines with an Aura. I was so excited to actualy get a diagnosis. It explained a lot of my visual symptoms but I was’nt convinced it was causing such chronic dizzyness. A 11year migraine? Thats a doozy! Anyway, in my reasearch I found this site. A relationship between anxiety, migraines, and chronic dizzyness. I never thought I’d find what seems to be such an accurate diagnosis for my symptoms. It gives me such great hope! The first step in recovery is identifying the problem. Thank you!
Severe stress and anxiety for a number of years? check
Depression ? check
Strange onset of daily lightheadedness and dizziness? check
Multiple ENT/Neurologist visits that come up empty? check
Finally, I found a doctor in Houston with a magic bullet. TOPAMAX!!! Works really well on my symptoms. Boy can I tell when I miss a couple of days’ doses. Hope it works for you…
i have read your article concerning chronic dizziness. my family has been dealing with an issue pretty much along these lines with our mother. she will be 65 tomorrow (8/6) and has been suffering of chronic dizziness for that last 13 years, which has in turn caused the severe panic attacks. her attacks are so severe that they are calling them tia’s but after the attack is over she shows no signs of a tia. she has seen several neurologists over the years and yet we still have no answers as to what is causing these problems. she has been to the clevelend clinic several times also. it has been difficult to watch her condition over the years. she has what she calls “spinners” she can be standing in her room and one will hit her and within seconds she in in the floor.
i guess my question to you ~ is do you know of a dr in the cincinnati ohio area that specializes in this study? or what kind of tests should i ask her neurologist to run? she has had multiple cat scans, mris, eegs, ekgs, blood work and many others that i cant even recall.
any advice you have will be greatly appreciated.
thank you