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Dizzy? It May Be an Anxiety Disorder!

by Mike on November 14, 2008 · 244 comments

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:

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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