Dizzy? It May Be an Anxiety Disorder!

– Posted in: Anxiety

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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263 Comments… add one
Deirdre June 18, 2015, 1:39 am

I was just diagnosed with Chronic Subjective Dizziness today after 3 years of all day dizxiness (not spinning) that ranges from mikd to severe with no apparent patterns. What is the best medication to take for anxiety and what dosage? I have to wait 3 months to see the psychiatrist prescribing meds. ?!? But I have a doctor for migraines and knows she can/will prescribe what I need. Anyone find relief with a Particular drug? I read about Amtryptolin 10 mg to start with but that seems very low. Any help is appreciated. :)
I have tried almost everything under the sun…except medication for anxiety.

Josh k June 22, 2015, 1:17 pm

Cutting caffiene out of my diet, and exercise helps a LOT. I was dizzy for about 6 months. I recommend Brazilian Jiu Jitsu, besides exercise it also gives confidence.

Jim September 16, 2015, 12:14 pm

I had no idea there were so many people experiencing many of the identical symptoms I’ve been dealing with for nearly 3 years.
I’ve been disgnosed with Adrenal Fatigue, Autoimmune Disorder, Ankylosing Spondylitis/Iritis, Mitochondrial Disorder, PTSD/military related, Depression, Cervical Stenosis, Degenerative Joint Disease, Autoimmune Autonomic Ganglionopathy and Peripheral Neuropathy.
As my PC doc says, I’m the healthiest looking and sickest patient she sees.
I’ve tried numerous medications over the years and all of them have either failed to produce any viable results or have caused such horrific side effects that I had to stop taking them.
I also have flare-ups of intense, painful symptoms even though I’ve made no discernible changes in my diet or daily activities, which have become very limited.
I worked with a nutritionist for several months but nothing changed other than the cost of the food that she recommended…organic and “specialty” items are outrageously priced.
I talk with my psych on a regular basis, but that hasn’t positively impacted the way I typically feel on most days–dizzy and tired.
At this point I have no idea where to turn next because the medical providers, and I’ve seen a LOT of them, are either stumped or opted out due to the complexity and time required to delve into these issues, so I assume they considered as me as being non-essential.
I’ll continue following this site in the hope that someone, somewhere uncovers something worthwhile for all of us…

Anita A Dolliver August 9, 2016, 8:27 pm

I found this article to be helpful and informative. I have suffered from dizziness for 2 years. I always assumed it was related to my anxiety. It also seems to be related to my migraines. I have only seen 2 doctors regarding the dizziness and both were unable to understand why I was dizzy. One doctor said I had vertigo and the other completely disregarded my complaint. Having it described here helps to calm the anxiety it causes.

Glenn January 24, 2017, 2:31 pm

I suffered from 1969-1986 with on and off periods of “dizziness” NOT VERTIGO. Sometime for months at a time. Dr’s were no help. CAT scan was negative in ’86, spinal tap negative in 1970. Was given Halcion for sleep in ’86 after the CAT scan. I found if I used it in the DAYTIME the dizziness disappeared for quite a long time after only one dose! I was finally put on xanax and have been taking that from .5 mg a day to 4.5 mg a day over the years (dosage has gone up and down) currently on .5-1.5 mg a day as needed. No more “dizziness”.

Deirdre January 24, 2017, 10:24 pm

Wanted to update since my last comment. I did try amtriptyline 10mg and although I am not cured, my daily life is much better. I have been taking it about 3 months. I would now call the dizziness “mild”. Often times it’s not there at all. The doc told me to start with 10mg and work up to 30mg, but I was never able to get up to 20. It knocks me out. So for now, it’s much better. I take it at night. Life is definitely better, but not fully resolved. It’s been 4 years!

Crystal February 27, 2017, 4:28 pm

I have been dealing with this for the last 8 years and no Dr can figure it out. It takes doing your own research for you to diagnose yourself. I take .5 Ativan and that seems to be enough to take the edge off. If I wait too long to take it, it takes almost 2 hours to get myself calmed down though. I do not want to go on any other meds.
Crystal recently posted…5 Easy Yet Effective Ways to Calm Yourself Down When You’re Feeling AnxiousMy Profile

Carlo April 10, 2017, 1:50 am

I’ve been suffering from chronic anxiety for many years. I can’t say what works for other people but I can say for sure that mediation and exercise worked for me. Thank you for sharing this information

Pie May 23, 2017, 10:33 pm

I’ve been diagnosed with GAD and panic disorder last week and dizziness has been on and off since last year now. I attributed that to my beta blocker but I also have GERD and esophagitis and chronic sinusitis.

Reading through this article though made me more convinced that it is anxiety related. I am very sensitive to movements in my environment. Although I can sometimes feel the ringing sound in one ear but this is also a sign of anxiety.

I am on peri and my anxiety is now feisty. I don’t even want to take a walk sometimes and my stomach acid is always acting.

Tiffany Querry May 24, 2017, 12:57 am

Hello. I hope this helps you. When I first started having dizzy spells, I swore everything and anything was wrong with me. Finally, after 4 years, I look back and the dizziness was a result of a couple of things I have. Gerd and severe stomach acid and when it gets inflamed, it causes dizziness. If I have a sinus infection it causes dizziness as well. Before I had anxiety, the symptoms of GERD and sinus issues didn’t make me feel dizzy, but when I developed anxiety disorder, all my sensitivities was heightened. So with that being said when you have anxiety disorder and you get dizzy it could 1. Be a panic attack and showing its colors through dizziness
2. It could be your stomach acid.
3. It could be a sinus ear issue. You are just that super sensitive to anxiety. I hope that makes sense. It does get better with time and education.

Dawn June 8, 2017, 3:35 pm

Just a fyi? TERRIBLE picture to use for people who have “dizzy” issues. Very triggering :(

Andrea Hudson June 9, 2017, 8:46 am

After suffering with vertigo for almost 20yrs and also being an anxiety sufferer (agoraphobic for about 12 of those years) and also a migraineur, I have finally got a theory. This, of course won’t apply to everyone but I thought it was worth a share, just in case it may apply to you.

I was told I had BPPV (positional vertigo) after nothing else could be found and description of my symptoms, I also have silent migraines (can’t remember the technical name, but I get aura and neurological stuff, like vertigo, without ever actually getting the head pain.)Trust me, I’d rather have the head pain of my good old classic migraines.

Onto my theory. I do believe those things do cause vertigo but ultimately, I believe my vertigo is sparked from not really going a lot of places, stay home, seeing the same walls, same landscape, same everything. Then when I do go out and in different settings, new stimuli, it precipitates the vertigo, since I’m already prone to it.

I came up with this theory after keeping intensive records of my activity, lack thereof and when my vertigo would “act up”.

Especially, when I broke my anxiety/panic/agoraphobia cycle by self employing myself as a mobile public Notary and also property inspections. I made myself go out, everyday. Nothing too Public where I would be around a lot of people for long periods. But driving around, getting in and out of my car, etc. I realized weeks, then months would go by and no overwhelming vertigo.

I stopped doing this job, due to circumstances, not related to vertigo and BOOM, after being back in the house for a couple weeks, the vertigo slowly began returning and now, it’s almost back to a daily, sometime debilitating, occurrence.

I’m back to making myself get out everyday, even if it’s just for a short drive or a walk.

Any thoughts on this?

Mike Nichols June 12, 2017, 11:52 am

I have suffered from vertigo since the mid 1990’s and also have agoraphobia. With the help of my psychiatrist, I have learned how to overcome the agoraphobia in many instances and now lead an almost-normal life, with few places and situations that I cannot go to. Unlike you I have noted no correlation between the vertigo and agoraphobia. My vertigo is worse than it’s ever been and I have to use a cane and a walker to get around. I’m not saying that your experience is invalid, but that it seems that the connection between anxiety and vertigo is different with each individual.
Mike Nichols recently posted…Children’s Mental Health: One of the Most Pressing Issues of Our TimeMy Profile

Mike Nichols June 12, 2017, 11:57 am

I have suffered from vertigo since the mid 1990’s and also have agoraphobia. With the help of my psychiatrist, I have learned how to overcome the agoraphobia in many instances and now lead an almost-normal life, with few places and situations that I cannot go to yet. Unlike you I have noted no correlation between the vertigo and agoraphobia. My vertigo is worse than it’s ever been and I have to use a cane and a walker to get around. I’m not saying that your experience is invalid, but that it seems that the connection between anxiety and vertigo is different with each individual.
Mike Nichols recently posted…Children’s Mental Health: One of the Most Pressing Issues of Our TimeMy Profile

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