A clinical taxonomy of dizziness and anxiety in the otoneurological setting

Abstract

Dizziness can be associated with otologic, neurologic, medical, and psychiatric conditions. This paper focuses on the interface between otologic and psychiatric conditions. Because dizziness often is situation specific, concepts of space and motion sensitivity (SMS), space and motion discomfort (SMD), and space and motion phobia (SMP) are needed to understand the interface. We present a framework involving several categories of interactions between balance and psychiatric disorders. The first category is that of dizziness caused by psychiatric disorder (psychiatric dizziness), including hyperventilation-induced dizziness during panic attacks. The second category involves chance cooccurrence of a psychiatric disorder and a balance disorder in the same patient. The third category involves problematic coping with balance symptoms (psychiatric overlay). The fourth category provides psychological explanations for the relationship between anxiety and balance disorders, including somatopsychic and psychosomatic relationships. The final category, neurological linkage, focuses on the overlap in the neurological circuitry involved in balance disorders and anxiety disorders.

Introduction

In this paper, we will discuss the various ways in which dizziness, balance disorders, and anxiety or other psychiatric conditions may interact clinically. Our discussion of this interaction includes a description of the symptomatology of dizziness and the concept of space and motion sensitivity (SMS) and space and motion discomfort (SMD) as they occur in anxiety disorders and vestibular disorders. After laying this foundation, the interface between vestibular and psychiatric disorders in general will be explicated, from the perspective of an otoneurological clinician in a dizziness clinic.

Dizziness as an experience is internal or private in nature. As with other private sensations (e.g., pain), the verbal labeling of the experience is not subject to direct social validation. Therefore, different verbal descriptors are used by different individuals, and conversely, the same verbal descriptor may mean different sensations for different individuals. Synonyms for dizziness often are defined by an analogy to physical events or actions, such as voluntarily hyperventilating, voluntarily spinning around, or taking an amusement park ride. Terms such as floating, spinning, swimming, walking on clouds, giddiness, feeling unreal, disoriented, or lightheaded all have connotations to external actions or events. Note that many of these terms do not connote a sense of “spinning.”