Vertigo pp 455-468 | Cite as

Psychiatric disorders and vertigo

  • Thomas Brandt


The sensation of vertigo, a subjective complaint, is sometimes defined as a hallucination of movement or an illusion. Since the evaluation of hallucinations and illusions is an essential part of psychiatric practice, such definitions place vertigo at the threshold of clinical psychiatry (Trimble 1984). Psychogenic vertigo is relatively common among psychiatric patients, especially phobic postural vertigo (Chap. 32; p. 469), one of the three major psychiatric conditions manifesting as psychogenic vertigo (Brandt 1996). Of 1370 consecutive neurological patients presenting at our dizziness unit in Munich between 1989 and 1995, 15% had phobic postural vertigo.The two other major psychiatric conditions manifesting as psychogenic vertigo are panic disorder and agoraphobia, conditions that can exist separately or together. According to the review of Furman and Jacob (1997), the following guidelines are used in current clinical practice for the diagnosis of psychiatric dizziness: the dizziness is not characterised by true vertigo, the dizziness can be replicated by hyperventilation, psychiatric symptoms precede the onset of dizziness, and the dizziness occurs in anxious or phobic individuals. The reliability, however, of these features is limited and thus Furman and Jacob propose a more “narrow” definition of psychiatric dizziness as follows: the dizziness occurs exclusively in combination with other symptoms as part of a recognised psychiatric symptom cluster and this symptom cluster is not itself related to vestibular dysfunction.


Panic Disorder Panic Attack Vestibular Dysfunction Separation Anxiety Disorder Phobic Postural Vertigo 
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  1. Agras WS, Chapin HN, Oliveau DC (1972) The natural history of phobia. Arch Gen Psychiatry 26: 315–317PubMedCrossRefGoogle Scholar
  2. Allum JHJ, Huwilen M, Honegger F (1994) Objective measures of non-organic vertigo using dynamic posturography. In: Taguchi K, Igarashi M, Moris S (eds) Vestibular and neural front. Elsevier, Amsterdam, pp 51–55Google Scholar
  3. Allum JHJ, Huwiler M, Honegger F (1996a) Prior intention to mimic a balance disorder: does central set influence normal balance corresponding responses? Gait Posture 4: 39–51CrossRefGoogle Scholar
  4. Allum JHJ, Huwiler M, Honegger F (1996b) Identifying cases of non-organic vertigo using dynamic posturography. Gait Posture 4: 52–61CrossRefGoogle Scholar
  5. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorder, 4`h edn (DSM-IV). American Psychiatric Association, Washington DCGoogle Scholar
  6. Aronson TA (1987) Is panic disorder a distinct diagnostic entity? A critical review of the borders of a syndrome. J Nery Ment Disease 175: 584–594CrossRefGoogle Scholar
  7. Atchinson PR, Thompson PD, Frackowiak RSJ, Marsden CD (1993) The syndrome of gait ignition failure: A report of six cases. Movement Dis 8: 285–292Google Scholar
  8. Baker BL, Cohen DC, Saunders JT (1973) Self-directed desensitisation for acrophobia. Behav Res Ther 11: 79–89PubMedCrossRefGoogle Scholar
  9. Benedikt N (1870) “Platzschwindel”. Allg Wiener Med Ztg 15: 488–489Google Scholar
  10. Bing R (1924) Lehrbuch der Nervenkrankheiten, 3rd edn. Urban & Schwarzenberg, Berlin, pp 663–667Google Scholar
  11. Brandt Th (1984) Visual vertigo and acrophobia. In: Dix MR, Hood ID (eds) Vertigo. Wiley, Chichester, pp 439–466Google Scholar
  12. Brandt Th (1991a) Vertigo: Its multisensory syndromes. Springer, London, pp 291–304Google Scholar
  13. Brandt Th (1991b) Man in motion. Historical and clinical aspects of vestibular function. Brain 114: 2159–2174PubMedCrossRefGoogle Scholar
  14. Brandt Th (1996) Phobic postural vertigo. Neurology 46: 1515–1519PubMedCrossRefGoogle Scholar
  15. Brandt Th (1998) Neuro-otological and psychiatric abnormalities. J Neurol Neurosurg Psychiatry 65: 619PubMedCrossRefGoogle Scholar
  16. Brandt Th, Daroff RB (1980) The multisensory physiological and pathological vertigo syndromes. Ann Neurol 7: 195–203PubMedCrossRefGoogle Scholar
  17. Brandt Th, Huppert D, Dieterich M (1994) Phobic postural vertigo, a first follow-up. J Neurol 241: 191–195PubMedCrossRefGoogle Scholar
  18. Brown DR, Eaton WW, Sussman L (1990) Racial differences in prevalence of phobic disorders. J Nery Ment Dis 178: 434–441CrossRefGoogle Scholar
  19. Cohen B (1984) The roots of vestibular and oculomotor research. Intro Hum Neurobiol 3: 121Google Scholar
  20. Cohen DC (1977) Comparison of self-report and overt behavioural procedures for assessing acrophobia. Behav Ther 8: 17–23CrossRefGoogle Scholar
  21. Crowe RR, Noyes R, Pauls DL, Slymen D (1983) A family study of panic disorder. Arch Gen Psychiatry 40: 1065–1069PubMedCrossRefGoogle Scholar
  22. Crum-Brown A (1874) On the sense of rotation and the anatomy and physiology of the semicircular canals of the internal ear. J Anat Physiol 8: 327–331Google Scholar
  23. Curlee J, Stern H (1973) The fear of heights among alcoholics. Bull Menniger Clin 37: 615–623Google Scholar
  24. Dejerine J (1914) Semiologie des affections du système nerveux. Masson, Paris, pp 541–549Google Scholar
  25. De Paulo JR, Folstein MF (1978) Psychiatric disturbances in neurological patients. Ann Neurol 4: 225–228CrossRefGoogle Scholar
  26. Desai BT, Porter RJ, Penry JK (1982) Psychogenic seizures. Arch Neurol 39: 202–209PubMedCrossRefGoogle Scholar
  27. de Sauvages F (1770–1771) Nosologie Methodique. Herrissant, ParisGoogle Scholar
  28. Eagger S, Luxon LM, Davies RA, Coelho A, Ron MA (1992) the trunk during stance and gait. Psychiatric morbidity in patients with peripheral vestibular disorder: Clinical and neuro-otological study. J Neurol Neurosurg Psychiatry 55: 383–387Google Scholar
  29. Fitzgerald G, Stengel E (1945) Vestibular reactivity to caloric stimulation in schizophrenics. J Ment Sci 91: 93–100Google Scholar
  30. Freud S (1895) Über die Berechtigung, von der Neurasthenie einen bestimmten Symptomencomplex als “Angstneurose” abzutrennen. Neurol Centralbl 12: 50–66Google Scholar
  31. Frommberger U, Angenendt J, Berger M (1995) Die Behandlung von Panikstörungen and Agoraphobien. Nervenarzt 66: 173–186PubMedGoogle Scholar
  32. Furman JM, Jacob RG (1997) Psychiatric dizziness. Neurology 48: 1161–1166PubMedCrossRefGoogle Scholar
  33. Gates JR, Ramani V, Whalen S, Loewenson R (1985) Ictal characteristics of pseudoseizures. Arch Neurol 42: 1183–1187PubMedCrossRefGoogle Scholar
  34. Goethe JW v (1771) In: Selbstbiographische Schriften, Dichtung and Wahrheit. 9. Buch der Straßburger Tischgesellschaft, SelbsterziehungGoogle Scholar
  35. Gresty MA, Bronstein AM, Brandt Th, Dieterich M (1992) Neurology of the otolith function: Peripheral and central disorders. Brain 155: 647–673Google Scholar
  36. Grösser O-J (1984) J. E. Purkyne’s contributions to the physiology of the visual, the vestibular and the oculomotor systems. Hum Neurobiol 3: 129–144Google Scholar
  37. Gullick TA, Spinks IP, King DW (1982) Pseudoseizures: ictal phenomena. Neurology 32: 24–30CrossRefGoogle Scholar
  38. Guralnick MJ (1973) Behaviour therapy with acrophobic mentally retarded young adults. J Behav Ther Exp Psychol 4: 263–265CrossRefGoogle Scholar
  39. Hallpike CS, Harrison MS, Slater E (1951) Abnormalities of the caloric test results in certain varieties of mental disorder. Acta Otolaryngol 39: 151–159PubMedCrossRefGoogle Scholar
  40. Hand I, Wittchen HU (1986) Panic and phobias. Springer, Berlin, Heidelberg, New YorkGoogle Scholar
  41. Harris EL, Noyes R, Crowe RR, Chandry DR (1983) Family study of agoraphobia. Arch Gen Psychiatry 40: 1061–1064PubMedCrossRefGoogle Scholar
  42. Hinchcliffe ER (1967) Personality profile in Menière’s disease. J L a r yngol Otolaryngol 81: 476–481Google Scholar
  43. Huppert D, Kunihiro T, Brandt Th (1995) Phobic postural vertigo (154 patients): its association with vestibular disorders. J Audiol Med 4: 97–103Google Scholar
  44. Jacob RG, Lilienfield SO, Furman JMR, Durrant JD, Turner SM (1989) Panic disorder with vestibular clinical observation and descriptions of space and motion phobic stimuli. J Anxiety Dis 3: 117–130CrossRefGoogle Scholar
  45. Jacob RG, Furman JM, Durrant JD, Turner SM (1997) Surface dependence: a balance control strategy in panic disorder with agoraphobia. Psychosomatic Med 59: 323–330Google Scholar
  46. Janet P (1920) The major symptoms of hysteria, 2nd edn. Macmillan, New YorkGoogle Scholar
  47. Keane JR (1989) Hysterical gait disorders: 60 cases. Neurology 39: 586–589PubMedCrossRefGoogle Scholar
  48. Kirk C, Saunders M (1977) Primary psychiatric illness in a neurological outpatient department in North-East England. Acta Psychiatr Scand 56: 294–302PubMedCrossRefGoogle Scholar
  49. Knights EB, Folstein MF (1977) Unsuspected emotional and cognitive disturbances in medical patients. Ann Intern Med 89: 723–724CrossRefGoogle Scholar
  50. Lance JW (1996) Transient sensations of impending loss of consciousness: the “blip” syndrome. J Neurol Neurosurg Psychiatry 60: 437–438PubMedCrossRefGoogle Scholar
  51. Lempert Th, Dieterich M, Huppert D, Brandt Th (1990) Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 82: 335–340PubMedCrossRefGoogle Scholar
  52. Lempert T, Brandt T, Dieterich M, Huppert D (1991) How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol 238: 140–146PubMedCrossRefGoogle Scholar
  53. Lilienfeld SO, Jacob RG, Furman JMR (1988) Vestibular dysfunction followed by panic disorder with agoraphobia. J Nery Ment Dis 177: 700–701Google Scholar
  54. Lipowski ZJ (1967) Review of consultation. Psychiatry and psychosomatic medicine. II. Clinical aspects. Psychosom Med 29: 201–244PubMedGoogle Scholar
  55. Luther JS, McNamara JO, Carwile S, Miller P, Hope V (1982) Pseudoepileptic seizures: methods and video analysis to aid diagnosis. Ann Neurol 12: 458–462PubMedCrossRefGoogle Scholar
  56. Mach E (1875) Grundlinien der Lehre von den Bewegungsempfindungen. Engelmann, LeipzigGoogle Scholar
  57. Maier W, Buller R (1988) One-year follow-up of panic disorders. Eur Arch Psychiatr Neurol Sci 238: 105–109Google Scholar
  58. Marks IM (1981) Space “phobia”: a pseudo-agoraphobic syndrome. J Neurol Neurosurg Psychiatry 44: 387–391PubMedCrossRefGoogle Scholar
  59. Marsden CD (1995) Psychogenic problems associated with dystonia. In: Wiener WJ, Lang AE (eds) Behavioral neurology movement disorders. Raven Press, New York, pp 319–326Google Scholar
  60. Mavissakalian M (1988) The placebo effect in agoraphobia -II. J Nery Ment Dis 176: 446–448CrossRefGoogle Scholar
  61. Mellstrom M, Cicala GA, Zuckerman M (1976) General versus specific trait anxiety measures in the prediction of fear of snakes, heights and darkness. J Consult Clin Psychol 44: 83–91PubMedCrossRefGoogle Scholar
  62. Merskey H, Buhrich NA (1975) Hysteria and organic brain disease. Br J Med Psychol 48: 359–376PubMedCrossRefGoogle Scholar
  63. Michelson LK, Marchione K (1991) Behavioral, cognitive, and pharmacological treatments of panic disorder with agoraphobia: Critique and synthesis. J Consult Clin Psychol 59: 100–114Google Scholar
  64. Mirabile CS, Glueck BC (1980) Motion sickness susceptibility and patterns of psychotic illness. Arch Gen Psychiatry 37: 42–50PubMedCrossRefGoogle Scholar
  65. Noyes R, Clancy J, Hoenk PR, Hymen DJ (1980) The prognosis of anxiety neurosis. Arch Gen Psychiatry 37: 173–178PubMedCrossRefGoogle Scholar
  66. Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higher-level gait disorders, particularly in the elderly. Neurology 43: 268–279PubMedCrossRefGoogle Scholar
  67. Page MGR, Gresty MA (1985) Motorist’s vestibular disorientation syndrome. J Neurol Neurosurg Psychiatry 84: 729–735CrossRefGoogle Scholar
  68. Peck CL (1977) Desensitization for the treatment of fear in the high level adult retardate. Behav Res Ther 15: 137–148PubMedCrossRefGoogle Scholar
  69. Pogâny E (1958) Über den Höhenschwindel. Mschr Ohrenheilk Laryng-Rhinol 92: 209–213Google Scholar
  70. Pratt RTC, McKenzie W (1958) Anxiety states following vestibular disorders. Lancet 11: 347–349CrossRefGoogle Scholar
  71. Rigatelli M, Casolari L, Bergamini G, Guidetti G (1984) Psychosomatic study of sixty patients with vertigo. Psychother Psychosom 41: 91–99PubMedCrossRefGoogle Scholar
  72. Ritter B (1969a) Treatment of acrophobia with contact desensitization. Behav Res Ther 7: 41–45PubMedCrossRefGoogle Scholar
  73. Ritter B (1969b) The use of contact desensitization, demonstration-plus-participation and demonstration-alone in the treatment of acrophobia. Behav Res Ther 7: 157–164PubMedCrossRefGoogle Scholar
  74. Rockwood CA, Eilert (1969) Camptocormia. J Bone Joint Surg 51: 553–556Google Scholar
  75. Schilder P (1933) The vestibular apparatus in neurosis and psychosis. J Nery Ment Dis 78: 1–23CrossRefGoogle Scholar
  76. Sheehan DV, Ballenger J, Jacobsen G (1980) Treatment of endogenous anxiety with phobic hysterical and hypocondriacal symptoms. Arch Gen Psychiatry 37: 51–59PubMedCrossRefGoogle Scholar
  77. Shevitz SA, Silberfarb PM, Lipowski ZJ (1976) Psychiatric consultations in a general hospital. A report on 1000 referrals. Dis Nery Syst 37: 259–300Google Scholar
  78. Sinel M, Eisenberg MS (1990) Two unusual gait disturbances: astasia, abasia, and camptocormia. Arch Phys Med Rehab 71: 1078–1080Google Scholar
  79. Singerman B, Rieder E, Folstein LM (1980) Emotional disturbance in hearing clinic patients. Br J Psychiatry 137: 58–62PubMedCrossRefGoogle Scholar
  80. Soreff H (1983) Camptocormia. Arch Orthop Trauma Surg 101: 151–152CrossRefGoogle Scholar
  81. Stahl SM, Soefje S (1995) Panic attacks and panic disorder: The great neurologic impostors. Semin Neurol 15: 126–132Google Scholar
  82. Strümpell A (1899) Lehrbuch der speziellen Pathologie and Therapie der Inneren Krankheiten. vol. 3, 12th edn. Vogel, Leipzig, pp 614–616Google Scholar
  83. Sullivan M, Clark MR, Katon WJ, Fischl M, Russo D, Dobie RA, Vorhees R (1993) Psychiatric and otologic diagnoses in patients complaining of dizziness. Arch Intern Med 153: 1479–1484PubMedCrossRefGoogle Scholar
  84. Takeya T, Baron JB, Ohno Y, Agathon M, Andersson JC, Ushio N, Bessineton JC, Pacifici M, Lemaire V, Chavannes N, Noto R (1978) Comparative study of post-traumatic and psychogenic acrophobia (fear of height). Agressologie 19: 19–92Google Scholar
  85. Takeya T, Ohno Y, Matsubara H, Yasuda K, Wantanabe S, Shinzato R, Tanaka Y, Noda S (1979) Physiological changes in the treatment of acrophobia (fear of height). Clin Otolaryngol 4: 197–205PubMedCrossRefGoogle Scholar
  86. Trimble MR (1984) Psychiatric aspects of vertigo. In: Dix MR, Hood DD (eds) Vertigo. Wiley, Chichester, pp 345–358Google Scholar
  87. Uimonen S, Laitakari K, Kiukaaniemi K, Sorri M (1995) Does posturography differentiate malingerers from vertiginous patients? J Vestib Res 5: 117–124PubMedCrossRefGoogle Scholar
  88. Whitlock FA (1967) The aetiology of schizophrenia. Acta Psychiatr Scand 43: 144–162PubMedCrossRefGoogle Scholar
  89. Williams D (1975) The borderland of epilepsy revisited. Brain 98: 1–12PubMedCrossRefGoogle Scholar
  90. Williams DT, Ford B, Fahn S (1995) Phenomenology and psychopathology related to pyschogenic movement disorders. In: Wiener WJ, Lang AE (eds) Behavioral neurology movement disorders. Raven Press, New York, pp. 231–257Google Scholar
  91. Wittchen H, Essau CA (1993) Epidemiology of panic disorder: progress and unresolved issues. J Psychiatr Res 27: 47–68PubMedCrossRefGoogle Scholar
  92. Wolpe J (1958) Psychotherapy by reciprocal inhibition. Stanford University Press, StanfordGoogle Scholar
  93. Yardley L, Luxon L, Bird J, Lear S, Britton J (1994) Vestibular and posturographic test results in people with symptoms of panic and agoraphobia. J Audiol Med 3: 48–65Google Scholar
  94. Yardley L, Watson S, Britton J, Lear S, Bird J (1995) Effects of anxiety arousal and mental stress on the vestibulo-ocular reflex. Acta Otolaryngol (Stockh) 115: 597–602CrossRefGoogle Scholar
  95. Zitrin CM, Klein DF, Woerner MG (1980) Treatment of acrophobia with group exposure in vivo and imipramine. Arch Gen Psychiatry 37: 63–72PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 2003

Authors and Affiliations

  • Thomas Brandt
    • 1
  1. 1.Neurologische Klinik, Klinikum GroßhadernLudwig-Maximillians-UniversitätMunichGermany

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