Vertigo pp 469-479 | Cite as

Phobic postural vertigo

  • Thomas Brandt


Phobic postural vertigo (PPV) (Brandt and Dieterich 1986; Brandt 1996) has been described as a syndrome that is distinguishable from panic disorder, agoraphobia, and the pseudo-agoraphobia syndrome “space phobia” (Marks 1981). Since we began diagnosing it as a clinical entity, PPV has become the second-most common cause of vertigo in our dizziness unit (p. 23). Closely connected with gait and posture, PPV is characterised by a combination of non-rotational vertigo with subjective postural imbalance and unsteadiness, normal neuro-otological tests, and phobic avoidance behaviour mainly in patients with an obsessive-compulsive personality. The monosymptomatic subjective disturbance of balance manifests with superimposed attacks that occur with and without recognisable provoking factors in one and the same patient. The patient experiences them with and without accompanying excess anxiety, misleading both patient and physician to make a false diagnosis of organic disease. Although an association of PPV with anxiety disorders is evident, not all patients present with symptoms of anxiety or panic during attacks of vertigo. However, most patients develop a disabling “phobic/avoidance pattern” (Kapfhammer et al. 1997). These patients contact neurologists or otolaryngologists first and foremost and not psychiatrists or psychotherapists, since their prevailing complaint is distressing postural imbalance and vertigo.


Panic Disorder Efference Copy Dysthymic Disorder Illusory Movement Episodic Ataxia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Agras WS, Chapin HN, Oliveau DC (1972) The natural history of phobia. Arch Gen Psychiatry 26: 315–317PubMedCrossRefGoogle Scholar
  2. Ballenger JC, Burrows GD, Du Pont RL (1988) Alprazolam in panic disorder and agoraphobia: results from a multicentre trial. Arch Gen Psychiatry 45: 413–422PubMedCrossRefGoogle Scholar
  3. Barlow DH (1990) Long-term outcome for patients with panic disorder treated with cognitive-behavioral therapy. J Clin Psychiatry 51 (Suppl A): 17–23PubMedGoogle Scholar
  4. Beitman BD, Basha I, Flaker G, De Rosear L, Mukerji V, Lamberti J (1987) Non-fearful panic disorder: panic attacks without fear. Behav Res Ther 25: 487–492PubMedCrossRefGoogle Scholar
  5. Brandt Th (1996) Phobic postural vertigo. Neurology 49: 1480–1481CrossRefGoogle Scholar
  6. Brandt Th, Daroff RB (1980) The multisensory physiological and pathological vertigo syndromes. Ann Neurol 7: 195–203PubMedCrossRefGoogle Scholar
  7. Brandt Th, Dieterich M (1986) Phobischer AttackenSchwankschwindel. Ein neues Syndrom. Munch med Wochenschr 128: 247–250Google Scholar
  8. Brandt T, Huppert D, Dieterich M (1994) Phobic postural vertigo: a first follow-up. J Neurol 241: 191–195PubMedCrossRefGoogle Scholar
  9. Brandt T, Kapfhammer HP, Dieterich M (1997) Phobischer Schwankenschwindel. Eine weitere Differenzierung psychogener Schwindelzustände erscheint erforderlich. Nervenarzt 68: 848–849Google Scholar
  10. Bronstein AM (1995) Visual vertigo syndrome: clinical and posturography findings. J Neurol Neurosurg Psychiatry 59: 472–476PubMedCrossRefGoogle Scholar
  11. Bronstein AM, Gresty MA, Luxon LM, Ron MA, Rudge P, Yardley L (1997) Phobic postural vertigo. Neurology 49: 1480–1481PubMedCrossRefGoogle Scholar
  12. Brown JJ, Baloh RW (1987) Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. J Otolaryngol 8: 219–223.CrossRefGoogle Scholar
  13. Crowe RR (1990) Panic disorder: genetic considerations. J Psychiatr Res 24: 129–134PubMedCrossRefGoogle Scholar
  14. Eckhardt-Henn A, Hoffman SO, Tettenborn B, Thamlske C, Hopf HC (1997) Phobischer Schwindel. Nervenarzt 68: 806–812PubMedCrossRefGoogle Scholar
  15. Ford CV, Folks DGC (1985) Conversion disorders: an overview. Psychosomat 26: 371–382CrossRefGoogle Scholar
  16. Frommberger U, Angenendt J, Berger M (1995) Die Behandlung von Panikstörungen und Agoraphobien. Nervenarzt 66: 173–186PubMedGoogle Scholar
  17. Furman JM, Jacob RG (1997) Psychiatric dizziness. Neurology 48: 1161–1166PubMedCrossRefGoogle Scholar
  18. Fyer AJ, Mannuzza S, Gallops MS, Martin LY, Aaronson C, Gorman JM, Liebowitz MR, Klein DF (1990) Familial transmission of simple phobias and fears. Arch Gen Psychiatry 47: 252–256PubMedCrossRefGoogle Scholar
  19. Gordon CR, Spitzer O, Doweck I, Melamed Y, Shupak A (1995) Clinical features of Mal de debarquement: Adaption and habituation to sea conditions. J Vestib Res 5: 363–369Google Scholar
  20. Gresty MA, Bronstein AM, Brandt Th, Dieterich M (1992) Neurology of otolith function: Peripheral and central disorders. Brain 155: 647–673Google Scholar
  21. Holst E v, Mittelstaedt H (1950) Das Reafferenzprinzip ( Wechselwirkung zwischen Zentralnervensystem und Peripherie ). Naturwissenschaften 37: 464–476Google Scholar
  22. Huppert D, Brandt T, Dieterich M, Strupp M (1994) Phobischer Schwankschwindel. Nervenarzt 65: 421–423PubMedGoogle Scholar
  23. Huppert D, Kunihiro T, Brandt T (1995) Phobic postural vertigo (154 patients): its association with vestibular disorders. J Audiol Med 4: 97–103Google Scholar
  24. Kapfhammer HP, Mayer C, Hock U, Huppert D, Dieterich M, Brandt T (1997) Course of illness in phobic postural vertigo. Acta Neurol Scand 95: 23–28PubMedCrossRefGoogle Scholar
  25. Krafczyk S, Schlamp V, Dieterich M, Haberhauer P, Brandt Th (1998) Increased body sway at 3.5–8 Hz in patients with phobic postural vertigo. Neurosci Lett 259: 149–152CrossRefGoogle Scholar
  26. Lazare A (1981) Current concepts in psychiatry. Conversion symptoms. N Engl J Med 305: 745–748PubMedCrossRefGoogle Scholar
  27. Lesser IM, Rubin RT, Pecknold JC, Rifkin A, Sinson RP, Lydiard RB, Burrows GD, Noyes R, Du Pont RL (1988) Secondary depression in panic disorder and agoraphobia. I. Frequency, severity, and response to treatment. Arch Gen Psychiatry 45: 437–443Google Scholar
  28. Lilienfeld SO, Jacob RG, Furman JMR (1988) Vestibular dysfunction followed by panic disorder with agoraphobia. J Nery Ment Dis 177: 700–701Google Scholar
  29. Mair IWS (1996) The mal de débarquement syndrome. J Audio] Med 5: 21–25Google Scholar
  30. Marks IM (1981) Space “phobia”: a pseudo-agoraphobic syndrome. J Neurol Neurosurg Psychiatry 44: 387–391PubMedCrossRefGoogle Scholar
  31. Murphy T (1993) Mal de debarquement syndrome: a forgotten entity? Otolaryngol Head Neck Surg 109: 10–13PubMedGoogle Scholar
  32. Noyes R, Clancey J, Hoenk PR, Hymen DJ (1980) The prognosis of anxiety neurosis. Arch Gen Psychiatry 37: 42–50CrossRefGoogle Scholar
  33. Noyes R, Holt CS (1994) Anxiety disorders. In: Winokur G, Clayton PJ (eds) The medical basis of psychiatry, 2nd edn. Saunders, PhiladelphiaGoogle Scholar
  34. Page MGR, Gresty MA (1985) Motorist’s vestibular disorientation syndrome. J Neurol Neurosurg Psychiatry 84: 729–735CrossRefGoogle Scholar
  35. Pratt RTC, McKenzie W (1958) Anxiety states following vestibular disorders. Lancet II: 347–349Google Scholar
  36. Stahl SM, Soefje S (1995) Panic attacks and panic disorder: The great neurologic impostors. Semin Neurol 15: 126–132Google Scholar

Copyright information

© Springer-Verlag London 2003

Authors and Affiliations

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

Personalised recommendations