Which comes first? psychogenic dizziness versus otogenic anxiety

Authors

  • Jeffrey P. Staab MD, MS,

    Corresponding author
    1. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, U.S.A.
    2. The Balance Center, University of Pennsylvania, Philadelphia, PA, U.S.A.
    • Dr. Jeffrey P. Staab, Assistant Professor of Psychiatry, Hospital of the University of Pennsylvania, Founders Pavilion, F11.015, 3400 Spruce Street, Philadelphia, PA 19104, U.S.A.
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  • Michael J. Ruckenstein MD

    1. Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, U.S.A.
    2. The Balance Center, University of Pennsylvania, Philadelphia, PA, U.S.A.
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  • This article was presented at The Eastern Section Meeting of the Triological Society, Boston MA, January 25, 2003.

Abstract

Objective: To investigate the hypotheses that physical neurotologic conditions may trigger anxiety disorders (otogenic pattern of illness), that psychiatric disorders may produce dizziness (psychogenic pattern), and that risk factors for these syndromes may be identified. Study Design: Retrospective review of all patients (N = 132) treated at a tertiary care balance center from 1998 to 2002 for psychogenic dizziness with or without physical neurotologic illnesses. Methods: All patients underwent comprehensive neurotologic and psychiatric evaluations with attention to the longitudinal course of symptoms and risk factors for psychopathology. Patients were grouped according to the condition first causing dizziness. Risk factors were compared across groups. Results: Three equally prevalent patterns of illness were found: anxiety disorders as the sole cause of dizziness (33% of cases), neurotologic conditions exacerbating preexisting psychiatric disorders (34%), and neurotologic conditions triggering new anxiety or depressive disorders (33%). Panic disorder and agoraphobia were significantly more prevalent than less severe phobias in the first two groups, whereas the opposite pattern existed in the third group (P < .0001). More patients in the first two groups had risk factors for anxiety disorders (P < .05). Depression was not a primary cause of dizziness in any patient. Vestibular neuronitis, benign paroxysmal positional vertigo, and migraine were the most common neurotologic conditions. Conclusions: These data support the hypothesis that physical neurotologic conditions may trigger psychopathology as often as primary anxiety disorders cause dizziness. A third pattern appears to be equally common wherein physical neurotologic conditions exacerbate preexisting psychiatric illnesses. Individuals at risk for anxiety disorders may be more likely to have primary psychopathology.

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