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Psychogenic vertigo, particularly phobic postural vertigo (PPV), [1,2] is common. Of 768 consecutive neurologic patients presenting at our dizziness unit in Munich between 1989 and 1992 Table 1, 158 (21%) had benign paroxysmal positioning vertigo and 129 (17%) had PPV, whereas less than 10% had other well-known disorders such as Meniere's disease and vestibular neuritis. The frequency of psychogenic vertigo and the diagnostic uncertainties prompt this review.
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Table 1. Frequency of different kinds of vertigo syndromes in 768 patients seen in a dizziness unit (1989-1992)
Patients with somatization symptoms consult specialists for their symptom of primary concern; with vertigo, it is the neurologist or otolaryngologist. I will discuss the interrelationship between psychiatric disorders and vestibular function and different forms of psychogenic vertigo before defining the clinical entity of PPV.
Vestibular dysfunction secondary to psychiatric disorders and psychiatric disorders secondary to vestibular dysfunction.
Attempts to define a neurophysiologic link between psychiatric disorders and somatic symptoms have concentrated on vertigo for centuries, [3-5] even before the remarkable group of 19th century scientists discovered the functions of the labyrinths and laid the foundation of modern vestibular and ocular motor research. [6-7] The vestibular-psychiatric interrelationships include the following: (1) schizophrenic patients often have abnormal responses in vestibular testing; [8] (2) patients with anxiety neurosis exhibit greater sensitivity and directional preponderance in vestibular testing; [9] (3) psychiatric, in particular schizophrenic, patients are more susceptible to motion sickness; [10] (4) patients with vestibular symptoms, particularly Meniere's disease, have a high frequency of abnormalities on psychometric tests; [11-13] (5) feeling dizzy or unsteady are among the 13 cardinal symptoms of panic attacks as defined in DSM-IV, [14] and the dizziness may even be present between attacks; [15] (6) psychiatric morbidity is high in unselected patients with vestibular disorders and remains high on strictly selected patients with documented organic vestibular dysfunction; [16] and (7) organic vestibular disease may precipitate as …
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