Types of dizziness and its relationship with psychological symptoms in patients with chronic dizziness

Ahmad Chitsaz, Faribourz Khourvash, Zahra Tolou-Ghamari, Ali Gholamrezaei, Azadeh Noormohamadi


Dizziness could be categorized as one of the most common medical complaints of patients referred to the neurology clinics. The aim of this study was to evaluate the type of dizziness and its relationship with psychological disorders in patients with chronic complaints. 179 patients with a range of 18 to 65 years were studied. Patients were asked to complete the revised questionnaire form that contained 90 questions related to the signs based on severity scale vertigo tool. Subsequently to detect organic or non-organic vertigo, the patients were divided into two groups. Patients were asked to complete the given questionnaire form. For psychiatric disorders screening questions of international standard for testing SCL-90-R were used. Vertigo severity scale was used for the evaluation of dizziness severity. To compare quantitative variables between the two groups independent t-Test was used and p value of ≤0.05 was considered as significant. Of the total population 70.9% were females. 74% of patients have had dizziness due to organic causes and 26% have had dizziness due to non-organic causes. Dimension scores related to somatic complaints, obsessive-compulsive, depression, anxiety, paranoid ideation and global severity index in individuals with non-organic vertigo was significantly higher than other groups. There was a significant direct relationship between the overall score related to intensity of dizziness and all of the questionnaire dimensions'. There was significant correlation between the extent of physical complaints and the fear for morbid (p<0.001). The score of extent related to dizziness/balance in patient with vertigo due to organic causes and score of extent related to autonomic/anxiety in patient with vertigo due to non-organic causes was significantly higher than other groups.


Dizziness; psychological symptoms; somatoform disorders

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Weidt S, Bruehl AB, Straumann D, Hegemann SC, Krautstrunk G, Rufer M. Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship. BMC Health Serv Res. 14:317. doi: 10.1186/1472-6963-14-317, 2014.

Ketola S, Havia M, Appelberg B, Kentala E. Psychiatric symptoms in vertiginous patients. Nord J Psychiatry. 69(4):287-91. doi: 10.3109/08039488.2014.972976. Epub 2014 Nov 14, 2015.

Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord. 17(4):369-88, 2003.

Best C, Eckhardt-Henn A, Tschan R, Dieterich M. Why do subjective vertigo and dizziness persist over one year after a vestibular vertigo syndrome? Ann N Y Acad Sci. 334-7, 2009.

Dieterich M, Eckhardt-Henn A. Neurological and somatoform vertigo syndromes. Nervenarzt. 75(3):281-302, 2004.

Staab JP. Chronic dizziness: the interface between psychiatry and neuro-otology. Curr Opin Neurol. 19(1): 41-8, 2006.

Andersson G, Hagman J, Talianzadeh R, Svedberg A, Larsen HC. Dual-task study of cognitive and postural interference in patients with vestibular disorders. Otol Neurotol. Mar;24(2):289-93, 2003.

Dieterich AE-HaM. Psychiatric Disorders in Otoneurology Patients. . Neurol Clin 23:731–49, 2005.

Kondo M, Kiyomizu K, Goto F, Kitahara T, Imai T, Hashimoto M, Shimogori H, Ikezono T, Nakayama M, Watanabe N, Akechi T. Analysis of vestibular-balance symptoms according to symptom duration: dimensionality of the Vertigo Symptom Scale-short form. Health Qual Life Outcomes. 2015 Jan 22;13:4. doi: 10.1186/s12955-015-0207-7.

Mègnigbêto CA, Sauvage JP, Launois R. [The European Evaluation of Vertigo (EEV) scale: a clinical validation study]. Rev Laryngol Otol Rhinol (Bord). 2001;122(2):95-102.

Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord. 17(4):369-88, 2003.

Paillard AC, Quarck G, Paolino F, Denise P, Paolino M, Golding JF, Ghulyan-Bedikian V. Motion sickness susceptibility in healthy subjects and vestibular patients: effects of gender, age and trait-anxiety. J Vestib Res. 23(4-5):203-9. doi: 10.3233/VES-130501, 2013.

Schniepp R, Brandt T, Huth S, Pradhan C, Jahn K, Wuehr M. Gait characteristics of patients with phobic postural vertigo: effects of fear of falling, attention, and visual input. J Neurol. 261(4):738-46. doi: 10.1007/s00415-014-7259-1. Epub 2014 Feb 12, 2014.

Schmid G, Dieterich M, Henningsen P, Lahmann C, Sattel H,. Psychotherapy in dizziness: a systematic review. J Neurol Neurosurg Psychiatry. 82(6):601-6, 2011.

Zur O, Carmeli E. The University of California Los Angeles Dizziness Questionnaire: advantages and disadvantages. J Vestib Res. 23(6):279-83. doi: 10.3233/VES-130480, 2013.

Schniepp R, Brandt T, Jahn K, Krafczyk S, Novozhilov S, Pradhan C, Wuehr M. Nonlinear variability of body sway in patients with phobic postural vertigo. Front Neurol. 15;4:115. doi: 10.3389/fneur.2013.00115. eCollection 2013.

Jacob RG RM, Furman JM. Optic flow-induces sway in anxiety disorders associated with space and motion discomfort. J Anxiety Disord. 9:411–25, 1997.

Erin G. Piker GPJ, Devin L. McCaslin,Sarah L. Grantham. Psychological Comorbidities and Their Relationship to Self-Reported Handicap in Samples of Dizzy Patients. J Am Acad Audiol. 19:337-47, 2008.

Wada M, Takeshima T, Nakamura Y, Nagasaka S, Kamesaki T, Oki H, Kajii E. Incidence of dizziness and vertigo in Japanese primary care clinic patients with lifestyle-related diseases: an observational study. Int J Gen Med. 2015 Apr 16;8:149-54. doi: 10.2147/IJGM.S82018. eCollection 2015.

Zalewski CK, Chien WW, King KA, Muskett JA, Baron RE, Butman JA, Griffith AJ, Brewer CC. Vestibular Dysfunction in Patients with Enlarged Vestibular Aqueduct. Otolaryngol Head Neck Surg. 2015 May 12. pii: 0194599815585098.

Muller I, Kirby S, Yardley L. Understanding patient experiences of self-managing chronic dizziness: a qualitative study of booklet-based vestibular rehabilitation, with or without remote support. BMJ Open. e007680. doi: 10.1136/bmjopen-2015-007680, 2015.

Jacob RG, Whitney SL, Detweiler-Shostak G, Furman JM. Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: a pilot study. J Anxiety Disord. Jan-Apr;15(1-2):131-46, 2001.

Best C, Eckhardt-Henn A, Tschan R, Dieterich M. Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. Results of a prospective longitudinal study over one year. J Neurol. Jan;256(1):58-65, 2009.

Tschan R, Wiltink J, Best C, Beutel M, Dieterich M, Eckhardt-Henn A. Validation of the German version of the Vertigo Handicap Questionnaire (VHQ) in patients with vestibular vertigo syndromes or somatoform vertigo and dizziness. Psychother Psychosom Med Psychol. Sep-Oct;60(9-10):e1-12, 2010.

Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience. Dec 29;164(4):1579-87, 2009.

Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M. Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry. May;77(5):658-64, 2006.

Eckhardt-Henn A, Tschan R, Best C, Dieterich M. Somatoform vertigo syndrome. Nervenarzt. Aug;80(8):909-17, 2009.

Schmid G, Henningsen P, Dieterich M, Sattel H, Lahmann C. Psychotherapy in dizziness: a systematic review. J Neurol Neurosurg Psychiatry. Jun;82(6):601-6, 2011.

Monzani D, Casolari L, Guidetti G, Rigatelli M. Psychological distress and disability in patients with vertigo. J Psychosom Res. Jun;50(6):319-23, 2001.

Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A, Dieterich M, Beutel ME. Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey. J Psychosom Res. May;66(5):417-24, 2009.

R. M. Standardizing and Validating of SCL-90-R in Iran [MSc Thesis]. Tehran University of Medical Sciences.

Balaban CD, Jacob JR, and Furman JM. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Review of Neurotherapeutics. 11(3): 379-94, 2011.

Ettigi P, Meyerhoff AS, Chirban JT, Jacobs JR, WilsonRR. The quality of life and employment in panic disorder. Journal of Nervous and Mental Disease. 185:368–72, 1997.


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