Some cases of chronic dizziness may be tied to a psychiatric disorder, according to a new study published in The Journal of the American Osteopathic Association. The cause-and effect relationship can go both ways, with a psychiatric disorder triggering dizziness or vice versa.
The researchers looked over published studies focusing on the link between mental disorders and dizziness. They found that psychiatric disorders (primarily anxiety-related conditions) may be present in up to 15 percent of patients experiencing dizziness.
In general, chronic dizziness can result from a variety of underlying health problems, most commonly involving neurologic, vestibular and cardiac diseases. For sufferers who have been to several specialty physicians without ever receiving a diagnosis, however, a psychiatric referral may help them find relief, researchers said.
In fact, psychiatric disorders appear to be the second most common cause of chronic dizziness. The first is vestibular disease, which affect parts of the inner ear and brain responsible for controlling balance.
“One of the reasons the underlying cause can be so difficult to diagnose is that the way dizziness is experienced can vary dramatically,” said Zak Kelm, D.O., psychiatry resident at Ohio State University and lead author of this study.
Dizziness can fall into a number of broad categories, including vertigo (spinning sensation), presyncope (near-fainting), and disequilibrium (imbalance). When a patient’s description of symptoms appears consistent with one of these categories, doctors are better able to make an accurate diagnosis.
“Patients who have a difficult time describing their symptoms, or seem to experience several different symptoms, are likely experiencing non-specific dizziness,” Kelm said. “When physicians see patients who report general or vague dizziness, it should be a cue to ask about the patient’s mental health.”
The link between dizziness and psychiatric disorders is complex. It is often quite difficult to determine which one is causing the other or whether the interplay is reciprocal.
In an attempt to better understand this relationship, researchers have introduced the term chronic subjective dizziness (CSD). This is a condition in which patients experience dizziness most days for more than three months.
People with CSD often describe feeling heavy-headed, light-headed or imbalanced. Some feel as if the floor is moving, while others feel disassociated or far away from their environment. Many say their symptoms worsen with complex stimuli, such as being in a crowded space.
In one of the studies, one-third of patients with CSD had a primary anxiety disorder and no history of vestibular disorder or another disease that could cause dizziness. Another one-third had no history of a psychiatric disorder but had a vestibular disease that triggered an onset of anxiety.
The last one-third had a history of an anxiety or other psychiatric disorder, then developed a medical condition that triggered dizziness. In those cases, the pre-existing psychiatric disorder had become worse and resulted in chronic dizziness.
In any of these cases, it is important that the underlying or resulting psychiatric disorder is addressed.
“One of the reasons psychiatric disorders are overlooked is because many physicians are uncomfortable suggesting to patients that they might have a mental illness,” Kelm said.
“I think asking the patient about their stress levels and whether they’ve experienced anxiety can make the conversation more approachable for both parties.”
Once referred to a psychiatrist, some patients find success with cognitive-behavioral therapy (CBT); however, pharmacotherapy appears to be most helpful. Selective serotonin reuptake inhibitors (SSRIs) have proven effective, with approximately 50 percent of patients given an SSRI experiencing complete remission of symptoms, and 70 percent reporting a significant decrease in symptoms.
The authors note that a whole-person treatment approach — taking into account the patient’s mental and emotional health as well as their physical health — can help physicians get to the root of the problem more quickly.
Source: American Osteopathic Association