Can mental health problems cause dizziness?
Anxiety, in particular, can cause psychogenic dizziness, but rarely causes true vertigo (the sensation of self-motion).
These patients may appear normal on objective diagnostic tests but may describe lightheadedness when asked to hyperventilate. If given some time during the initial visit the patient may express anxiety about a particular life event or about life issues in general.
The patient might express concern about health problems or may describe the occurrence of specific stressors.
Anxiety disorders commonly present with chronic continuous dizziness and patients may not appreciate the relationship of dizziness and anxiety symptoms.
Anxiety patients may describe their symptoms as an out-of-body experience, floating, or an internal spinning sensation without visualizing the environment spinning. These psychophysiologic symptoms represent a combination of psychiatric and physiologic factors.
Some patients, particularly patients with migraine, are chronically sensitive to motion (self and surround). Anxiety disorders may last for days and may be precipitated by stress, complex visual motion (large screen theater), and confining spaces with large crowd movement.
Anxiety-related dizziness is best managed by standard anxiety therapy.
Stress has been shown, in several objective studies, to exacerbate vertigo. Therefore, take the patient seriously when she or he describes having stress.
A mild vestibular impairment may be present but the effects may be magnified by the stress, either in the patient’s personal/family life or in the patient’s professional/work life.
Therefore psychogenic dizziness may be one component of a more complex picture.
Psychogenic dizziness may be situational, i.e., related to specific events or places, such as having an MRI if the individual is claustrophobic, going to the workplace when the patient is having some problems with coworkers, going to court during divorce proceedings, or being in crowds if the individual has posttraumatic stress disorder.
The clinical picture in these patients includes short-term, variable episodes of dizziness, with or without true vertigo, shortness of breath or a sense of “blacking out,” sudden vasovagal signs when the individual is sitting still and not moving his head, paresthesias, or symptoms that become worse in the presence of the spouse or significant other.
These patients should be treated for the vestibular disorder, if one is present. They may benefit from sensible advice and information about the nature of the vestibular disorder and the possible relationship of dizziness to stress or anxiety.
They may benefit from meeting with a qualified mental health professional for counseling with cognitive behavioral therapy or other forms of psychotherapy as appropriate to the patient’s mental health problem.
The same patients may benefit from judicious use of medications, but beware of the side effects of medications, including dizziness!
They may also benefit from working with an occupational therapist on redesigning or modifying the patient’s lifestyle to reduce stressors.
