If you’ve suffered from dizziness for a long time, there’s a good chance you’ve been told it’s just anxiety. However, you know that you’re experiencing vertigo, unsteadiness, poor balance and travel sickness. Perhaps your symptoms are aggravated by seeing other people move, by travelling on an escalator, or by walking through a supermarket. You might even experience nausea, sweating and a rapid heart beat.
The link between dizziness and anxiety has been questioned since the 1800’s when agoraphobia was first described (Staab et al 2013). However, it’s only over the last 20 years that the connection has been made concrete. Without a doubt there’s a strong link between the two. However, it’s a bidirectional. Dizziness can cause anxiety and anxiety can cause dizziness (Probst T et al 2017).
So, you’re anxious, does this mean your dizziness isn’t real? Of course not. Your symptoms are 100% real. Anxiety causes changes in how your body and brain function, resulting in a real change in how your control balance.
Persistent Posturo-Perceptual Dizziness (triple PD) is a newly classified conditions tries to describe dizziness where no true damage can be found. Again, this doesn’t mean it’s all in your head. PPPD occurs in people who had a brief episode of vertigo e.g. BPPV. It occurs in people with anxiety but no history of vestibular dysfunction. Finally, it occurs in people with chronic vestibular dysfunction but no history of anxiety (Chiarella et al 2016). It’s very similar, and perhaps replaces, the diagnoses of Chronic Subjective Dizziness and Phobic Postural Vertigo.
(Reference: Stabb et al 2017)
It appears that personality types are important. If you’re highly strung, nervous and naturally anxious, then unfortunately you’re more likely to develop PPPD (Probst T et al 2017). However, your initial vertigo severity is linked to anxiety levels and the possible development of PPPD (Chiarella et al 2016).
Currently we don’t know the precise nature of PPPD, but research suggests a few different reasons. Your brain uses information from your eyes, ears and feedback from your body to build a map your body and environment. This controls your movement, balance and posture.
PPPD patients, we believe, start to rely more on the visual system (Stabb et al 2017). If you look at your surroundings you’ll notice just how complex the world is. There are lines, textures, changes in light, subtle changes in colour etc… All of which can create visual illusions, changes depth perception, contrast etc… Your brain normally corrects for this by comparing that information to what the ears and body are saying.
It’s quite normal to sway a little when standing still, studies have shown that people with PPPD actually sway less! However, they are far more vigilant and tense, so when they do sway/wobbly they feel less stable (Stabb et al 2017).
Finally, the areas of the brain that combine multi-sensory information appear to be less active. Whereas, the areas which detect threat seem to be more active i.e. less sense of where you are and what’s happening around you creates more fear of falling/injury.
(Reference: Stabb et al 2013)
Yes, but treatment needs to be comprehensive. We need to assess how you create balance e.g. are you using your visual system too much? Assess whether anxiety is playing a role in your symptoms. Assess for other causes of dizziness e.g. vestibular neuritis. After the assessment I will explain your results and put together a plan to address each component of your dizziness.
Research shows that understanding the cause of your dizziness helps reduce the symptoms. Furthermore, having easy access to a therapist while performing a vestibular rehab program helps to reduce symptoms. (Muller et al. 2015)
You will normally need to perform daily exercises 2-3 times per day. However, the exercises may only take 5-10 minutes.
If you think PPPD sounds like you the next step is to get in touch with suitable healthcare professional. Your ENT, neurologist, neurophysiotherapist or chiropractic neurologist should be able to help. You are welcome to contact me with any questions you may still have. I work as a chiropractor with a special interest in neurology in Woking.
Your GP may not have heard of PPPD is as it was only classified in 2017. Equally not all chiropractic clinics are suitable for treatment. Be sure to contact them before making an appointment.
Probst T et al. Psychological distress longitudinally mediates the effect of vertigo symptoms on vertigo-related handicap. J Psychosom Res. 2017.
Muller, I., Kirby, S. and 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, 5 (5), e007680. 2015.
Stabb et al. Threat Assessment and Locomotion: Clinical Applications of an Integrated Model of Anxiety and Postural Control. SeminNeurol. 2013.
Stabb et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of vestibular research. 2017.