Psychogenic Vertigo

The sensation of vertigo, a subjective complaint, is sometimes defined as a hallucination of movement or an illusion. Since evaluation of hallucinations and illusions is an essential part of psychiatric practice, such definitions place vertigo at the doorstep of clinical psychiatry (Trimble 1984). Vertigo is a frequent symptom of psychiatric illness, in particular in anxiety, depression, and personahty disorders, but less frequent in psychosis. However, to complicate matters, because of its incapacitating nature vestibular dysfunction frequently causes psychiatric illness. This may bias the diagnosis of organic vertigo syndromes by a considerable neurotic overlay e.g. in patients with Menière’s disease. Alternatively, a transient labyrinthine dysfunction, e.g. in vestibular neuritis, may initiate development of neurosis in which anxiety, panic attacks and depression are most common, and which typically preserves subjective vertigo and postural imbalance although the peripheral lesion is already either recovered or centrally compensated. In the latter case there is a history of an initial rotational vertigo, lateropulsion and nausea (with the objective clinical signs of horizontal rotatory nystagmus and unilateral hyporesponsiveness to caloric irrigation) which is followed by a more indefinite chronic dizziness with subjective postural imbalance or spells of vertigo during active body movements, associated with anxiety and change in behaviour (see Phobic Postural Vertigo, p. 292). Obsessional subjects are more likely to proceed from organic to psychiatric disease, and the obvious presence of an obsessional personality will support the diagnosis of this condition.