Visually-induced dizziness is associated with sensitivity and avoidance across all senses
Open accessAbstract
BACKGROUND: Persistent postural perceptual dizziness (PPPD) is a common chronic condition presenting in neurology and neuro-otology clinics. Symptoms lie on a spectrum in the general population. The cause is unknown and thought to involve interactions between visual and vestibular systems, but symptoms also correlate with anxiety and migraine. OBJECTIVE: To test whether PDDD symptoms are associated with reported differences in other senses (touch, hearing, smell and taste); to investigate possible mediation via anxiety or migraine; to discover the proportion of variance accountable to these non-vestibular factors. METHODS: We measured self-report multisensory sensitivity, anxiety, visual difficulties, visual discomfort and migraine in patients with PPPD (N = 29) and a large general population cohort (N > 1100). We used structural equation modelling to examine relationships between the factors using a step-wise approach. RESULTS: We found increased self-reported over-sensitivity in sensory domains beyond vision and balance in both patients with PPPD and non-clinical participants with more PPPD symptoms. SEM analysis revealed that anxiety partly, but not wholly, mediated this relationship. Adding visual difficulties and visual discomfort to the model allowed it to explain 50% of PPPD symptom variance. Most of the path coefficients and mediation effects in our model were unchanged between participants with and without migraine. CONCLUSIONS: Our findings support the idea that PPPD is a complex neurological condition that includes broad perceptual factors, and may suggest that some brains are predisposed to generalised cross-modal sensory-overload. This may give rise to vulnerability to severe PPPD should a vestibular insult occur.
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Few subjective scales are validated for assessing the intensity of visual vertigo, and these scales are limited by recall bias because they require individuals to rate symptoms from memory.
“Few subjective scales are validated for assessing the intensity of VV, yet these scales are limited by recall bias, as they require individuals to rate their symptoms from memory.”
From A Pilot Study to Assess Visual Vertigo in People with Persistent Postural–Perceptual Dizziness with a New Computer-Based Tool (2023) · cites this paper as [10]
The Method > Measures section describes the Visual Vertigo Analogue Scale as a subjective rating of dizziness in nine situations, and the Discussion > Caveats section acknowledges limitations of self-reported ratings. Neither section says that few visual-vertigo scales are validated or identifies recall bias from rating symptoms from memory; the caveat concerns introspection and response bias instead. Page numbers were not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPeople with PPPD tend to avoid provocative situations and activities in daily life, so their VVAS scores may not reflect present reality.
“People with PPPD tend to avoid provocative situations and activities in daily life, thus, the scoring of the items may not reflect the present reality [10].”
From A Pilot Study to Assess Visual Vertigo in People with Persistent Postural–Perceptual Dizziness with a New Computer-Based Tool (2023) · cites this paper as [10]
The Results (Patient cohort comparison; page not supplied) report greater sensory avoidance in patients with PPPD, and the Methods (Measures; page not supplied) identify the VVAS items as situations that trigger visually induced dizziness. The paper does not establish that patients avoid those particular situations in daily life or that avoidance makes VVAS scores unrepresentative of their present condition. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAvoidant behaviors are common in people with visual vertigo.
“Such avoidant behaviors are common in people with VV [10].”
From A Pilot Study to Assess Visual Vertigo in People with Persistent Postural–Perceptual Dizziness with a New Computer-Based Tool (2023) · cites this paper as [10]
The Results (Patient cohort comparison; page unavailable) report greater sensory avoidance in patients with persistent postural-perceptual dizziness (PPPD) than in a non-clinical comparison group. The paper measures visually induced dizziness, but its avoidance analysis excludes visual and movement items. It therefore supports an association with avoidance, not the specific claim that the avoidant behaviors at issue are common in people with visual vertigo. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Sensory integration and learning disorders
Ayres, A. J. (1973) · Western Psychological Services eBooks · Cited by 1,381 · see citing works
BARSKY, A. J., & Borus, J. F. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-11-199906010-00016 · Cited by 964 · see citing works
Dunn, W. (1997) · Infants & Young Children · doi:10.1097/00001163-199704000-00005 · Cited by 899 · see citing works
Staab, J. P., Eckhardt-Henn, A., Horii, A., Jacob, R., Strupp, M., Brandt, T., & Bronstein, A. (2017) · Journal of Vestibular Research · doi:10.3233/ves-170622 · Cited by 840 · see citing works
Edge co-occurrence in natural images predicts contour grouping performance
Geisler, W. S., Perry, J. S., Super, B. J., & Gallogly, D. P. (2001) · Vision Research · doi:10.1016/s0042-6989(00)00277-7 · Cited by 678 · see citing works
A Comparison of the Performance of Children With and Without Autism on the Sensory Profile
Kientz, M. A., & Dunn, W. (1997) · American Journal of Occupational Therapy · doi:10.5014/ajot.51.7.530 · Cited by 466 · see citing works
Neurological bases for balance–anxiety links
Balaban, C. D., & Thayer, J. F. (2001) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(00)00042-6 · Cited by 438 · see citing works
The adult sensory profile: measuring patterns of sensory processing.
Brown, C., Tollefson, N., Dunn, W., Cromwell, R., & Filion, D. (2001) · American Journal of Occupational Therapy · doi:10.5014/ajot.55.1.75 · Cited by 422 · see citing works
Visual vertigo: Symptom assessment, spatial orientation and postural control
Guerraz, M. (2001) · Brain · doi:10.1093/brain/124.8.1646 · Cited by 369 · see citing works
Popkirov, S., Staab, J. P., & Stone, J. (2018) · Practical Neurology · doi:10.1136/practneurol-2017-001809 · Cited by 334 · see citing works
Is The Cerebral Cortex Hyperexcitable or Hyperresponsive in Migraine?
Coppola, G., Pierelli, F., & Schoenen, J. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01500.x · Cited by 332 · see citing works
Brandt, T. (1996) · Neurology · doi:10.1212/wnl.46.6.1515 · Cited by 323 · see citing works
Visual vertigo syndrome: Clinical and posturography findings
Bronstein, A. M. (1995) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.59.5.472 · Cited by 307 · see citing works
Neural substrates linking balance control and anxiety
BALABAN, C. (2002) · Physiology & Behavior · doi:10.1016/s0031-9384(02)00935-6 · Cited by 269 · see citing works
Which comes first? Psychogenic dizziness versus otogenic anxiety
Staab, J. P., & Ruckenstein, M. J. (2003) · The Laryngoscope · doi:10.1097/00005537-200310000-00010 · Cited by 265 · see citing works
Lidstone, J., Uljarević, M., Sullivan, J., Rodgers, J., McConachie, H., Freeston, M., Le Couteur, A., Prior, M., & Leekam, S. (2014) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2013.10.001 · Cited by 264 · see citing works
Sensory Modulation and Affective Disorders in Children and Adolescents With Asperger’s Disorder
Pfeiffer, B., Kinnealey, M., Reed, C. N., & Herzberg, G. L. (2005) · American Journal of Occupational Therapy · doi:10.5014/ajot.59.3.335 · Cited by 238 · see citing works
Eagger, S., LUXON, L. M., Davies, R. A., Coelho, A., & Ron, M. A. (1992) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.55.5.383 · Cited by 233 · see citing works
Expanding the Differential Diagnosis of Chronic Dizziness
Staab, J. P., & Ruckenstein, M. J. (2007) · Archives of Otolaryngology–Head & Neck Surgery · doi:10.1001/archotol.133.2.170 · Cited by 217 · see citing works
Visual Dependency and Dizziness after Vestibular Neuritis
Cousins, S., Cutfield, N. J., Kaski, D. N., Palla, A., Seemungal, B. M., Golding, J. F., Staab, J. P., & Bronstein, A. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0105426 · Cited by 200 · see citing works
Human discrimination of fractal images
Knill, D. C., Field, D., & Kerstent, D. (1990) · Journal of the Optical Society of America A · doi:10.1364/josaa.7.001113 · Cited by 193 · see citing works
Migraine-anxiety related dizziness (MARD): a new disorder?
Furman, J. M. R. (2004) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.048926 · Cited by 187 · see citing works
Visual Distortion Provoked by a Stimulus in Migraine Associated With Hyperneuronal Activity
Huang, J., Cooper, T. G., Şatana, B., Kaufman, D. I., & Cao, Y. (2003) · Headache The Journal of Head and Face Pain · doi:10.1046/j.1526-4610.2003.03110.x · Cited by 181 · see citing works
The Relationship between Sensory Processing Difficulties and Anxiety Level of Healthy Adults
Engel‐Yeger, B., & Dunn, W. (2011) · British Journal of Occupational Therapy · doi:10.4276/030802211x13046730116407 · Cited by 181 · see citing works
Abnormal white matter microstructure in children with sensory processing disorders
Owen, J. P., Marco, E. J., Desai, S. S., Fourie, E., Harris, J., Hill, S. S., Arnett, A. B., & Mukherjee, P. (2013) · NeuroImage Clinical · doi:10.1016/j.nicl.2013.06.009 · Cited by 168 · see citing works
Krusemark, E. A., & Li, W. (2011) · Journal of Neuroscience · doi:10.1523/jneurosci.4394-10.2011 · Cited by 157 · see citing works
Predictors of clinical recovery from vestibular neuritis: A prospective study
Cousins, S., Kaski, D., Cutfield, N., Arshad, Q., Ahmad, H., Gresty, M. A., Seemungal, B. M., Golding, J., & Bronstein, A. M. (2017) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.386 · Cited by 156 · see citing works
The human visual system is optimised for processing the spatial information in natural visual images
Párraga, C. A., Troscianko, T., & Tolhurst, D. J. (2000) · Current Biology · doi:10.1016/s0960-9822(99)00262-6 · Cited by 151 · see citing works
Visual vertigo analogue scale: An assessment questionnaire for visual vertigo
Dannenbaum, E., Chilingaryan, G., & Fung, J. (2011) · Journal of Vestibular Research · doi:10.3233/ves-2011-0412 · Cited by 145 · see citing works
Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder?
Best, C., Tschan, R., Eckhardt-Henn, A., & Dieterich, M. (2009) · Neuroscience · doi:10.1016/j.neuroscience.2009.09.034 · Cited by 142 · see citing works
Visual discomfort and the spatial distribution of Fourier energy
Penacchio, O., & Wilkins, A. J. (2015) · Vision Research · doi:10.1016/j.visres.2014.12.013 · Cited by 139 · see citing works
Adolescent/Adult Sensory Profile
Brown, C. E. (2024) · Routledge eBooks · doi:10.4324/9781003522645-33 · Cited by 132 · see citing works
Jacob, R. G., Woody, S. R., Clark, D. B., Lilienfeld, S. O., Hirsch, B. E., Kucera, G. D., Furman, J. M., & Durrant, J. D. (1993) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/bf00965035 · Cited by 127 · see citing works
Serotonin Reuptake Inhibitors for Dizziness With Psychiatric Symptoms
Staab, J. P., Ruckenstein, M. J., Solomon, D., & Shepard, N. T. (2002) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.128.5.554 · Cited by 123 · see citing works
López‐Solà, M., Pujol, J., Wager, T. D., Garcia‐Fontanals, A., Blanco‐Hinojo, L., Garcia-Blanco, S., Poca‐Dias, V., Harrison, B. J., Contreras‐Rodríguez, O., Monfort, J., et al. (2014) · Arthritis & Rheumatology · doi:10.1002/art.38781 · Cited by 121 · see citing works
OVERVIEW OF PSYCHOLOGIC EFFECTS OF CHRONIC DIZZINESS AND BALANCE DISORDERS
Yardley, L. (2000) · Otolaryngologic Clinics of North America · doi:10.1016/s0030-6665(05)70229-2 · Cited by 118 · see citing works
Sensory processing in schizophrenia: missing and avoiding information
Brown, C. E., Cromwell, R. L., Filion, D. L., Dunn, W., & Tollefson, N. (2002) · Schizophrenia Research · doi:10.1016/s0920-9964(01)00255-9 · Cited by 113 · see citing works
Sensory subtypes and anxiety in older children and adolescents with autism spectrum disorder
Uljarević, M., Lane, A., Kelly, A., & Leekam, S. (2016) · Autism Research · doi:10.1002/aur.1602 · Cited by 108 · see citing works
Visual Contrast Processing in Migraine
Shepherd, A. (2000) · Cephalalgia · doi:10.1046/j.1468-2982.2000.00119.x · Cited by 99 · see citing works
Panic in otolaryngology patients presenting with dizziness or hearing loss
Clark, D. B., Hirsch, B. E., Smith, M. G., Furman, J. M. R., & Jacob, R. G. (1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.8.1223 · Cited by 93 · see citing works
Development and Validation of the Migraine Screen Questionnaire (MS‐Q)
Láinez, M. J. A., Domínguez, M., Rejas, J., Palacios, G., Arriaza, E., Garcia‐Garcia, M., & Madrigal, M. M. (2005) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2005.00265.x · Cited by 87 · see citing works
Discomfort from urban scenes: Metabolic consequences
Le, A. T. D., Payne, J., Clarke, C., Kelly, M. A., Prudenziati, F., Armsby, E., Penacchio, O., & Wilkins, A. J. (2017) · Landscape and Urban Planning · doi:10.1016/j.landurbplan.2016.12.003 · Cited by 86 · see citing works
Schniepp, R., Wuehr, M., Huth, S., Pradhan, C., Brandt, T., & Jahn, K. (2014) · Journal of Neurology · doi:10.1007/s00415-014-7259-1 · Cited by 81 · see citing works
Adolescent/Adult Sensory Profile and Obsessive–Compulsive Disorder
Rieke, E. F., & Anderson, D. (2009) · American Journal of Occupational Therapy · doi:10.5014/ajot.63.2.138 · Cited by 80 · see citing works
Cucchiara, B. L., Datta, R., Aguirre, G. K., Idoko, K. E., & Detre, J. A. (2014) · Cephalalgia · doi:10.1177/0333102414547782 · Cited by 80 · see citing works
Contribution of symptoms and beliefs to handicap in people with vertigo: A longitudinal study
Yardley, L. (1994) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1994.tb01100.x · Cited by 79 · see citing works
Long-term clinical outcome in vestibular neuritis
Bronstein, A. M., & Dieterich, M. (2018) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000652 · Cited by 73 · see citing works
Persistent postural perceptual dizziness is on a spectrum in the general population
Powell, G., Derry-Sumner, H., Rajenderkumar, D., Rushton, S. K., & Sumner, P. (2020) · Neurology · doi:10.1212/wnl.0000000000009373 · Cited by 73 · see citing works
Self-citationHäufigste Schwindelform im mittleren Alter: phobischer Schwankschwindel
Strupp, M. L., Glaser, M., Karch, C., Rettinger, N., Dieterich, M., & Brandt, T. H. (2003) · Der Nervenarzt · doi:10.1007/s00115-003-1567-5 · Cited by 67 · see citing works
Enhanced Olfactory Sensory Perception of Threat in Anxiety: An Event-Related fMRI Study
Krusemark, E. A., & Li, W. (2012) · Chemosensory Perception · doi:10.1007/s12078-011-9111-7 · Cited by 64 · see citing works
Ödman, >., & Maire, R. (2008) · Acta Oto-Laryngologica · doi:10.1080/00016480701805455 · Cited by 62 · see citing works
An Inability to Exclude Visual Noise in Migraine
Tibber, M. S., Kelly, M. G., Jansari, A. S., Dakin, S. C., & Shepherd, A. J. (2014) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.14-13877 · Cited by 60 · see citing works
Persistent Postural-Perceptual Dizziness: A Matter of Higher, Central Dysfunction?
Holle, D., Steinberg, B. S., Wurthmann, S., Naegel, S., Ayzenberg, I., Diener, H., Katsarava, Z., & Obermann, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0142468 · Cited by 59 · see citing works
Psychiatric Disorders in Otoneurology Patients
Eckhardt‐Henn, A., & Dieterich, M. (2005) · Neurologic Clinics · doi:10.1016/j.ncl.2005.01.008 · Cited by 47 · see citing works
Ousdal, O. T., Andreassen, O. A., Server, A., & Jensen, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0096146 · Cited by 43 · see citing works
Sezier, A., Saywell, N. L., Terry, G., Taylor, D., & Kayes, N. M. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024326 · Cited by 40 · see citing works
Anxiety among individuals with visual vertigo and vestibulopathy
Zur, O., Schoen, G., Dickstein, R., Feldman, J., Berner, Y., Dannenbaum, E., & Fung, J. (2015) · Disability and Rehabilitation · doi:10.3109/09638288.2014.1002577 · Cited by 35 · see citing works
Psychiatric Considerations in the Management of Dizzy Patients
Staab, J. P. (2019) · Advances in oto-rhino-laryngology · doi:10.1159/000490286 · Cited by 34 · see citing works
A review of the burden of vertigo
Holmes, S., & Padgham, N. D. (2011) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2010.03585.x · Cited by 32 · see citing works
Visual Activities Questionnaire: Assessment of subscale validity for cataract surgery outcomes
Gothwal, V. K., Wright, T. A., Lamoureux, E. L., et al. (2009) · Journal of Cataract & Refractive Surgery · doi:10.1016/j.jcrs.2009.05.058 · Cited by 27 · see citing works
Garcia, F. V., Coelho, M. H., & Figueira, M. L. (2003) · PubMed · Cited by 20 · see citing works
Powell, G., Penacchio, O., Derry-Sumner, H., Rushton, S. K., Rajenderkumar, D., & Sumner, P. (2021) · Journal of Vestibular Research · doi:10.3233/ves-190578 · Cited by 17 · see citing works
Self-citationIs there a link between dizziness and vision? A systematic review
Armstrong, D., Charlesworth, E., Alderson, A. J., & Elliott, D. B. (2016) · Ophthalmic and Physiological Optics · doi:10.1111/opo.12299 · Cited by 13 · see citing works
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Chen, T.-A. J., Dion Parenteau, M.-L., Marchand, K., Zhang, H. Z., Dannenbaum, E., Lamontagne, A., & Fung, J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12051766 · Cited by 8 · see citing works
“Such avoidant behaviors are common in people with VV [10].”
Background
- Authors
- Powell, G., Derry-Sumner, H., Shelton, K., Rushton, S., Hedge, C., Rajenderkumar, D., & Sumner, P.
- Affiliations
- Cardiff University (GB)
- University Hospital of Wales (GB)
- Corresponding author
- Powell, Georgina
- Venue
- Journal of Neurology
- Published
- 2020-04-18
- Volume
- 267
- Issue
- 8
- Pages
- 2260-2271
- ISSN
- 0012-1037 (ISSN-L)
- 0340-5354
- 1432-1459
- PMC
- PMC7359147
- OpenAlex
- W3015676651
- Cited by
- 31
- References
- 65
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 7
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Aston Publications Explorer (Aston University) (acceptedVersion)
- Funders
- Wellcome Trust (104943/Z/14/Z)
- Cardiff University (097824/Z/11/Z)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- persistent postural-perceptual dizziness, anxiety, migraine, visual discomfort, vision problems, sensory avoidance, vestibular perception
- MeSH terms
- Anxiety, Dizziness, Postural Balance, Humans, Vertigo, Vestibule, Labyrinth, Vestibular Diseases
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