Phobic postural vertigo
Abstract
Phobic postural vertigo (PPV) (Brandt and Dieterich 1986; Brandt 1996) has been described as a syndrome that is distinguishable from panic disorder, agoraphobia, and the pseudo-agoraphobia syndrome “space phobia” (Marks 1981). Since we began diagnosing it as a clinical entity, PPV has become the second-most common cause of vertigo in our dizziness unit (p. 23). Closely connected with gait and posture, PPV is characterised by a combination of non-rotational vertigo with subjective postural imbalance and unsteadiness, normal neuro-otological tests, and phobic avoidance behaviour mainly in patients with an obsessive-compulsive personality. The monosymptomatic subjective disturbance of balance manifests with superimposed attacks that occur with and without recognisable provoking factors in one and the same patient. The patient experiences them with and without accompanying excess anxiety, misleading both patient and physician to make a false diagnosis of organic disease. Although an association of PPV with anxiety disorders is evident, not all patients present with symptoms of anxiety or panic during attacks of vertigo. However, most patients develop a disabling “phobic/avoidance pattern” (Kapfhammer et al. 1997). These patients contact neurologists or otolaryngologists first and foremost and not psychiatrists or psychotherapists, since their prevailing complaint is distressing postural imbalance and vertigo.
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PPPD is not a diagnosis of exclusion.
“Furthermore, PPPD is not a diagnosis of exclusion [12, 24, 75].”
Difficulty with self-motion is part of PPV, SMD, and CSD.
“Difficulty with self-motion is part of PPV [12, 13], SMD [39], and CSD [75, 81].”
Mild anxiety and depressive symptoms and phobic behaviors were included in the descriptions of PPV, but were considered comorbidities of CSD.
“Mild anxiety and depressive symptoms and phobic behaviors were included in the descriptions of PPV [12, 13], but were considered comorbidities of CSD [24, 75, 80].”
Tilting and sliding sensations are included in the Bárány Society's definition of non-spinning vertigo, but these are not typical symptoms of PPPD.
“Tilting and sliding sensations are included in the Bárány Society’s definition of non-spinning vertigo [9], but these are not typical symptoms of PPPD [12, 13, 24, 75].”
Most patients with PPPD report more severe symptoms when standing or walking than when sitting or lying down.
“Most patients with PPPD report more severe symptoms when standing or walking than when sitting or lying down [12, 13, 75].”
Postural provocation is a distinguishing feature of PPV.
“Postural provocation is a distinguishing feature of PPV [12, 13].”
Positive results on these questionnaires indicate that an anxiety or depressive disorder is likely, either as the sole cause of vestibular symptoms or co-existing with PPPD.
“Positive results indicate that an anxiety or depressive disorder is likely, either as the sole cause of vestibular symptoms or co-existing with PPPD [12, 58, 75, 79].”
No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD, and chronic dizziness following acute vestibular syndromes.
“No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD, and chronic dizziness following acute vestibular syndromes [7, 12, 23, 28, 30, 79].”
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Häufigste Schwindelform im mittleren Alter: phobischer Schwankschwindel
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Persistent Postural-Perceptual Dizziness: A Matter of Higher, Central Dysfunction?
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Phobic postural vertigo: Body sway during visually induced roll vection
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Self-citationMigraine-related vertigo: Diagnosis and treatment
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Self-citationPosture and balance responses to a sensory challenge are related to anxiety in mice
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Five keys for diagnosing most vertigo, dizziness, and imbalance syndromes: an expert opinion
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Acrophobia impairs visual exploration and balance during standing and walking
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Management of the patient with chronic dizziness
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Comorbidities in vestibular migraine
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Rocking dizziness and headache: A two-way street
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Nonlinear Variability of Body Sway in Patients with Phobic Postural Vertigo
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- Authors
- Brandt, T.
- Affiliations
- LMU Klinikum (DE)
- Corresponding author
- Brandt, Thomas
- Venue
- Neurology
- Published
- 1996-06
- Volume
- 46
- Issue
- 6
- Pages
- 1515-1519
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W2162266658
- Cited by
- 323
- References
- 52
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 15 · 2023: 20 · 2022: 13 · 2021: 12 · 2020: 23 · 2019: 14 · 2018: 15 · 2017: 16 · 2016: 16 · 2015: 9 · 2014: 17 · 2013: 12 · 2012: 12
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- phobic postural vertigo, postural imbalance, phobic avoidance, obsessive-compulsive personality, anxiety disorders, dizziness, misdiagnosis, gait and posture
- MeSH terms
- Adolescent, Adult, Agoraphobia, Behavior Therapy, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Models, Neurological, Motion Perception, Obsessive-Compulsive Disorder, Otolithic Membrane, Phobic Disorders, Posture, Psychophysiologic Disorders, Schizophrenia, Vertigo, Vestibule, Labyrinth, Panic Disorder
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