Somatoform Vertigo and Dizziness Syndromes

  • Thomas Brandt
  • Marianne Dieterich
  • Michael Strupp


These syndromes account for a large proportion of complex forms of dizziness, imbalance, and fear of falling.

Phobic postural vertigo is an important and the most frequent form of somatoform vertigo/dizziness. The patients complain of postural dizziness and subjective stance and gait unsteadiness without this being evident to an observer; moreover, their results in neuro-otological tests are normal. Anxious control of postural balance is causative and accompanied by co-contraction of antigravity muscles. Therapy is based on psychoeducational explanation and behavioral therapy.


Efference Copy Phobic Disorder Vestibular Neuritis Vestibular Migraine Episodic Ataxia 
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  1. Andersson G, Asmundson GJ, Denev J, Nilsson J, Larsen HC. A controlled trial of cognitive behavior therapy combined with vestibular rehabilitation in the treatment of dizziness. Behav Res Ther. 2006;44:1265–73.PubMedCrossRefGoogle Scholar
  2. Barsky AJ, Wyshak GL. Hypochondriasis and somatosensory amplification. Br J Psychiatry. 1990;157:404–9.PubMedCrossRefGoogle Scholar
  3. Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M. Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry. 2006;77:658–64.PubMedCrossRefGoogle Scholar
  4. Best C, Eckhardt-Henn A, Tschan R, Bense S, Dieterich M. Psychiatric morbidity and comorbidity in different vestibular vertigo syndrome: results of a prospective longitudinal study over one year. J Neurol. 2009a;256:58–65.PubMedCrossRefGoogle Scholar
  5. Best C, Eckhardt-Henn A, Tschan R, Dieterich M. Who is a risk for psychiatric distressed after vestibular disorder? Results from a prospective one-year follow-up. Neuroscience. 2009b;164:1579–87.PubMedCrossRefGoogle Scholar
  6. Brandt T. Phobic postural vertigo. Neurology. 1996;46:1515–9.PubMedCrossRefGoogle Scholar
  7. Brandt T, Dieterich M. Phobischer Attacken-Schwankschwindel, ein neues Syndrom. Munch Med Wochenschr. 1986;128:247–50.Google Scholar
  8. Brandt T, Huppert D, Dieterich M. Phobic postural vertigo: a first follow-up. J Neurol. 1994;241:191–5.PubMedCrossRefGoogle Scholar
  9. Brandt T, Strupp M, Novozhilov S, Krafczyk S. Artificial neural network posturography detects the transition of vestibular neuritis to phobic postural vertigo. J Neurol. 2012;259:182–4.PubMedCrossRefGoogle Scholar
  10. Bronstein AM. The visual vertigo syndrome. Acta Otolaryngol (Stockh). 1995;520:45–8.CrossRefGoogle Scholar
  11. Bronstein AM. Vision and vertigo: some visual aspects of vestibular disorders. J Neurol. 2004;251:381–7.PubMedCrossRefGoogle Scholar
  12. Dieterich M, Eckhardt-Henn A. Neurologische und somatoforme Schwindelsyndrome. In: Henningsen P, Gündel H, Ceballos-Baumann A, editors. Neuro-Psychosomatik. Grundlagen und Klinik neurologischer Psychosomatik. Stuttgart: Schattauer; 2006. p. 253–65.Google Scholar
  13. Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord. 2003;431:1–20.Google Scholar
  14. Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, et al. Psychiatric comorbidity in different organic vertigo syndromes. J Neurol. 2008;255:420–8.PubMedCrossRefGoogle Scholar
  15. Furman JM, Jacob RG. Psychiatric dizziness. Neurology. 1997;48:1161–6.PubMedCrossRefGoogle Scholar
  16. Godemann F, Schabowska A, Naetebusch B, Heinz A, Ströhle A. The impact of cognitions on the development of panic and somatoform disorders: a prospective study in patients with vestibular neuritis. Psychol Med. 2006;36:99–108.PubMedCrossRefGoogle Scholar
  17. Heinrichs N, Edler C, Eskens S, Mielczarek MM, Moschner C. Predicting continued dizziness after an acute peripheral vestibular disorder. Psychosom Med. 2007;69:700–7.PubMedCrossRefGoogle Scholar
  18. Holmberg J, Karlberg M, Harlacher U, Rivano-Fischer M, Magnusson M. Treatment of phobic postural vertigo. A controlled study of cognitive-behavioral therapy and self-controlled ­desensitization. J Neurol. 2006;253:500–6.PubMedCrossRefGoogle Scholar
  19. Holmberg J, Karlberg M, Harlacher U, Magnusson M. One-year follow-up of cognitive ­behavioural therapy for phobic postural vertigo. J Neurol. 2007;254:1189–92.PubMedCrossRefGoogle Scholar
  20. Huppert D, Kunihiro T, Brandt T. Phobic postural vertigo (154 patients): its association with ­vestibular disorders. J Audiol. 1995;4:97–103.Google Scholar
  21. Huppert D, Strupp M, Rettinger N, Hecht J, Brandt T. Phobic postural vertigo – a long-term ­follow-up (5–15 years) of 106 patients. J Neurol. 2005;252:564–9.PubMedCrossRefGoogle Scholar
  22. Kapfhammer HP, Mayer C, Hock U, Huppert D, Dieterich M, Brandt T. Course of illness in phobic postural vertigo. Acta Neurol Scand. 1997;95:23–8.PubMedCrossRefGoogle Scholar
  23. Krafczyk S, Tietze S, Swoboda W, Valkovic P, Brandt T. Artificial neural network: a new diagnostic posturographic tool for disorders of stance. Clin Neurophysiol. 2006;117:1692–8.PubMedCrossRefGoogle Scholar
  24. Marks JM. Space “phobia”: a pseudo-agoraphobic syndrome. J Neurol Neurosurg Psychiatry. 1981;48:729–35.Google Scholar
  25. Murphy TP. Mal de debarquement syndrome: a forgotten entity? Otolaryngol Head Neck Surg. 1993;109:10–3.PubMedGoogle Scholar
  26. Querner V, Krafczyk S, Dieterich M, Brandt T. Patients with somatoform phobic postural vertigo: the more difficult the balance task, the better the balance performance. Neurosci Lett. 2000;285:21–4.PubMedCrossRefGoogle Scholar
  27. Querner V, Krafczyk S, Dieterich M, Brandt T. Somatoform phobic postural vertigo: body sway during optokinetically induced roll vection. Exp Brain Res. 2002;143:269–75.PubMedCrossRefGoogle Scholar
  28. Schmid G, Henningsen P, Dieterich M, Sattel H, Lahmann C. Psychotherapy in vertigo – a systematic review. J Neurol Neurosurg Psychiatry. 2011;82(6):601–6.PubMedCrossRefGoogle Scholar
  29. Staab JP. Chronic subjective dizziness. Continuum (Minneap Minn). 2012;18:1118–41.Google Scholar
  30. Strupp M, Glaser M, Karch C, Rettinger N, Dieterich M, Brandt T. The most common form of dizziness in middle age: phobic postural vertigo. Nervenarzt. 2003;74:911–4.PubMedCrossRefGoogle Scholar
  31. Tschan R, Best C, Beutel M, Knebel A, Wiltink J, Dieterich M, et al. Patients’ psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) one year after vestibular disease. J Neurol. 2011;258:104–12.PubMedCrossRefGoogle Scholar
  32. Tschan R, Eckhardt-Henn A, Scheurich V, Best C, Dieterich M, Beutel M. Steadfast-effectiveness of a cognitive behavioral self-management program of patients with somatoform vertigo and dizziness. Psychother Psychosom Med Psychol. 2012;62(3–4):111–9.PubMedGoogle Scholar
  33. Von Holst E, Mittelstaedt H. Das Reafferenzierungsprinzip (Wechselwirkungen zwischen Zentralnervensystem und Peripherie). Naturwissenschaften. 1950;37:461–76.Google Scholar
  34. Wuehr M, Pradhan C, Novozhilov S, Krafczyk S, Brandt T, Jahn K, Schniepp R. Inadequate interaction between open- and closed-loop postural control in phobic postural vertigo. J Neurol. 2013;260:1314–23.PubMedCrossRefGoogle Scholar
  35. Yardley L, Redfern MS. Psychological factors influencing recovery from balance disorders. J Anxiety Disord. 2001;15:107–19.PubMedCrossRefGoogle Scholar
  36. Yarrow K, Brown P, Gresty MA, Bronstein AM. Force platform recordings in the diagnosis of primary orthostatic tremor. Gait Posture. 2001;13:27–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Thomas Brandt
    • 1
  • Marianne Dieterich
    • 2
  • Michael Strupp
    • 2
  1. 1.Clinical Neurosciences and Center for Vertigo & Balance DisordersUniversity of MunichMunichGermany
  2. 2.Department of Neurology and Center for Vertigo & Balance DisordersUniversity of MunichMunichGermany

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