Dizziness Combined With Anxiety, A Common Problem Not Well Recognized In Healthcare – And What Can Be Done? Part 2

Part 1 introduced a common but poorly known disorder which occurs when a person suffers a severe attack of dizziness or vertigo(1-4)  and what results is a neurological problem that can be very debilitating(3)(5)(6)  and can last for months or years(3) even with young(1)(2)(3)(6)(7)  healthy people.

The good news is brain scan studies in the past few years have been showing the actual physical changes in the brain when people suffer from this condition.(1)(8)

This condition is called PPPD (Persistent-Postural Perceptual Dizziness), recently recognized by the World Health Organization(9) which is a combination of several disorders scientists have been studying the past several decades with names such as “phobic postural vertigo”, “chronic subjective dizziness,”“psychogenic gait disorders”, and others.(9)

The good news about this disorder is it is quite treatable,(10) and recognizing that there is a physical neurological cause(1)(7)(8)(11)(12) is the first step to getting better. (12)

From there, it is all about bringing back normal movement(6) and a vestibular specialist (inner ear balance specialist) is the healthcare provider that can help you on the path to getting better.(10)(13)


To Read Part 1 Click Here 


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Health Advice Disclaimer

We make every effort to ensure that we accurately represent the injury advice and prognosis displayed throughout this blog. However, examples of conditions and their prognosis are based on typical representations of those conditions that we commonly see in physical therapy. The information given is not intended as representations of every individual’s potential condition. As with any injury, each person’s symptoms can vary widely and each person’s recovery can also vary depending upon background, genetics, previous medical history, psychological status and history, motivation to follow physical therapy advice and various other factors.

It is impossible to give a 100% complete accurate diagnosis and prognosis
without a thorough physical examination and likewise the advice given cannot be deemed fully accurate in the absence of this examination from a vestibular specialist.

Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this blog.


  1. Wurthmann S, Naegel S, Steinberg BS, Theysohn N, Diener HC, Kleinschnitz C, et al. Cerebral gray matter changes in persistent postural perceptual dizziness. Journal of Psychosomatic Research. 2017;103:95-101.
  2. Yan Z, Cui L, Yu T, Liang H, Wang Y, Chen C. Analysis of the characteristics of persistent postural-perceptual dizziness: A clinical-based study in China. International Journal of Audiology. 2017;56(1),33-37.
  3. Huppert D, Strupp M, Rettinger N, Hecht J, Brandt T. Phobic postural vertigo. A long-term follow-up (5 to 15 years) of 106 patients. J Neurol. 2005;252:564-569.
  4. Godemann F, Siefert K, Hantschke‐Bruggemann M, Neu P, Seidl, Ströhle A. What accounts for vertigo one year after neuritis vestibularis—anxiety or a dysfunctional vestibular organ? J Psychiatr Res. 2005;39:529–534
  5. 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;260:1314-1323.
  6. Schniepp R, Wuehr M, Huth S, Pradhan C, Brandt T, Jahn K. Gait characteristic of patients with phobic postural vertigo: effects of fear of falling, attention, and visual input. J Neurol. 2014;261:738-746
  7. Bittar RS, Sohsten Lins EM. Clinical characteristics of patients with persistent postural-perceptual dizziness. Braz J Otorhinolaryngol. 2015;81:276-82.
  8. Indovina I, Riccelli R, Chiarella G, PetroloC, Augimeri A, Giofre L, Lacquaniti F, Staab JP, Passamonti L. Role of the Insula and Vestibular System in Patients with Chronic Subjective Dizziness: An fMRI Study Using Sound Evoked Vestibular Stimulation. Front Behav Neurosci. 2015;9:334
  9. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2017; 0:1-9.
  10. Obermann M, Bock E, Sabev N et al. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study. J Neurol . 2015;262(9):2083–2091.
  11. Riccelli R, Passamonti L, Toschi N, Nigro S, Chiarella G, Petrolo C, et al. Altered Insular and Occipital Responses to Simulated Vertical Self-Motion in Patients with Persistent Postural-Perceptual Dizziness. Front Neurol. 2017;8:529.
  12. Shaaf H, Hesse G. Patients with long-lasting dizziness: a follow-up after neurotological and psychotherapeutic inpatient treatment after a period of at least 1 year. Eur Arch Otorhinolaryngol. 2015;272:1529-1535.
  13. Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Frontiers in Neurology. 2012;3(169):1-5.


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