Dizziness and fear of falling: A behavioural and physiological approach to Phobic Postural Vertigo

Dizziness is a common problem and it often co-exists with anxiety. Level of anxiety is the best predictor of handicap for dizzy patients. There is diagnostic controversy and few treatment programs for such patients. These patients can be labeled as panic disorder with agoraphobia or by the concept of Phobic Postural Vertigo which is characterized by dizziness or imbalance in standing or walking despite normal clinical balance tests and avoidance behaviours. This thesis aimed to investigate the benefits and shortcomings of the concept of Phobic Postural Vertigo and to develop treatment methods.

We compared posturography results of patients with Phobic Postural Vertigo with healthy subjects. Patients with Phobic Postural Vertigo had more sway in frequencies above 0.1 Hz. Vibratory proprioceptive stimulation increased differences between populations. Patients were less able to use vision to compensate for vibratory stimulation.

We compared results in questionnaires for patients with Phobic Postural Vertigo with unselected patients with dizziness. Patients with Phobic Postural Vertigo, and especially women, experienced higher degree of handicap, anxiety and dizziness severity.

During cognitive behavioural therapy for those patients it was found that a fear of falling was provoked by standing and by misinterpretation of spontaneous body sway. Patients restricted their body sway area by co-contracting postural muscles. It is hypothesized that this behaviour leads to muscular fatigue, pain problems and distorted proprioception. There are however also other factors behind patients dizziness. Treatment methods were developed, mainly targeting the misinterpretaton of spontaneous body sway, fear of falling and fear regulating postural responses including exposure to standing in specific situations.

One group of patients with Phobic Postural Vertigo had Cognitive Behavioural Therapy while another group underwent a self treatment procedure. Patients who had the additional Cognitive Behavioural Therapy fared considerably better in degree of handicap, anxiety and depression. In a one year follow up, treatment results deteriorated to pre-treatment levels. Men seemed to benefit more from the treatment.

Phobic Postural Vertigo is a relevant concept to describe the fear of falling and subsequent postural behaviours. As treatment results were not maintained future approaches might also includ physiotherapy and pharmacological treatment.