Dizziness Not Always Child's Play
Stop the Spinning
Type 4 -- Anxiety
Dizziness type 4 is anxiety.
According to Samuels, people who are scared, worried,
depressed, or agoraphobic [afraid of open spaces] use the word dizzy to mean
frightened, depressed, or anxious.
"You can recognize this type of dizziness because if you
take the word 'dizzy' out of all their sentences and replace it with the word
'anxious,' their sentences make more sense," he says.
Type 4 dizziness is often, but not always, caused by
depression, says Samuels.
"It could also be [due to] an anxiety disorder, or the
patient may have phobias in the family, in which case a psychiatrist could
[prescribe] appropriate medications or psychotherapy or behavior-modification
therapy," he says.
Samuels says that on average, every 1,000 dizzy patients will
have 1,500 dizzy complaints. This means that many people will have more than
one type of dizziness.
"It is common to see a person with vertigo from post-viral
infection [and also from] anxiety -- because vertigo makes them anxious -- so
they have a combination of type 1 and type 4 dizziness," he says. "Or,
they are dizzy because of near-fainting episodes because one doctor has put
them on medications that cause dizziness, and this has made them anxious. A
patient could have all four types of dizziness, but that would be quite rare
In these mixed-type dizziness cases, Samuels would try to
identify the main cause and treat it first in the hope that secondary causes
would be related to the first.
Long-Lasting, Chronic Dizziness
Nearly everybody who is dizzy will get better. This is because
a person's sense of balance is a complex interaction between the brain, each
ear's separate vestibular system, and the sense of vision. When one component
breaks down, the others usually learn to compensate.
"There is not a major chance of permanent dizziness,"
Samuels says. "I don't think there is any reason why the nervous system
can't compensate for a broken vestibular system. People with vestibular
problems due to physical injury nearly always compensate. So if you can't
[compensate] when there is no physical injury, it means [a problem of mental or
emotional origin]. This doesn't mean a person is not suffering -- if they say
it, it is so. The question is how can I help them. The answer is by not messing
with the vestibular system, but by dealing with the psychogenic issue."
This may be trickier than it seems.
"Patients want us to fix their problem either by giving
medicine or by cutting something out," says otolaryngologist Prass.
"Chronic imbalance can be fixed with balance therapy, but
if a person is uptight it is not going to work," he says. "For example,
if you always associate symptoms with going to the grocery store, we can treat
the person's disease, but if you still tighten up when you approach the store,
it can be a real roadblock to recovery."