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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.

Mixed-Type Dizziness

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 indeed."

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."

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