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PART IV  CONSTANT DIZZINESS THAT LASTS 24 HOURS A DAY FOR MONTHS AND EVEN YEARS This page intentionally left blank Dizziness and Anxiety You have been constantly dizzy for eight months. The dizziness takes several forms, from a lightheaded, swimming sensation to a sense of spinning inside the head even as your surroundings remain still. At times you have the bizarre sensation that the floor is moving up ­ toward you or that you may fall even when you are sitting still in a chair. You have had occasional dizziness in the past—­ lasting a month or two—­ but never this severe for this long. You have always been an anxious person, and you had a few panic attacks when you ­ were younger, but the anxiety seems to have gotten much worse since this constant dizziness started.­ People with an anxiety disorder typically do not go to doctors complaining of anxiety. Instead, they complain of other symptoms, including dizziness, palpitations, headache, gastrointestinal symptoms, and cognitive impairment. In studies of anxiety-­ related symptoms, dizziness is by far the most common , occurring in about two-­ thirds of ­ those who have anxiety. Anxiety-­ related dizziness has been given many names, including chronic subjective dizziness, psychophysiological dizziness , and phobic dizziness. ­ These are vague terms that are not very satisfying to patients or doctors. Anxiety is a negative emotion experienced in anticipation of a real or ­ imagined threat or dangerous circumstances. CHAPTER  7 Constant Dizziness for Months, Years 118 Nearly every­ one experiences mild anxiety from time to time, but some ­ people have an anxiety diathesis, meaning that they have an above-­ average emotional and physical response to threats. When an anxiety diathesis becomes severe enough to interfere with how someone functions in the world, the person is said to have an anxiety disorder. Most ­ people with anxiety disorder have a ­ family member with anxiety. Recent ge­ ne­ tic studies have identified specific ge­ ne­ tic variations that make it more likely that a person ­ will develop anxiety disorder. But how ­ these ge­ ne­ tic variations lead to dizziness and other symptoms is largely unknown. Looking at the ­ matter from another point of view, many­ people with dizziness also have an anxiety diathesis. A considerable proportion of ­ these ­ people could be diagnosed with anxiety disorder. Many patients in our clinics do not have a past history of an anxiety disorder that preceded the onset of dizziness, however. It can therefore be difficult or impossible to know ­ whether an anxiety disorder is causing dizziness or some other disorder that ­ causes dizziness, such as an inner ear disorder, is also causing anxiety. As some ­ people with dizziness say, “I was never anxious, ­ until I started feeling dizzy.” Indeed, based on data from the US Census Bureau’s 2008 National Health Interview Survey, one study found that ­ people with “vestibular vertigo” ­ were three times more likely to have depression, anxiety, and/or panic disorder. Vestibular vertigo was defined as spinning vertigo, positional vertigo, or recurrent dizziness and nausea with ­ either movement of the visual scene or with head movement or imbalance. Although such an association study does not establish a cause-­ and-­ effect relationship between dizziness and anxiety and depression, it does indicate that if you are dizzy, you are more likely to have Dizziness and Anxie t y 119 anxiety and depression than the general population. Can we say ­ whether the psychiatric symptoms or the vestibular vertigo came first in an individual patient? Often we cannot. A practical approach is to take the view that anxiety and dizziness often co-­ occur, and both need to be addressed, ­ either with the same intervention or with separate interventions. Discussing which genes are involved in the risk for anxiety disorder is beyond the scope of this book, but ­ there is scientific agreement that multiple genes are involved. Some genes increase the risk of developing anxiety disorder while ­ others decrease it. Variations in genes associated with the production and breakdown of the neurotransmitter serotonin have received ­ great attention ­ because medi­ cations that raise the serotonin level in the brain have proven effective in treating anxiety. However, ­ there is ­ little doubt that variations in many other genes eventually ­ will be identified as contributing to the production of anxiety disorder. The availability of the ­ human genome and rapid, cost-­ efficient gene sequencing have accelerated the pace of ge­ ne­ tic research. Unexpected links are being found between psychiatric disorders previously thought to be distinct and unrelated. Such disorders are likely to be substantially reclassified...

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Additional Information

ISBN
9781421420912
Related ISBN
9781421420905
MARC Record
OCLC
964524376
Pages
208
Launched on MUSE
2016-12-10
Language
English
Open Access
No
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