Scientific Study

Emotional Impacts of Vestibular Disorders

The mind/body connection

Vestibular disorders affect individuals physically AND psychologically. These disorders are variable not only in their physical manifestation, but in their psychological manifestation as well. And while it is important to understand your physical symptoms, it is equally important to understand your psychological symptoms as they can often trigger and/or exacerbate your physical symptoms.

The mind/body connection is complex. Emotional factors – the way we think, feel and behave – can have a significant effect, for better or worse, on our physical health and our capacity to recover from illness. Emotions can trigger genuine physiological arousal. In the context of a vestibular disorder, a vicious cycle may develop whereby physical symptoms initially triggered by your condition result in anxiety and/or other emotional responses and further increase feelings of dizziness, vertigo, or other vestibular symptoms.

Triggers

In my work treating individuals with vestibular disorders I have identified frequently occurring experiences and issues that can set off emotional disturbance. It starts with the diagnostic process. The lengthy, convoluted journey of visiting numerous specialists offering various opinions can be frustrating, to say the least. What’s worse, some of you might have been told your symptoms are being caused by anxiety and depression and that the symptoms are “in your head.”

The sudden onset of symptoms, the unpredictability, and variability that often occur with a vestibular disorder are terrifying, unsettling and turn your world upside down … literally and figuratively. Another common experience I’ve often heard people describe is what I refer to as the invisibility of your illness. Vestibular disorders are, well, invisible … and thus more likely to be misunderstood. Most of the time people with vestibular disorders don’t look sick or unwell. Unlike a broken limb, a runny nose, a cough, or a positive blood test or scan, the damage/injury can’t be seen, furthering this lack of understanding. However, invisible does not mean imaginary. This invisibility can lead to another common concern: a fear of being misperceived as lazy.

Other common concerns include: worrying you may be perceived as drunk due to balance issues and sensitivity to light, sound and geometric patterns.

Anxiety – The Most Common Complaint

Anxiety, fear, and panic are probably the most common emotional responses people have when diagnosed with a vestibular disorder. Anxiety often manifests in response to feeling ungrounded and insecure about being steady on your feet. A fear of falling due to imbalance, dizziness or lightheadedness is commonly reported. Panic attacks are also commonly reported. A panic attack is “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time [symptoms such as palpitations, sweating, trembling, shortness of breath, nausea, feeling dizzy] occur.” (DSM-V, 2013) It is no wonder that given the predominance of physiological symptoms, a panic attack is often mistaken for a medical condition, such as a heart attack.

In the context of a vestibular condition, a panic attack only serves to exacerbate physical symptoms, as well as trigger fears of losing control. In response to anxiety, fear and panic, individuals with vestibular conditions experience increased social isolation, withdrawing from social interaction and avoiding activities that normally bring them pleasure and satisfaction. It is important to note that it is very often fear and anxiety, not the actual physical symptoms that interfere with functioning.

Sadness & Depression

Having a vestibular disorder often results in a change in life style. Changes to your activity level (at home and at work), your independence, your abilities, your stamina, and your relationships are experienced as losses. Loss, grief, and the process of mourning are just some of the feelings and experiences that these changes arouse. Social isolation can lead to feelings of loneliness. Feeling misunderstood by family members, friends, even physicians fosters a sense of helplessness and hopelessness. Guilt is commonly expressed in response to not being able to perform your usual duties and responsibilities. In addition, you may experience sleep and appetite disturbance and lethargy. These are the many forms and manifestations that sadness and depression can take in response to a vestibular condition.

Relationships & Interpersonal Stress

“I get dizzy too” or “It’s all in your head.” Are these responses you’ve heard from family members, friends, even physicians when you explain your vestibular symptoms? It wouldn’t be surprising if you have heard them … and felt misunderstood, frustrated and alone. Add to these feelings the need to rely more on others, to be more dependent on family members and friends for help with tasks you could easily do on your own previously and what you’ve got is a new challenge of managing interpersonal stress that didn’t exist before your vestibular condition. This tension in relationships often leads to increased arguments, social withdrawal, and loss of closeness and connection with even the most important people in your life at a time when these connections are vital.

Your Sense of Self

I was once running an educational group for people suffering from vestibular disorders and we were discussing the emotional impact of their respective conditions. One person described looking at herself in the mirror and not recognizing the reflection staring back at her. Nothing about her physical appearance had changed, but she felt like such a different person that she was basically unrecognizable to herself.

This anecdote painfully demonstrates the kind of change to your sense of self that can occur to those suffering from a vestibular disorder. The discrepancy between how you know yourself now and how you knew yourself before erodes self-esteem and self-worth. Unable to perform your usual responsibilities, changes in your role in relationships, and inability to perform your job can really call into question your identity and how you know yourself. This is probably the most profound change expressed by individuals with vestibular conditions.

Coping Strategies

Thankfully, there are ways to overcome these difficulties and improve your mood, functioning, and quality of life. An important first step is awareness. Understanding your own emotional responses to the stress of having a vestibular disorder is an imperative first step in the process of recovery, both psychologically and physically. This can lead to an informative and inspiring exploration into the dynamics of your individual stress triggers and their origins. Keeping a daily journal that tracks activities, degree and frequency of symptoms, and strategies employed to combat each symptom can be a helpful tool in increasing awareness and self-monitoring of difficulties. In addition, learning stress management techniques can be quite effective in minimizing the emotional aspects of vestibular disorders. A variety of relaxation techniques, such as diaphragmatic breathing, progressive muscle relaxation and visualization/imagery can combat negative feelings. Other cognitive techniques include thought stopping and the use of positive self-statements. And while it may be difficult and unfamiliar, asking others for help can eliminate some unnecessary stress and strain while also allowing others to get a sense of what you’re going through, and to see what your difficulties are and how you are struggling to function with your vestibular disorder.

Treatment

Participation in psychotherapy provides support, validation and normalization in an individualized setting. Emotions can interfere with and hinder your physical recovery by exacerbating your physical symptoms. Working with a therapist to better manage your emotions will maximize your physical recovery. A therapist can also work with you on identifying, learning and applying the various stress management techniques mentioned above into your day-to-day life. Using these techniques consistently can help to restore a sense of control.

Working with a therapist also provides an opportunity to address the interpersonal tension that often co-exists with a vestibular disorder through developing improved communication skills. Treatment can and often does involve family members and close friends to facilitate their education of your disorder, as well as to work on improving communication. In addition, being in treatment can facilitate acceptance of this new aspect of your identity, helping you to create a more integrated sense of self. Participation in a support group can also really help to minimize feeling misunderstood and alone while providing validation.

It is not easy to share these kinds of complications. It takes strength and courage. But the benefits are well worth it.

By Dr. Rachel Bilgrei, PsyD