Panic disorder with vestibular dysfunction: Further clinical observations and description of space and motion phobic stimuli

Abstract The phenomenology of panic was examined in eight patients with panic disorder referred for vestibular and audiological testing due to symptoms of dizziness or imbalance between or during panic attacks. It was found that all patients had otoneurological abnormalities; half of the patients showed abnormalities consistent with dysfunction of the peripheral vestibular organ. An analysis of situations or activities that elicited anxiety and/or discomfort revealed a “space and motion phobic” stimulus pattern. Space and motion stimuli are characterized by one of the following attributes: (a) excessive vestibular stimulation; (b) lack of visual orienting or fixation cues; (c) unusual, incongruous, or complex movements of both the visual surround and self. A case description is included to illustrate the longitudinal development of panic vestibular symptoms. The relationship between panic disorder and vestibular disorders and its implications for treatment are discussed.