Patients’ psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease

Abstract

Secondary somatoform dizziness and vertigo (SVD) is an underdiagnosed and handicapping psychosomatic disorder, leading to extensive utilization of health care and maladaptive coping. Few long-term follow-up studies have focused on the assessment of risk factors and little is known about protective factors. The aim of this 1-year follow-up study was to identify neurootological patients at risk for the development of secondary SVD with respect to individual psychopathological disposition, subjective well-being and resilient coping. In a prospective interdisciplinary study, we assessed mental disorders in n=59 patients with peripheral and central vestibular disorders (n=15 benign paroxysmal positional vertigo, n=15 vestibular neuritis, n=8 Menière's disease, n=24 vestibular migraine) at baseline (T0) and 1 year after admission (T1). Psychosomatic examinations included the structured clinical interview for DSM-IV, the Vertigo Symptom Scale (VSS), and a psychometric test battery measuring resilience (RS), sense of coherence (SOC), and satisfaction with life (SWLS). Subjective well-being significantly predicted the development of secondary SVD: Patients with higher scores of RS, SOC, and SWLS at T0 were less likely to acquire secondary SVD at T1. Lifetime mental disorders correlated with a reduced subjective well-being at T0. Patients with mental comorbidity at T0 were generally more at risk for developing secondary SVD at T1. Patients' dispositional psychopathology and subjective well-being play a major predictive role for the long-term prognosis of dizziness and vertigo. To prevent secondary SVD, patients should be screened for risk and preventive factors, and offered psychotherapeutic treatment in case of insufficient coping capacity.

Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society

“…67,68,71,98]. Arguments against the idea included concerns that the mix of physical and psychological symptoms and personality traits that constitute PPV is difficult to operationalize in clinical practice [75] and may have to be updated based on newer research [76,85], and that including PPV as a subtype of PPPD without validating their relationship could perplex clinicians and investigators. In the end, a simple majority of subcommittee members voted against including PPV as a subtype of PPPD.…”

Management of Functional Somatic Syndromes and Bodily Distress

“…Acute organic illnesses, stressful work conditions and adverse life events are important precipitating factors for FSS and bodily distress [60,61,62,63,64]. If persisting, these factors together with the effect of predisposing personality aspects and other important psychosocial state and trait characteristics like health anxiety, illness convictions, and avoidance behavior induce a shift to chronification and contribute to the maintenance of the symptoms of FSS and bodily distress.…”

The Handbook of Salutogenesis

“…Concerning the severity of other symptoms, Ahola, Saraheimo, Forsblom, Hietala, and Groop (2010) and Richardson, Adner, and Nordstrom (2001) suggest that higher SOC scores are related to lower HbA1c values in diabetic patients, and Bergman, Malm, Karlsson, and Bertero (2009) report less angina attacks in heart patients with higher SOC scores. Li et al (2015) describe negative correlations between higher SOC scores, symptom duration, and symptom severity in general, and Tschan et al (2011) see a reduced likeliness of developing secondary somatoform dizziness after vestibular disease in patients with higher SOC.…”