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Ptsd dizziness. Vestibular Impairment in Veterans with PTSD: Understanding Dizziness and Related Symptoms

How does PTSD affect vestibular function in veterans. What are the common symptoms associated with vestibular impairment in PTSD patients. Can anxiety exacerbate dizziness and disorientation in veterans with PTSD. How does traumatic brain injury contribute to vestibular symptoms in PTSD.

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The Link Between PTSD and Vestibular Symptoms in Veterans

Posttraumatic stress disorder (PTSD) is a debilitating anxiety disorder that can significantly impact the lives of veterans who have experienced traumatic events. While the psychological effects of PTSD are well-documented, there is growing evidence of a connection between PTSD and vestibular impairment, which can lead to symptoms such as dizziness, disorientation, and postural imbalance.

A groundbreaking study conducted by Haber, Chandler, and Serrador (2016) sheds light on the prevalence and nature of vestibular-related symptoms in veterans with PTSD. Their research aims to address the gap in understanding the etiology of these symptoms and explore potential contributing factors.

Common Vestibular Symptoms Reported by Veterans with PTSD

  • Dizziness
  • Disorientation
  • Postural imbalance
  • Vertigo
  • Difficulty navigating crowded environments (e.g., grocery stores, shopping malls)

Is there a correlation between the severity of PTSD symptoms and vestibular impairment. The study found that veterans with more severe PTSD symptoms reported increased vestibular-related symptoms, suggesting a potential link between the two conditions.

Assessing Vestibular Function in Veterans with PTSD

To evaluate the relationship between PTSD and vestibular symptoms, the researchers employed a comprehensive set of assessment tools:

  1. Posttraumatic Stress Disorder Checklist (PCL-C) – to measure PTSD symptoms
  2. Dizziness Handicap Inventory (DHI) – to assess dizziness-related handicap
  3. Vertigo Symptom Scale Short Form (VSS-SF) – to evaluate vertigo symptoms
  4. Chambless Mobility Inventory (CMI) – to measure mobility and avoidance behaviors
  5. Neurobehavioral Scale Inventory (NSI) – to assess neurobehavioral symptoms

By comparing the results of these assessments, the researchers were able to identify patterns and correlations between PTSD symptoms and vestibular function.

Key Findings: Vestibular Impairment in Veterans with PTSD

The study revealed several significant findings regarding vestibular impairment in veterans with PTSD:

  • Veterans with PTSD reported three times more dizziness-related handicap compared to veterans without PTSD.
  • Those with increased avoidance behaviors reported more vertigo and dizziness-related handicap than veterans with PTSD and reduced avoidance.
  • There was a positive correlation between the severity of PTSD symptoms and the reported vestibular-related symptoms.

Do these findings suggest a direct causal relationship between PTSD and vestibular impairment. While the study demonstrates a strong association, further research is needed to establish causality and explore the underlying mechanisms.

Potential Contributing Factors to Vestibular Symptoms in PTSD

The researchers identified several potential factors that may contribute to the increased reporting of vestibular symptoms in veterans with PTSD:

1. Anxiety

Anxiety, a core component of PTSD, may exacerbate or even trigger vestibular symptoms. The heightened state of arousal and hypervigilance associated with PTSD could potentially affect the vestibular system’s functioning or the perception of vestibular sensations.

2. Vestibular Component

There may be a direct impact of PTSD on the vestibular system itself. Traumatic experiences could potentially lead to physiological changes in the vestibular apparatus or its neural connections, resulting in impaired function.

3. Interactive Effect of Anxiety and Vestibular Impairment

The researchers propose that there might be a synergistic effect between anxiety and vestibular impairment. This interaction could amplify the perception of vestibular symptoms and their impact on daily functioning.

4. Traumatic Brain Injury (TBI)

While not the primary focus of the study, the researchers acknowledge the potential role of TBI in contributing to vestibular symptoms in veterans with PTSD. Many veterans with PTSD have also experienced TBI, which can independently cause vestibular dysfunction.

How does traumatic brain injury intersect with PTSD and vestibular impairment. The complex interplay between TBI, PTSD, and vestibular symptoms warrants further investigation to untangle their individual and combined effects.

Implications for Clinical Practice and Future Research

The findings of this study have important implications for both clinical practice and future research in the field of PTSD and vestibular function:

  • Clinicians treating veterans with PTSD should be aware of the potential for vestibular symptoms and consider incorporating vestibular assessments into their evaluation protocols.
  • Treatment approaches for PTSD may need to be adapted to address vestibular impairment, potentially including vestibular rehabilitation or targeted interventions for dizziness and balance issues.
  • Further research is needed to explore the underlying mechanisms linking PTSD and vestibular dysfunction, as well as to develop effective treatment strategies that address both psychological and vestibular symptoms.
  • Longitudinal studies could help determine whether vestibular symptoms precede, coincide with, or follow the onset of PTSD, providing insight into the causal relationship between the two conditions.

Can targeted interventions for vestibular symptoms improve overall outcomes for veterans with PTSD. This question remains to be answered through future clinical trials and research efforts.

The Role of Avoidance Behaviors in Vestibular Symptoms

One intriguing finding of the study was the relationship between avoidance behaviors and vestibular symptoms in veterans with PTSD. Those who reported higher levels of avoidance also experienced more severe vertigo and dizziness-related handicap.

This connection raises several questions:

  • Does avoidance of certain environments or situations exacerbate vestibular symptoms?
  • Could exposure therapy or other interventions aimed at reducing avoidance behaviors also help alleviate vestibular symptoms?
  • Is there a bidirectional relationship between avoidance and vestibular impairment, where each reinforces the other?

Understanding the interplay between avoidance behaviors and vestibular symptoms could lead to more targeted and effective interventions for veterans with PTSD.

Addressing the Challenges of Vestibular Impairment in PTSD

The recognition of vestibular symptoms as a significant issue for veterans with PTSD presents both challenges and opportunities for improving their quality of life. Some potential approaches to addressing these challenges include:

1. Integrated Care Models

Developing interdisciplinary care teams that include mental health professionals, neurologists, and vestibular specialists could provide more comprehensive treatment for veterans experiencing both PTSD and vestibular symptoms.

2. Tailored Rehabilitation Programs

Creating rehabilitation programs that address both the psychological aspects of PTSD and the physical symptoms of vestibular impairment may lead to better outcomes for affected veterans.

3. Education and Awareness

Increasing awareness among healthcare providers about the potential link between PTSD and vestibular symptoms can lead to earlier detection and intervention.

4. Adaptive Technologies

Exploring the use of adaptive technologies or assistive devices that can help veterans with PTSD and vestibular impairment navigate challenging environments more easily.

How can virtual reality technologies be leveraged to create safe, controlled environments for exposure therapy and vestibular rehabilitation in veterans with PTSD. This innovative approach could potentially address both the psychological and physical aspects of the condition simultaneously.

The Impact of Vestibular Symptoms on Daily Life for Veterans with PTSD

The study’s findings highlight the significant impact that vestibular symptoms can have on the daily lives of veterans with PTSD. These symptoms can affect various aspects of functioning, including:

  • Mobility and independence
  • Social interactions and relationships
  • Employment and occupational performance
  • Overall quality of life

Understanding the full extent of these impacts is crucial for developing comprehensive support systems and interventions for affected veterans.

How do vestibular symptoms interact with other common comorbidities in veterans with PTSD, such as depression or substance use disorders. The complex interplay between these conditions may require a holistic approach to treatment and rehabilitation.

Future Directions in Research and Treatment

While this study provides valuable insights into the relationship between PTSD and vestibular symptoms in veterans, it also opens up new avenues for future research and treatment development:

1. Neuroimaging Studies

Utilizing advanced neuroimaging techniques to investigate potential structural or functional changes in the vestibular system and related brain regions in veterans with PTSD.

2. Longitudinal Research

Conducting long-term studies to track the evolution of vestibular symptoms in relation to PTSD progression and treatment outcomes.

3. Pharmacological Interventions

Exploring the potential of medications that could address both PTSD symptoms and vestibular impairment simultaneously.

4. Genetic and Epigenetic Factors

Investigating whether genetic predisposition or epigenetic changes following trauma may contribute to the development of vestibular symptoms in individuals with PTSD.

Can biomarkers be identified to predict which veterans with PTSD are more likely to develop vestibular symptoms. The identification of such biomarkers could lead to earlier interventions and more personalized treatment approaches.

As research in this field continues to evolve, it is crucial to maintain a patient-centered approach, considering the unique experiences and needs of each veteran affected by PTSD and vestibular impairment. By addressing both the psychological and physical aspects of these conditions, healthcare providers and researchers can work towards improving the overall well-being and quality of life for veterans who have served their countries.

Symptoms Associated with Vestibular Impairment in Veterans with Posttraumatic Stress Disorder

. 2016 Dec 29;11(12):e0168803.

doi: 10.1371/journal.pone.0168803.

eCollection 2016.

Yaa O Haber 
1
 
2
, Helena K Chandler 
2
, Jorge M Serrador 
1
 
2
 
3

Affiliations

Affiliations

  • 1 Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, New Jersey, United States of America.
  • 2 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, New Jersey, United States of America.
  • 3 Cardiovascular Electronics, National University of Ireland Galway, Galway, Ireland.
  • PMID:

    28033352

  • PMCID:

    PMC5199023

  • DOI:

    10.1371/journal.pone.0168803

Free PMC article

Yaa O Haber et al.

PLoS One.

.

Free PMC article

. 2016 Dec 29;11(12):e0168803.

doi: 10.1371/journal.pone.0168803.

eCollection 2016.

Authors

Yaa O Haber 
1
 
2
, Helena K Chandler 
2
, Jorge M Serrador 
1
 
2
 
3

Affiliations

  • 1 Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, New Jersey, United States of America.
  • 2 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, New Jersey, United States of America.
  • 3 Cardiovascular Electronics, National University of Ireland Galway, Galway, Ireland.
  • PMID:

    28033352

  • PMCID:

    PMC5199023

  • DOI:

    10.1371/journal.pone.0168803

Abstract

Posttraumatic stress disorder (PTSD) is a chronic and disabling, anxiety disorder resulting from exposure to life threatening events such as a serious accident, abuse or combat (DSM IV definition). Among veterans with PTSD, a common complaint is dizziness, disorientation and/or postural imbalance in environments such as grocery stores and shopping malls. The etiology of these symptoms in PTSD is poorly understood and some attribute them to anxiety or traumatic brain injury. There is a possibility that an impaired vestibular system may contribute to these symptoms since, symptoms of an impaired vestibular system include dizziness, disorientation and postural imbalance. To our knowledge, this is the first report to describe the nature of vestibular related symptoms in veterans with and without PTSD. We measured PTSD symptoms using the Posttraumatic Stress Disorder Checklist (PCL-C) and compared it to responses on vestibular function scales including the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Scale Short Form (VSS-SF), the Chambless Mobility Inventory (CMI), and the Neurobehavioral Scale Inventory (NSI) in order to identify vestibular-related symptoms. Our findings indicate that veterans with worse PTSD symptoms report increased vestibular related symptoms. Additionally veterans with PTSD reported 3 times more dizziness related handicap than veterans without PTSD. Veterans with increased avoidance reported more vertigo and dizziness related handicap than those with PTSD and reduced avoidance. We describe possible contributing factors to increased reports of vestibular symptoms in PTSD, namely, anxiety, a vestibular component as well as an interactive effect of anxiety and vestibular impairment. We also present some preliminary analyses regarding the contribution of TBI. This data suggests possible evidence for vestibular symptom reporting in veterans with PTSD, which may be explained by possible underlying vestibular impairment, worthy of further exploration.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Regression analysis between total PCL…

Fig 1. Regression analysis between total PCL score and total vestibular symptom subscale (VSS-V).

Increased…


Fig 1. Regression analysis between total PCL score and total vestibular symptom subscale (VSS-V).

Increased PTSD symptoms are associated with increased vestibular symptom endorsement within 30 days of study participation (r2 = 0.32, n = 66, p< 0.0001, two tailed).

Fig 2. The correlation between total PCL…

Fig 2. The correlation between total PCL score and total dizziness handicap score.

A higher…


Fig 2. The correlation between total PCL score and total dizziness handicap score.

A higher PCL score indicates more severe PTSD symptoms while a higher DHI score indicates a greater handicap due to dizziness symptoms. Total PCL score and DHI score were significantly correlated (r2 = 0.34, n = 62, p< 0.0001, two tailed).

Fig 3. The correlation between PCL score…

Fig 3. The correlation between PCL score and self-reported vertigo symptoms.

As veterans scored higher…


Fig 3. The correlation between PCL score and self-reported vertigo symptoms.

As veterans scored higher on PCL indicating more PTSD symptoms, there was also a tendency towards higher scores on the vertigo self-report scale (r2 = 0.27, n = 55, p < 0.0001, two tailed).

Fig 4. A comparison of veteran self-reports…

Fig 4. A comparison of veteran self-reports on Chambless Mobility Inventory when accompanied.

Veterans with…


Fig 4. A comparison of veteran self-reports on Chambless Mobility Inventory when accompanied.

Veterans with PTSD report increased discomfort and or avoidance of theatres, malls and supermarkets when accompanied by someone they trust. Note * denotes p

Fig 5. A comparison of veteran self-reports…

Fig 5. A comparison of veteran self-reports of avoidance when alone.

Veterans report a greater…


Fig 5. A comparison of veteran self-reports of avoidance when alone.

Veterans report a greater discomfort or avoidance when alone in theatres, malls and supermarkets when they are by themselves. Note * denotes p

Fig 6. A working hypothesis of the…

Fig 6. A working hypothesis of the relationship between vestibular function and anxiety.

Anxiety and…


Fig 6. A working hypothesis of the relationship between vestibular function and anxiety.

Anxiety and peripheral vestibular dysfunction have been associated with increased fall risk. Additionally both anxiety and peripheral vestibular dysfunction may interact and therefore lead to increased dizziness.

See this image and copyright information in PMC

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This work was supported by the War Related Illness and Injury Study Center (WRIISC) and the Office of Public Health within the Department of Veteran Affairs. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Dizziness due to a traumatic experience

Dizziness due to trauma

Do you regularly suffer from dizziness? Do you sometimes feel light-headed and think you might faint? Then it is wise to find out what is causing it. There are several possible different causes. Although dizziness can sometimes be scary, it does not always have to have a very serious cause. That is precisely why it is necessary to find out the cause, so that you can remedy or prevent it.

What is dizziness anyway?

Becoming dizzy can have a physical or mental cause. Whatever the cause, it affects the balance organ. The balance organ is located in the inner ear and reacts to the position of the head. When you feel dizzy, you feel dizzy and your balance organ, together with the eyes and the muscles in the neck and legs, are the cause of this. These parts send signals through with which you can easily correct your body. If the signals are not passed on properly, you become dizzy and have difficulty keeping your balance.

What causes dizziness?

For many people, physical complaints play an important role in the cause of dizziness. Examples are an inflammation of the balance organ, migraine or a problem with the blood circulation. In addition, there is also the ménière disease, which often makes you dizzy. In these cases, it is important to have a medical examination, so that you can be helped with medication or therapy.

Dizzy spells caused by stress or trauma

You can also get dizzy without any physical cause. In most cases, this is due to stress and tension. There can be times when things are not going so well. You may be under a lot of stress at work or a private situation may not be going so well. The tension and stress can build up to the point where you occasionally get dizzy. Again, this has to do with the fact that the signals are not passed on properly due to the stress. In these cases, it is necessary to solve or improve the problematic situation so that the stress disappears.

Stress and tension can also build up if you are suffering from an unprocessed trauma. A traumatic event keeps playing in your head like a film? If you have not been able to process the traumatic event for a long time, you get post-traumatic stress disorder (PTSD). PTSD can cause all sorts of symptoms, including dizziness. If an unprocessed trauma is the cause of the dizziness, EMDR can be the right treatment.

What is EMDR?

EMDR was developed in 1989 and is therefore still a relatively new treatment method. EMDR stands for ‘Eye Movement Desensitization and Reprocessing’. In short, through distraction by following something with your eyes, a place is given to the event, but without the trauma. EMDR is therefore specifically aimed at processing trauma and not at all complaints that may arise from an unprocessed trauma. If the trauma has been properly processed, all the symptoms, such as dizziness, will also have disappeared. EMDR is seen as a very successful method for trauma treatment.

Dizziness treatment with EMDR

During an EMDR session, the client has to visualise the traumatic moment, including the feelings and thoughts of that moment. At the same time, the client has to follow a hand movement or listen to a sound signal. This is a form of distraction, because at that moment you let go of the traumatic event completely. By doing this repeatedly, you will notice that the recall is much easier. Emotions play a lesser role in the retrieval of the trauma. In this way the trauma gets a place and all the accompanying symptoms disappear.

Following EMDR therapy in a modern way with Psylaris

Because you have to bring up the trauma again and again, EMDR can be hard. Certain tools can then be helpful. Psylaris, for example, has developed EMDR-remote. , an online platform. If the client has trouble getting out the door, EMDR can be given remotely via the platform. The platform offers the possibility of video calling and the practitioner has sufficient possibilities to use digital distraction techniques.

With EMDR-VR, Psylaris is taking important steps towards providing EMDR treatment via virtual reality. The client wears VR-glasses and is intensively distracted with lifelike distractions. The practitioner has the possibility to compose his/her own distraction tasks with photos and/or videos. With the VR glasses on, the client can be treated from home, but also in the treatment room.

EMDR therapy with modern methods

As a developer of modern methods and tools in mental healthcare, Psylaris has also made EMDR easy with modern techniques. Virtual reality, for example, plays an increasingly important role in the mental healthcare sector. With EMDR-VR and EMDR-plus, Psylaris has developed a VR-module. The module can easily be used by the practitioner and has many distraction possibilities. The client gets a more intense distraction than during a regular treatment. The VR glasses can be used both at home and in the treatment room. This makes both the practitioner and the client more flexible.

If the client is unable to come to the treatment centre, Psylaris uses EMDR-remote to make it possible to receive EMDR treatment at home. EMDR-remote is the online EMDR platform of Psylaris, where the practitioner and the client can conduct an EMDR session via video calling. Again, the practitioner has many possibilities to distract and the client, who is chained to the house, is still being treated.

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Post-traumatic dizziness – Neurology – LiveJournal

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Diagnosis of vertigo (D) occurring after traumatic brain injury (TBI) often presents significant difficulties. The latter are most likely due to two circumstances: [ 1 ] an unreasonably broad interpretation of the term “GC” and [ 2 ] the objective difficulty of identifying various injuries of the vestibular system.

In this article, the term “GC” refers to true GC, i.e., the sensation of an imaginary movement or rotation of objects around the patient or the patient himself in space. It is not uncommon for patients to name other sensations as well, such as feeling unsteady, slightly drunk, rocking in the waves, or heaviness in the head. These sensations are not HC, in most cases are not associated with damage to the vestibular system, are usually caused by experienced stress or, possibly, concomitant whiplash injury of the cervical spine and are not considered in this article.


read article: Whiplash injury of the neck (at laesus-de-liro.livejournal.com) [read]


Often, HC that occurs after an injury is considered a symptom of a concussion, without trying to clarify the mechanism of its occurrence. Meanwhile, the pathophysiology of post-traumatic GC is very diverse. The cause of such GC can be damage to both the peripheral vestibular apparatus and the central vestibular structures. Some of these conditions are in the area of ​​related interests of neurologists and doctors of other specialties, primarily otolaryngologists and traumatologists, which further complicates their diagnosis. Meanwhile, timely and accurate identification of the cause of post-traumatic HC is necessary for the selection of effective treatment and rehabilitation.

The main causes of post-traumatic HC are: [ 1 ] post-traumatic benign paroxysmal positional HC (BPPV), [ 2 ] perilymphatic fistula, [ 3 ] fractures of the temporal bone, [ 4 ] concussion maze and [ 5 ] brain stem damage:

more details in article “Post-traumatic dizziness”, authors: M. V. Zamergrad, L.M. Antonenko; Department of Nervous Diseases, First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health and Social Development of Russia (Neurological Journal, No. 2, 2012 [read]


see also article: Post-traumatic benign paroxysmal positional vertigo (at laesus-de-liro.livejournal.com) [read]


© Laesus De Liro 9 0012




Dear scientific authors materials that I use in my posts! If you see this as a violation of the “Copyright Law of the Russian Federation” or wish to see the presentation of your material in a different form (or in a different context), then in this case write to me (at the postal address: [email protected]) and I will immediately I will eliminate all violations and inaccuracies. But since my blog has no commercial purpose (and basis) [for me personally], but has a purely educational purpose (and, as a rule, always has an active link to the author and his scientific work), so I would be grateful to you for the chance make some exceptions for my messages (against existing legal regulations). Sincerely, Laesus De Liro.


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Posttraumatic benign paroxysmal positional vertigo versus idiopathic

Posttraumatic benign paroxysmal positional vertigo versus idiopathic

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Post-traumatic benign paroxysmal positional vertigo versus idiopathic vertigo

Journal:

Bulletin of otorhinolaryngology.

2019;84(1): 90‑90

How to quote:

Post-traumatic benign paroxysmal positional vertigo in comparison with idiopathic. Bulletin of otorhinolaryngology.
2019;84(1):90‑90.
Traumatic versus idiopathic benign positional vertigo: analysis of disease, treatment, and outcome characteristics. Vestnik Oto-Rino-Laringologii. 2019;84(1):90‑90. (In Russ.)

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Otolaryngol Head Neck Surg. 2018 Oct 16 (English – US) (available online before publication in print)

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The purpose of this article is to compare traumatic and idiopathic benign paroxysmal positional vertigo (BPPV). The study was conducted in the otorhinolaryngological center from 2007 to 2017. Traumatic BPPV was considered if dizziness symptoms appeared no later than 30 days after the injury. The history of the disease, comorbidities, characteristics of dizziness in both forms of BPPV were assessed. The results of the analysis of 1378 patients with BPPV were almost identical, 110 (8%) of which had a traumatic nature. The percentage of rapid recovery was quite high – 76%, relapses were noted in 38% of cases. Patients with post-traumatic BPPV were younger (mean age 61 vs 65 years; p = 0.007), and more often they were men (40% vs 27%; p = 0.004) compared with idiopathic. Traumatic BPPV was more common in both ears (32% vs 19%; p = 0.