[Panic disorder and vestibular/equilibrium dysfunctions: state of the art]

This paper reviews the literature on the links between panic disorder with or without agoraphobia and vestibular dysfunction. To date, it has been established that these conditions are encountered in high proportions in psychiatric samples and in patients consulting for equilibrium problems. Three models have tried to hypothesize the mechanisms underlying this co-occurrence. Agoraphobic avoidance and high anxiety level seem to be characteristics of individuals affected by both conditions. Moreover, vestibular dysfunctions appear to be predicted by individuals feeling uncomfortable in situations characterized by spatial and/or motor particularities. Additional studies on that topic would be beneficial. Further studies should try to better understand people with both panic disorder and dysfunctions of the equilibrium system. These individuals who suffer from both conditions may avoid activities that particularly call upon the equilibrium system, such as walking on uneven surfaces or undertaking some forms of transportation. The cognitive substrates pertaining to the feared consequences of the physical symptoms may also differentiate this group from uncomplicated anxiety disorder patients. For example, these individuals with uncomplicated panic disorder may fear having a heart attack or suffocating as a result of a panic attack, whereas individuals suffering from both conditions may be more prone to apprehending falling or vomiting. The paper also proposes (1) the analysis of characteristics of individuals in remission from both conditions so that effective components of treatment are emphasized, and (2) targets for treatment for these comorbid patients.