title: Adverse effects of health anxiety on management of a patient with benign paroxysmal positional vertigo, vestibular migraine and chronic subjective dizziness.
abstract: BACKGROUND
  Care of patients with vestibular symptoms focuses primarily on physical otoneurologic disorders; however, psychological factors can sustain symptoms, confound assessment, and adversely affect treatment. Health anxiety is a particularly pernicious process that simultaneously magnifies physical symptoms and inhibits medical care.
  
  
  OBJECTIVE
  To demonstrate the excess morbidity caused by vestibular health anxiety and its successful management in a patient with otoneurologic disease.
  
  
  METHODS
  Report of a 41-year-old woman with recurrent benign paroxysmal positional vertigo, vestibular migraine, and chronic subjective dizziness, who expressed grave concerns about her health, repeatedly questioned her otoneurologic diagnoses, and failed physical therapy and medication treatment until her health anxiety and otoneurologic illnesses were addressed simultaneously.
  
  
  CONCLUSIONS
  Health anxiety is an empirically validated concept that explains troublesome health-related beliefs and behaviors. It is frustrating for patients and health care teams, but can be treated successfully in otoneurology practice, thereby reducing physical symptoms, emotional distress, functional impairment, and health care overutilization.
authors.affiliation: Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, NE 68583-0731, USA. jhonaker2@unl.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Honaker
authors.forename: Jane M
authors.initials: JM
authors.lastname: Gilbert
authors.forename: Neil T
authors.initials: NT
authors.lastname: Shepard
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blum
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Staab
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology*; D001294:Attitude to Health; D065635:Benign Paroxysmal Positional Vertigo; D004244:Dizziness / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008881:Migraine Disorders / Q000150:complications / Q000628:therapy*; D014717:Vertigo / Q000150:complications / Q000628:therapy*; D014722:Vestibule, Labyrinth / Q000503:physiopathology*