PANIC, AGORAPHOBIA, AND VESTIBULAR DYSFUNCTION

Objective: Otoneurological abnormalities have been reported in panic d isorder. The purpose of this investigation was to determine the preval ence of such findings in panic disorder with and without agoraphobia a nd to discern whether vestibular dysfunction was associated with speci fic symptoms. Method: Clinical audiological and vestibular tests were administered to 30 patients with uncomplicated panic disorder (without agoraphobia or with only mild agoraphobia), 29 patients with panic di sorder with moderate to severe agoraphobia, 27 patients with anxiety b ut no history of panic attacks, 13 patients with depressive disorders but no history of anxiety or panic attacks, and 45 normal comparison s ubjects. Evaluators were blind to subjects' diagnostic group. Quantita tive measures of subjects' discomfort with space and motion and of the frequency of certain symptoms between and during panic attacks were o btained. Anxiety state levels were measured during the vestibular test s. Results: Vestibular abnormalities were common in all the groups but most prevalent in the patients with panic disorder with moderate to s evere agoraphobia. Vestibular dysfunction was associated with space an d motion discomfort and with frequency of vestibular symptoms between, but not during, panic attacks. There were no major differences betwee n the two panic groups in anxiety levels during vestibular testing. Th ere were no significant differences between groups on the audiological component of the test battery. Exploratory data analysis indicated th at the constellation of vestibular tests most specific for agoraphobia was one indicating compensated peripheral vestibular dysfunction. Con clusions: Subclinical vestibular dysfunction, as identified by clinica l tests, may contribute to the phenomenology of panic disorder, partic ularly to the development of agoraphobia in panic disorder patients.