Differential diagnosis and management of suspected atypical chronic psychogenic dizziness using the International Classification of Functioning, Disability and Health model: a case report

BACKGROUND: Dizziness in older adults is a complex, often multifactorial condition that can lead to an increased risk of falls, heightened anxiety, and loss of independence. Its nonspecific presentation complicates accurate diagnosis and treatment planning given the potential involvement of vestibular, musculoskeletal, cardiovascular, or psychological systems. PURPOSE: The purpose of this case report is to describe the differential diagnosis process for a patient with atypical chronic dizziness and highlight the role of the International Classification of Functioning, Disability and Health (ICF) model, with particular attention to emotional factors involved. CASE DESCRIPTION: The patient was a 79-year-old female referred to outpatient physical therapy for persistent dizziness, blurred vision, and feelings of unsteadiness. Her dizziness was present for 40 years but increased after the passing of her spouse and a traumatic fall. She also complained of headaches and neck pain. Initial examination findings supported a diagnosis of cervicogenic dizziness. Interventions included manual therapy, cervical stabilization, periscapular strengthening, and balance exercises. Despite improvements in cervical mobility, headache severity, and objective balance performance, the patient continued to report significant dizziness and fear of falling. Due to the lack of meaningful change in self-perceived dizziness and emotional triggers associated with symptom escalation, the diagnosis was revised to suspected psychogenic dizziness. The plan of care was adapted accordingly, and psychological services were suggested. OUTCOMES: Although improvements in cervical pain, mobility, and balance performance were observed, the patient's reported dizziness on both the Dizziness Handicap Inventory and Activities-specific Balance Confidence Scale showed no significant change. DISCUSSION: This case highlights the importance of considering psychological and emotional factors in evaluating chronic dizziness. The ICF model provided a valuable framework for identifying contributing personal and environmental factors affecting participation. It also emphasizes the relevance of interdisciplinary care in addressing the multifaceted nature of these contributing factors.