Weather changes and vertigo — why monsoon makes it worse

weather changes and vertigo matters because weather changes and vertigo can flare together, and patients need to know whether this is a simple trigger pattern or a sign of a different balance problem.

weather changes and vertigo: what patients should know

This is the symptom nobody talks about.

You’re dizzy. You go to the doctor. They test your balance. “It’s fine,” they say. But you KNOW something is wrong. Because you don’t feel like yourself.

The world feels like you’re watching it through glass. Your body doesn’t feel like yours. You’re floating. Detached. Unreal.

This is depersonalization and derealization, or DPDR. And it’s FAR more common in dizzy patients than anyone admits.

I’d say 30% of my patients with functional dizziness have some form of DPDR. But most never bring it up. They’re embarrassed. They think they’re “going crazy.”

I’m Dr. Prateek, and I see this pattern constantly in Hardoi.

Let me explain what’s happening to you.

What is Depersonalization-Derealization Disorder (DPDR)?: Vertigo Makes

These are two related dissociative experiences:

**Depersonalization:** Feeling disconnected from your own body. Like you’re watching yourself from outside. Your limbs feel unreal. Your actions feel like you’re observing them, not doing them.

**Derealization:** The world feels unreal. Colors seem muted. Sound seems distant. People’s faces look strange. You feel like you’re in a dream or behind a veil.

Most people experience these feelings during extreme stress — an accident, a panic attack, a frightening moment.

But in DPDR disorder, these feelings PERSIST and INTERFERE with life.

You go through weeks or months feeling detached. It’s exhausting. It’s scary.

And when it happens alongside dizziness, patients often think they’re having a stroke or losing their mind.

They’re not. The nervous system is just in a different mode.

Why DPDR Happens With Dizziness

The connection is neurological.

Your vestibular system (balance nerve) is directly wired into your sense of self. It tells your brain where your body is in space. Interoceptive signals from your inner ear, your neck, your joints — all feed into your BODY AWARENESS.

When the vestibular system misfires (or becomes hypervigilant to normal sensations), something weird happens.

Your brain can’t TRUST the body signals it’s getting.

“Is my body still here? Is the world stable? Am I real?”

So it does what any system does when the input is unreliable: It DISCONNECTS.

Depersonalization is a PROTECTIVE mechanism. When the body signal is chaotic, the brain says: “Okay, I’m unplugging from that unreliable input.”

It’s like disconnecting an infected phone. The problem is meant to protect you. But it also leaves you feeling ghostlike.

I explain this to patients:

“Your vestibular system is screaming at your brain: ‘Something’s wrong!’ Your brain responds by saying: ‘Okay, I’m going to stop listening to those signals.’ So you feel detached. But you’re not going crazy. Your brain is trying to protect you.”

This reframe helps. A lot.

The Dizzy-DPDR Cycle

Here’s the pattern I see constantly:

**Week 1:** Real vertigo episode. Maybe BPPV, maybe vestibular neuritis.

**Week 2:** During the episode, anxiety spikes. Panic. Hyperventilation.

**Week 3:** Vertigo starts improving. But now you notice something: You feel UNREAL. Detached. Like you’re in a dream.

**Week 4:** You test the sensation. “Am I still here? Is this real?” This repetitive testing LOCKS IN the DPDR.

**Week 5:** You go to the doctor. VNG is normal (because the BPPV resolved). “Your vertigo is fixed,” they say. But you still feel unreal.

**Weeks 6+:** You spiral. “If the VNG is normal, why do I feel this way? Am I crazy? Is it psychiatric?”

And now anxiety about the DPDR makes the DPDR WORSE.

It’s a cycle, just like panic-vertigo. But with a dissociative flavor.

Types of DPDR I See in Dizzy Patients

**Type 1: DPDR During the Acute Vertigo**

Patient has BPPV. Panic sets in. They dissociate to cope. During the episode, they feel unreal.

Once the BPPV resolves and anxiety drops, DPDR fades.

Treatment: Vestibular rehab + reassurance. Usually resolves in 2-4 weeks.

**Type 2: DPDR Conditioned by Dizziness**

Patient had BPPV months ago. It’s resolved. But they developed DPDR as a coping mechanism during it.

Now, even years later, they feel detached because the brain learned: “When dizzy sensations appear, disconnect.”

It becomes a HABIT, not a response to current vestibular dysfunction.

Treatment: This needs vestibular CBT + graded re-exposure to dizziness sensations. Also takes weeks to months.

**Type 3: DPDR Causing the Dizziness (Not the Other Way Around)**

Some patients develop pure DPDR first. No vestibular problem. Just anxiety-driven dissociation.

The DPDR causes interoceptive confusion, which FEELS like dizziness.

“I don’t feel connected to my body, so my balance doesn’t make sense” → “I feel dizzy.”

VNG is normal. Balance tests are normal. But they feel terrible.

Treatment: This is psychiatric. SSRIs + therapy. Vestibular rehab won’t help (there’s no vestibular problem).

How DPDR Manifests in Dizzy Patients

The symptoms overlap confusingly:

“My body feels separate from me” — depersonalization
“The world looks 2D or blurry” — derealization
“I feel like I’m floating” — could be either
“I feel like I’m watching myself move” — depersonalization
“The room feels far away or dream-like” — derealization
“I can’t tell which way is up” — could be vestibular OR DPDR
“Everything feels unreal, like I’m in a film” — derealization
“I don’t recognize my hands as mine” — depersonalization

Most patients describe it as: “I feel like I’m inside a bubble. Like the world is real but I’m not in it.”

A Case From My Practice

Anita, 38, teacher from Kannauj. Came in with dizziness and extreme anxiety.

She’d had one episode of severe vertigo 8 months ago. Treated it successfully. VNG back to normal.

But then she started feeling “unreal.”

“Doctor, I don’t feel like I. It’s like I’m outside my body, watching myself teach. The classroom looks like a movie set. The kids’ voices sound like they’re from far away.”

She was convinced she was losing her mind.

She’d tried multiple antidepressants. Been to 3 different ENT specialists. No one was addressing the dissociation specifically.

I did:
1. Confirmed her vestibular system was fine (VNG normal, balance normal)
2. Explained that DPDR is real AND separate from vestibular dysfunction
3. Referred her to a psychiatrist trained in dissociative disorders
4. Gave her specific grounding exercises for DPDR

The psychiatrist started her on a low-dose SSRI (sertraline). Not for “anxiety” in general. But specifically for dissociative symptoms.

Simultaneously, I had her do a CBT-based technique called “grounding”:
– Touch objects around you and describe them aloud (“This coffee cup is warm. It’s ceramic. It’s real.”)
– Name 5 things you see, 4 you can touch, 3 you hear, 2 you smell, 1 you taste
– Do this daily

Within 3 weeks, the depersonalization dropped from “constant” to “occasional.”

Within 8 weeks, it resolved mostly.

She’s now on maintenance sertraline and does grounding exercises when anxiety spikes.

“I feel like myself again,” she told me last month.

The Interoceptive Problem at the Heart of DPDR

Interoception is your brain’s ability to sense your body’s internal state.

In DPDR patients, interoception goes haywire.

Normal: “My heart is beating. I’m breathing. I’m stable in space.”
DPDR: “My heart feels weird. My breathing feels disconnected. Am I even here?”

The brain perceives normal body signals as THREATENING or STRANGE.

So it disengages. It says: “I’m not going to listen to these unreliable signals.”

Result: Detachment.

This is why grounding exercises work. They rebuild TRUST in interoceptive signals.

“My foot is on the ground. It’s cold. It’s real. I’m here.”

Repeated grounding retrains the brain: “These signals are reliable. I can trust them. I can stay connected.”

Testing for DPDR in Vertigo Patients

There’s no single blood test for DPDR. But I assess it clinically:

**Questions I ask:**
– Do you feel separated from your body?
– Does your body feel unreal?
– Does the world look flat, colorless, or dream-like?
– Do you feel like you’re watching yourself from above?
– Have you had these feelings AFTER the dizziness started?
– Do these feelings get worse with anxiety?

**The key:** If someone developed DPDR AFTER vestibular symptoms, it’s likely VESTIBULAR-triggered DPDR.

If DPDR is their PRIMARY problem and dizziness is secondary, it’s psychiatric.

Treatment Strategy

**For Vestibular-Triggered DPDR:**

1. **Treat the vestibular problem first** (maneuvers, rehab, etc.)
2. **Vestibular-specific CBT** — particularly graded exposure to dizziness sensations
3. **Grounding exercises** — retraining interoceptive trust
4. **Sometimes SSRIs** — if anxiety component is significant
5. **Reassurance and education** — “You’re not crazy. Your nervous system learned a protective response.”

**For Primary DPDR (No Actual Vestibular Disorder):**

1. **Psychiatry referral** — Not because it’s “not real,” but because the nervous system problem is in the brain’s threat-detection system, not the inner ear
2. **SSRIs** — More essential here
3. **Psychotherapy** — Usually CBT or trauma-focused if there’s underlying PTSD
4. **Grounding and mindfulness** — Not as primary treatment, but as coping tools

Why This Matters in Hardoi

Many patients in our region won’t accept a psychiatric diagnosis. The stigma is real. Family pressure is real.

“You’re saying it’s in my head,” they interpret. “But I FEEL dizzy!”

So I’ve learned to frame it differently:

“Your brain’s threat-detection system is too sensitive. It’s reading danger when there’s none. This is a NEUROLOGICAL problem, not a weakness. And it’s treatable.”

This lands better. It’s not “you’re crazy.” It’s “your nervous system needs recalibration.”

FAQ

**Q: If I have DPDR, does that mean I never actually had vertigo?**
A: No. You might have had real BPPV that triggered DPDR as a side effect. Or you might have a real vestibular disorder that’s resolved, but the DPDR stayed. Or you might have pure DPDR with no vestibular disorder. Testing helps clarify.

**Q: Can DPDR cause dizziness, or only the other way around?**
A: BOTH. Real dizziness can trigger DPDR. But DPDR can also CAUSE dizziness-like sensations because your balance confidence is shattered. The causality is bidirectional.

**Q: Is DPDR dangerous?**
A: It’s uncomfortable and scary, but not dangerous. You’re not losing your mind. Your nervous system is in a protective state. It can be trained back to normal.

**Q: How long does DPDR last?**
A: Depends on the cause. If it’s triggered by acute stress/dizziness, it usually resolves within weeks. If it’s become habitual (conditioned), it takes longer — months of consistent grounding. If it’s primary dissociative disorder, months to years with proper treatment.

**Q: Will medication fix it?**
A: SSRIs can help by lowering overall anxiety. But the real healing happens with exposure-based therapy and retraining interoceptive trust. Meds alone aren’t enough.

**Q: What if I don’t have a psychiatrist in my town?**
A: Online therapy is an option. There are Indian platforms with therapists trained in dissociation. Also, general vestibular rehab therapists can teach grounding exercises. Something is better than nothing.

The Bottom Line

Depersonalization-derealization is the hidden companion of dizziness that nobody talks about.

It’s scary. It feels like you’re losing your mind. But you’re not.

Your nervous system learned a protective response: “When the body signals are unreliable, disconnect.”

The solution is patient, consistent retraining. Grounding. Exposure. Sometimes medication. Therapy if needed.

Most importantly: You’re not alone. I see this every week in Hardoi.

And with the right approach, people get better.

—

References

1. Sar, V., et al. (2009). Dissociation and conversion in panic disorder. *Psychiatry and Clinical Neurosciences*, 63(4), 470-479.
2. Giesbrecht, T., et al. (2008). Dissociation in anxiety disorders: Evaluating the dissociative symptom scale (DSS-4). *Journal of Psychiatric Research*, 42(6), 482-488.
3. Hoyer, J., et al. (2005). Depersonalization, derealization and dissociation in panic disorder. *Journal of Anxiety Disorders*, 19(1), 85-95.

This article is for educational purposes. Please consult Dr. Prateek Porwal at Prime ENT Center, Hardoi for personal medical advice.

Dr. Prateek Porwal is an ENT & Vertigo Specialist with over 13 years of experience, holding MBBS (GSVM Medical College), DNB ENT (Tata Main Hospital), and CAMVD (Yenepoya University). He is the originator of the Bangalore Maneuver for Anterior Canal BPPV and has published research in Frontiers in Neurology and IJOHNS. Serving at Prime ENT Center, Hardoi.

Related reading:

• Your Anxiety Is Making You Dizzy: The Stress-Vertigo Link
• Vertigo and the Inner Ear
• The Vertigo Medication Trap: Why Pills Make It Worse

Reference: Persistent Postural-Perceptual Dizziness — Staab et al, 2017