Is Mal de Debarquement Psychogenic in Origin?
No, Mal de Debarquement Syndrome (MdDS) is not psychogenic in origin—it is a neurological vestibular disorder involving maladaptive neural plasticity in vestibular and sensory integration systems, not a psychological condition. 1
Neurological Basis of MdDS
MdDS is a movement disorder that originates in the vestibular system pathways, manifesting as a constant sensation of rocking, bobbing, or swaying. 2, 3 The condition arises from maladaptive neural plasticity following exposure to passive motion (such as boat or plane travel in classic MdDS), or can occur spontaneously. 1
The disorder predominantly affects women and typically begins after extended passive motion exposure, with symptoms persisting after the motion ceases. 4, 1
Objective findings include measurable rocking frequency, body drifting, and nystagmus that can be documented during clinical examination. 3
Static posturography demonstrates objective vestibular dysfunction in MdDS patients. 3
Evidence Against Psychogenic Origin
The successful treatment of MdDS with vestibular-specific interventions strongly argues against a psychogenic etiology:
Vestibular migraine management protocols (including verapamil, nortriptyline, topiramate) produce significant improvement in 73% of MdDS patients, with nearly all patients having personal or family history of migraine or atypical migraine symptoms. 4
Specialized vestibular treatment involving head rolling while watching rotating full-field visual surrounds produces 78% significant improvement in classic MdDS and 48% in spontaneous MdDS, with complete remission in 27% of classic cases at 1-year follow-up. 3
Treatment success correlates inversely with symptom duration and patient age—a pattern consistent with neuroplastic disorders, not psychogenic conditions. 3
Clinical Pitfalls to Avoid
Do not misdiagnose MdDS as a psychogenic disorder simply because the mechanism is poorly understood or because patients develop secondary psychological symptoms from the debilitating nature of the condition. 2, 1
The lack of clinical awareness among medical professionals has led to underrecognition and misdiagnosis of this neurological condition. 2, 1
While benzodiazepines and antidepressants are reported as beneficial for symptom management, their effectiveness likely relates to stress reduction and modulation of vestibular pathways rather than treating an underlying psychiatric disorder. 2, 5
Patients experience significant economic and psychological burden as a consequence of their vestibular symptoms, not as the cause. 5