Reframing the lived experience of persistent dizziness: insights from active inference

We present an active inference account of persistent dizziness predicated on models of enactivism and ecological psychology; including first-hand accounts of the patient’s lived experience. Mechanistically, we consider persistent dizziness to reflect an initial failure of sensory attenuation of vestibular and other sensory prediction errors. This failure becomes self-maintaining if the patient infers—or learns—that unattenuated prediction errors cannot be resolved through action. The ensuing formulation provides an integrative account of the pathophysiology of dizziness and how it underwrites—and is maintained by—affective inference and an altered sense of agency that shapes the experience of the person with dizziness. We foreground the holistic person-centered approach on offer from a clinical perspective, and consider complementary levels of therapeutic intervention under this theoretical framework.