Patients with POTS fear that data on abnormal haemodynamic physiology have been ignored

Abstract

Norcliffe-Kaufmann et al.1 recently reported that patients with postural orthostatic tachycardia syndrome (POTS) had an exaggerated anticipatory heart rate (HR) increase in the 30 s prior to head-up tilt (HUT). Based largely on these findings, the authors conclude that patients with POTS suffer from a ‘fear-conditioning behavioural response’ to the thought of standing, and that POTS is a ‘functional psychogenic disorder’ that would best be treated by mental health professionals. Their basic finding is of potential interest; unfortunately their conclusions ignore limitations in their participant selection, methodological approach, and prior research into POTS pathophysiology, and they illustrate their lack of knowledge of psychiatric diagnosis and care. A major study limitation is the choice to compare POTS patients with a healthy control group. In a previous report,2 participants with POTS scored higher on the anxiety sensitivity index than healthy control participants, but scores were not significantly different compared to the general population.2 Patients with chronic illness have elevated depression, anxiety and health anxiety scores compared to healthy controls.3 Consequently, Norcliffe-Kaufmann et al.1 should have chosen a control group with chronic illness but without an orthostatic disorder. Without this control group, the study finding of exaggerated anticipatory tachycardia to a tilt stimulus may simply reflect elevated somatic anxiety due to chronic illness.