Statements encapsulating common beliefs, behaviour and difficulties associated with vertigo, derived from in-depth interviews, were used to construct a Vertigo Handicap Questionnaire (VHQ) which was completed by 84 patients referred for vestibular testing. Factor analysis identified four principal components of handicap in addition to 'Anxiety and Depression', (which was isolated prior to analysis): 'Restriction of Activities', both physical and social; concern that vertigo would adversely affect social relationships ('Social Anxieties'); 'Fear of Vertigo', both the attacks themselves and their possible significance; and 'Severity of Attacks' which was multiplied with frequency of attacks to give a measure of reported physical disability. Multiple regression revealed that Severity x Frequency of attacks contributed to patient distress only indirectly, through its influence on the mediating psychological and behavioural variables. Significant patient benefit may therefore result from counselling or behavioural therapy, whether or not the vertigo itself can be controlled.