Nearly 50% of the patients in general medicine practice suffer from vertigo. In specialized vertigo clinics approximately 50% of the patients have either a primary or secondary somatoform vertigo, which develops after a peripheral vestibular disorder (in nearly 30%). The different subgroups of somatoform vertigo and a pathogenetic model for the two forms of somatoform vertigo are presented. Interesting interactions between neuro-anatomical, neurophysiological and psychological mechanisms concerning anxiety and vertigo are described. Therapeutic principles which are important for the treatment of patients with complex somatoform vertigo disorders are described.