We are interested in visually induced dizziness, more information here, which is best considered a symptom that appears within a number of conditions. However, Persistent Postural Perceptual Dizziness (PPPD or 3PD), is one of the conditions which is most characterised by visually induced dizziness and where it can be most chronic, impactful, and difficult to rehabilitate. PPPD was recently classified in 2017 (Staab et al., 2017), from four prior, separate, diagnoses: Visual Vertigo (Bronstein, 1995); Phobic Postural Vertigo (Brandt & Brandt, 2003); chronic subject dizziness (Ruckenstein & Staab, 2009); and space and motion discomfort (Jacob et al., 2009). PPPD is most prevalent in middle-aged women (Dieterich et al., 2016; Neuhauser, 2016; Strupp, 2003), although people from all ages and walks of life can be affected. Not all people will experience the symptoms of PPPD with the same intensity, or in the same manner, as with visually induced dizziness. However, there appears to be some situations that people consistently report always triggering their symptoms, as they contain such a large concentration of triggers each person will find at least one; a commonly cited example is the supermarket and busy moving traffic (McCabe, 1975; Söhsten et al., 2016; Staab, 2023; Staab et al., 2017).
As shown by the diagnostic criteria in Staab et al. (2017), visually induced dizziness in PPPD must be exacerbated by three factors: upright posture, active or passive motion, and exposure to moving visual stimuli/complex visual patterns (Staab et al., 2017). These symptoms do not need to be present at all times but do need to occur at least half of the time (most days) for a PPPD diagnosis to occur. As a result, getting diagnosed with PPPD can be a difficult task whilst all other potential causes must be investigated due to criterion E of the diagnosis criteria from Staab et al. (2017): the symptoms may not be better explained by another diagnosis (Staab et al., 2017). This often means that getting a PPPD diagnosis takes time. We must note, however, that PPPD is not a diagnosis of exclusion and does still require all other criteria to be a valid diagnosis. Many people with PPPD have comorbid anxiety (Guerraz et al., 2001; Staab et al., 2017; Trinidade, Cabreira, Kaski, et al., 2023; Zur et al., 2015). There is a growing understanding of the link between anxiety and PPPD, with recent research finding preexisting anxiety as a predictor of PPPD or PPPD-like dizziness (Trinidade, Cabreira, Goebel, et al., 2023)
Additional Resources
Persistent Postural-Perceptual Dizziness – Vestibular Disorders Association
What is Persistent Postural Perceptual Dizziness (PPPD)? | Ménière’s Society
References
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