What is PPPD or Persistent Postural-Perceptual Dizziness?

PPPD or Persistent Postural-Perceptual Dizziness is a condition which causes non-spinning dizziness and unsteadiness provoked by environmental or social factors. For some individuals, PPPD can cause chronic dizziness following an acute bout of dizziness or vertigo.

Persistent Postural-Perceptual Dizziness was previously known as Chronic Subjective Dizziness (CSD) and was given as a diagnosis when a patient experienced dizziness symptoms without any positive objective tests for a condition.

It is now seen as the most common vestibular condition affecting people in the 30-50 age group and the second most common diagnosis for all vestibular patients.

What causes this Condition?

Patients most often develop PPPD following an insult or injury to the balance system (such as vestibular migraine, vestibular neuritis, or BPPV), a medical issue (such as a severe episode of low blood pressure causing dizziness), or trauma (both physical or psychological).

Symptoms of PPPD

PPPD Persistant Postural Dizziness.Eviasis

PPPD Persistant Postural Dizziness

Patients with PPPD often describe a sense of internal motion (even without objective movement of the body), akin to a feeling of ‘rocking or swaying as if on a boat’, a sense of unsteadiness, vibrations inside the body, and walking ‘as if drunk’. Symptoms tend to be worse in busy or visually rich environments but can also persist even when the patient is lying in bed at night. There may be accompanying symptoms such as difficulty concentrating, short-term memory loss, and a sensation of derealisation (feeling detached from the world) or depersonalisation (feeling detached from oneself).

One of the most frustrating aspects of PPPD for patients is that others cannot see the problem, and so often patients report feeling ‘mis-understood’ by friends, family, or work colleagues.

Treatment of PPPD

Since PPPD is complex and is influenced by many different factors, treatment must be tailored to the individual and typically requires several different interventions to make meaningful, long lasting change.

Once the diagnosis is made, the first step in treatment is for the patient to understand what causes PPPD and how the brain misinterprets normal balance stimuli as a threat. Knowing what is happening will help patients feel better and motivate them to be more actively involved in their treatment.

Treatment for PPPD involves “retraining” the brain. At EYasis center we recommend a combination of vestibular rehabilitation therapy strategies in order to alleviate stress.  with acupuncture. Acupuncture is also recommended to alleviate anxiety and balances the nervous system in order to restore functionality and prohibit symptoms of PPPD.


1. Popkirov SStaab JPStone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness.
2. Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, Bronstein A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017;27(4):191-208.
3. Söhsten E, Bittar RS, Staab JP. Posturographic profile of patients with persistent postural-perceptual dizziness on the sensory organization test. J Vestib Res. 2016 Jul 2;26(3):319-26.