Persistent Postural Perceptual Dizziness (PPPD or 3PD) as Cause for Chronic Dizziness/Vertigo
Persistent Postural Perceptual Dizziness, PPPD or 3PD, is a not uncommon condition that causes persistent, long-term dizziness, often lasting three months or more. For many people, 3PD begins after a specific event that triggers dizziness or vertigo, such as vestibular migraine, benign paroxysmal positional vertigo (BPPV), Ménière's disease, or a mild concussion. These initial episodes can disrupt the brain’s normal balance mechanisms, setting the stage for 3PD to develop.Rather than fully recovering after the initial vestibular pathology has resolved, the brain remains in a heightened state of alertness, behaving as though danger is ever present and that dizziness may occur at any moment. This can lead to a near-constant sensation of movement, even when you are still. Many individuals start to feel anxious about situations that exacerbate their symptoms, such as being in busy environments or moving their heads in certain ways. Concerns about falling or losing balance may lead to changes in behavior, with people avoiding activities or situations that worsen their symptoms. Over time, these coping mechanisms can begin to significantly interfere with daily life.
This avoidance can trap individuals in a vicious cycle: as anxiety increases, symptoms often intensify, and as symptoms worsen, anxiety grows. Fatigue and difficulty concentrating are also common, making everyday tasks feel overwhelming. People with 3PD often find it challenging to explain their symptoms to others but know that something is profoundly wrong.
Symptoms tend to worsen when standing upright, observing motion, or looking at visually complex patterns, such as scrolling on a screen or being in a crowded place. On the other hand, relief is often found when lying down, sitting still, or immersing yourself in activities that hold your attention and bring enjoyment.
Such patients will often see multiple different medical specialists and undergo numerous testings which all ultimately come back normal.
This may lead many patients to feel like the chronic dizziness is “all in your head,” BUT the symptoms of 3PD are very real. Importantly, 3PD is not a mental health disorder, even though anxiety often plays a significant role in its development and persistence.
The path to recovery starts with an accurate diagnosis, which can bring a sense of understanding and control. Knowing what’s happening in your body is often the first step toward healing.
Treatment for 3PD, usually performed by a qualified vestibular physical therapist, typically involves retraining the brain through a combination of vestibular exercises, counseling, and cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a psychological treatment often used in helping patients manage the anxiety and stress associated with dizziness by changing their thought patterns and behaviors, ultimately reducing the intensity of dizziness episodes and improving their ability to perform daily activities. It focuses on addressing the fear of falling, health anxiety, and avoidance behaviors often present in PPPD patients by teaching coping strategies and gradual exposure techniques.
This multi-pronged approach helps the brain adapt and regain its ability to process balance and motion correctly. While there is no quick fix for PPPD, recovery is achievable with the right treatment plan, time, and a commitment to healing. With patience and support, it is possible to regain your quality of life.
Vestibular Physical Therapist who can help PPPD sufferers:
Amy Mcmillin, PT @treatdizzinessathome2023
Owner of Custom Care Rehab in Ohio
Website: https://customcarerehab.com
Email: treatdizzinessathome@gmail.com
Video created by Dr. Christopher Chang:
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