Persistent Postural Perceptual Dizziness

Persistent Postural Perceptual Dizziness (PPPD) is recognised as a form of Functional Neurological Disorder (FND). While many neurological conditions are caused by structural damage like a scar or a lesion, FND describes a problem with the 'software' of the nervous system rather than the 'hardware.' In the case of PPPD, the brain remains structurally healthy, but the way it sends and receives balance signals becomes disrupted. It is helpful to think of it as a communication error: the brain is stuck in a high alert mode, over processing sensory information that it would normally ignore.

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Unlike many other neurological conditions, PPPD involves no structural damage to the brain or inner ear; instead, symptoms arise from altered central processing of balance and sensory information. This shift in processing often follows an initial trigger event such as an episode of BPPV, a concussion, or a period of acute anxiety where the brain remains stuck in a defensive state even after the initial threat has resolved.

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Those living with PPPD typically experience persistent, non spinning dizziness or unsteadiness lasting more than three months. These symptoms are often exacerbated by standing, walking, or navigating visually busy environments like grocery stores or crowds. Because the nervous system is functioning in an overly sensitive state, the goal of treatment is often to 'reset and reprogram' the brain that has become 'overprotective.'