3PD – Persistent Postural-Perceptual Dizziness
3PD is a new name for conditions formerly known as phobic postural vertigo and chronic subjective dizziness. As the features, diagnostic criteria and treatment options of 3PD have been refined over the past several years, 3PD will appear for the first time in the next International Classification of Diseases, being released in 2017.
What is 3PD? 3PD is a non-vertiginous, waxing-waning dizziness and/or unsteadiness, persisting for at least 3 months, with symptoms present at least 15 days per month, but typically daily. 3PD often follows a separate triggering event (vestibular neuritis, vestibular migraine, head injury) that caused dizziness, vertigo or unsteadiness. With the anxiety or worry over an underlying sinister cause of these symptoms or with the anticipation of having another vestibular event, symptoms of 3PD develop.
What are the symptoms of 3PD? The symptoms of 3PD include dizziness and /or unsteadiness, worse when upright, head or body in motion, and in visually busy environments, becoming worse later in the day. Exacerbation of symptoms in grocery or large stores, when reading, scrolling on the computer or cell phone, and with exposure to complex patterns on carpeting, wallpaper or clothing, is common. The dizziness and/or unsteadiness become intrusive and those affected often report trouble focusing/concentrating or “brain fog”.
How is 3PD treated? Once other causes are ruled out with appropriate vestibular function and/or other diagnostic testing, a combination of medications, such as benzodiazepines and SSRIs (selective serotonin reuptake inhibitors) and vestibular rehabilitation therapy is often effective. With significant underlying anxiety, cognitive behavioral therapy may also be helpful.