REFERENCE · DIAGNOSTIC TECHNIQUE

PPPD Criteria and Clinical History

Clinician-focused educational reference; select assessment within professional competence, consent and an individual clinical plan.

Purpose and Suitability
Anatomy and Physiology
Preparation and Safety
Performing the Assessment
Interpreting Findings
Explaining the Result
Evidence and Limitations
Media and Accessibility
Research and Sources

Purpose and Suitability

Use this guide to organize a criteria-based interview for persistent dizziness. It owns the five-criteria outline previously on the symptom overview. The differential guide addresses investigations; the measurement guide addresses symptom burden and participation.

Criterion: A required feature of a defined diagnosis, considered together with the other required features.

Do not turn the five criteria into five independent bedside tests. The original clinical outline below requires all five and keeps other or coexisting disorders in view. [1]

Anatomy and Physiology

PPPD is classified as a functional vestibular disorder. Balance draws on inner-ear, visual and body-position information; altered processing and postural control are proposed mechanisms, not an individual diagnostic scan result. A psychiatric disorder is not required. [1]

Vestibular: Relating to the balance system, including the inner ear and its connections in the nervous system.

For explanation, start with the person’s reported sensations and the evidence supporting the diagnosis. Do not tell every person that anxiety or excessive visual dependence has been demonstrated as their cause.

Preparation and Safety

Offer a seated interview, a quiet visual setting and paper or spoken questions if screens are difficult. Ask what helps the person take part, whether they want a supporter present, and whether a break is needed. Do not require a standing or visual-motion challenge to authenticate the history.

Agree how much detail is useful. A brief retrospective timeline can be more manageable than asking for continuous symptom tracking. Establish urgent or substantially changed symptoms before pursuing a routine chronic-dizziness interview; use the symptom overview’s reassessment boundary.

Performing the Assessment

Technique outline: the five PPPD criteria

Criterion A—persistence: Establish one or more symptoms of dizziness, unsteadiness or non-spinning vertigo on most days for three months or more. Symptoms may wax and wane and need not last all day.
Criterion B—exacerbating factors: Confirm that persistent symptoms are worsened by upright posture, active or passive motion, and exposure to moving or complex visual stimuli. All three characteristic factors must be represented, although their effects may differ.
Criterion C—precipitant: Identify the vestibular, medical, neurological or psychological event that caused acute, episodic or chronic dizziness, unsteadiness or balance disruption, and establish a plausible transition into the persistent pattern.
Criterion D—impact: Confirm clinically significant distress or functional impairment.
Criterion E—exclusion: Determine that the symptoms are not better accounted for by another disease or disorder. Perform vestibular, neurological, cardiovascular or other assessment according to the presentation.
Document comorbid conditions rather than assuming they exclude PPPD. A person may have PPPD alongside a vestibular disorder, migraine or another condition when the complete criteria are met.
Explain which criteria are present, which alternative diagnoses were considered and what will prompt reassessment.

[1]

Interview record

The following is an authored documentation aid, not a validated questionnaire or scoring rule.

Question to settle	What to record
What does “dizzy” mean for this person?	Their own words; distinguish the usual background from separate attacks
How did the pattern develop?	Approximate onset, duration, symptomatic days, typical hours, fluctuations and available previous records
Which contexts worsen it?	A separate example for posture, movement and visual surroundings; note contexts no longer encountered
What preceded it?	The suspected precipitant, evidence for it and any uncertainty about the transition
What matters in daily life?	Distress, valued activities affected, help needed and the person’s priorities
What remains unexplained?	Findings requiring another assessment, coexisting diagnoses and a named follow-up plan

Invite corrections to the summary rather than seeking a particular answer. A supporter may add observations with consent, while the person’s account remains central.

Interpreting Findings

Record each criterion as supported, not supported or unresolved, with its evidence. An unresolved history calls for clarification or follow-up, not a guessed positive result. If a specific precipitant cannot be identified, particularly with gradual worsening, the consensus advises reassessment and prospective observation. [1]

The headings “Criterion E—exclusion” in the preserved outline and “no better explanation” in the inventory refer to the same requirement. They do not mean exhaustive normal testing establishes PPPD. Explain the positive pattern and the differential reasoning together.

Criterion D establishes meaningful impact; it does not quantify required assistance or prove capacity for an entire workday. For those questions, agree a separate everyday-function record.

Explaining the Result

Authored explanation example, to adapt to the actual findings: “We have discussed your usual dizziness, how long it has been happening, what makes it worse, how it started and what it interrupts. I will show you which parts fit PPPD and which still need an explanation. The assessment also needs to account for any other balance condition you have.”

If criteria remain unresolved, say so plainly: “We have enough information to plan support, but we still need to clarify the diagnosis.” Give the person a written summary and a way to raise new information.

Evidence and Limitations

The Bárány document is consensus guidance drawing on earlier syndromes, not a diagnostic-accuracy trial of this authored interview record. This page supplies no sensitivity or specificity for the criteria as a combined test. [1]

The prompts organize evidence; they are not additional requirements. Retrospective accounts may be incomplete, so document uncertain dates and missing records without treating uncertainty as evidence of fabrication. The project has not validated this record, prescribed an interview duration or established a minimum activity score.

Media and Accessibility

Media contributor brief

Create a static, accessible five-part diagram:

Most days for 3+ months
Worse upright, moving and with complex visual input
Began after a precipitating condition or event
Causes distress or impairment
Not better explained by another disorder

Add a separate note that all five criteria are required and that testing is selected to evaluate other or coexisting conditions. Avoid scrolling stripes, virtual supermarket footage, rotating patterns or autoplay animation. If visual examples are ever added, provide a static alternative first and a clear motion warning.

Keep text selectable, use a clear reading order and describe all five boxes in alt text. The diagram must not imply that a viewer can diagnose themselves by counting boxes. No patient quotations or identifiable clinical images are included in this draft.

Research and Sources

The preserved outline and inventory are grounded in the Bárány consensus. New interview prompts and example explanations are authored educational aids. Relevant criteria, diagnostic and differential sections were checked for this expansion; clinical review remains pending.

Citation	Figure	Full citation
[1]	—	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. Journal of Vestibular Research. 2017;27(4):191–208. FND-CIT-0027. https://doi.org/10.3233/VES-170622

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