Chronic subjective dizziness

The term chronic subjective dizziness (CSD) is used to describe a commonly encountered type of dizziness that is not easily categorized into one of several other types, and for which the physical examination is typically normal. Patients with CSD frequently initially suffer a sudden injury of some sort to their vestibular system, the neurologic network that preserves sense of balance. Even after this initial injury has healed, people with CSD usually describe a vague sense of unsteadiness worsened by triggers in their environment such as high places, standing on moving objects, or standing in motion-rich environments like busy streets or crowds. There is a clear indication that anxiety and other mental illnesses play a role in the dizziness symptoms that occur with CSD.

Scientists around the world have proposed renaming CSD as Persistent Postural-Perceptual Dizziness (PPPD) which better captures the multiple aspects of the condition under its title. It is under that title The World Health Organization has included PPPD in its draft list of diagnoses to be added the next edition of the International Classification of Diseases (ICD-11) in 2017.

Perhaps the first account of CSD was the German neurologist Karl Westphal's portrayal in the late 1800s of people who suffered dizziness, anxiety and spatial disorientation when shopping in town squares. This phenomenon was called "agoraphobia" to indicate a fear of the marketplace. The term is now used to describe a psychological fear, but Westphal's original description included many symptoms of dizziness and imbalance not included in the modern psychiatric definition. Unlike people who feel anxious in crowds because they feel something bad will happen, people with CSD may dislike crowds because all the movement leads to a sensation of dizziness.

Symptoms can include:

Symptoms of CSD can be worsened by any self precipitated motion, usually from the head, or the witnessing of motion from another subject. These are usually less noticeable when the person is laying still.

Effective treatments include vestibular rehabilitation therapy, medications such as SSRIs and psychotherapy, including the most effectively represented cognitive behavioral therapy.

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