Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Barany Society

Jeffrey P. Staab, Annegret Eckhardt‐Henn, Arata Horii, Rolf G. Jacob, Michael Strupp, Thomas Brandt, Adolfo M. Bronstein · Journal of Vestibular Research · 2017 · medicine · 10.3233/ves-170622 · record staab2017-diagnostic-criteria-for-persistent
tag layer · index · concepts · authors · עברית
Where this record's text came from. 2026-08-23 schema-0.3 pass: every quote verified as an exact substring of the staged text and anchored at merge time; concept terms verified present; every edge endpoint an existing node.
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Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 10 concept tags on this paper, all 10 are grounded in a quoted sentence. All carry the tagger's gloss of what the term means in this paper, which is not something the article can license.
PPPD chronic vestibular disorder persistent postural-perceptual dizziness chronic subjective dizziness VID VV functional psychogenic anxiety disorders MdDS the three exacerbating factors the only sensitivity and specificity in the paper belong to the SUPPLANTED term expert-consensus
Method, as described: an expert-consensus process with a stated decision rule - broad support, more than a simple majority, unanimity not required - iterated through four international meetings and a public posting, with the minority position printed

Legend

relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
concept edgeconcept_edgesan asserted relation between two concepts, with the sentence asserting it
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
contributioncontributionwhat the paper claims to add
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
object of studyobject_of_studywhat the paper is about — the thing it investigates
phenomenonphenomenonthe effect or regularity under study
research questionresearch_questionthe question the paper sets itself
sensesensesa distinct use of a term, quoted where the paper fixes it

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.3233/ves-170622. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 3 · claim_type 1 · concept_edges 6 · concepts 10 · content_tags 15 · contribution 1 · controls 3 · limitations 4 · mechanisms 11 · method 1 · object_of_study 1 · phenomenon 1 · research_question 1 · senses 4

Relations on this page carry a quotation for the claim. Where a relation was separately evidenced — and so tested against the vocabulary for its type — the row says so; 6 of 6 relations here carry that mark. The rest are the tagger’s reading of the sentence quoted beside them.

facettagfieldconf.whose words
object_of_studyA DIAGNOSIS CREATED BY MERGING FOUR OLDER TERMS RATHER THAN BY SPLITTING ONE - persistent postural-perceptual dizziness, assembled by the Barany Society from 30 years of research on phobic postural vertigo, space-motion discomfort, visual vertigo and chronic subjective dizziness, and written into the ICD-11 beta draft
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object_of_studythe paper's words
research_questionwhat a clinician must find before calling chronic dizziness PPPD, when no examination, laboratory test or image is pathognomonic and the diagnosis is nonetheless not one of exclusion
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research_questionthe paper's words
contributionfive diagnostic criteria A-E with seven explanatory notes, a differential diagnosis against nine named conditions, and a published account of where the committee's own consensus standard was not met
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contributionthe paper's words
claim_typemethod
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claim_typethe paper's words
phenomenonfour terms coined in four clinical settings over three decades, describing overlapping patients, consolidated into one name whose precursors are kept as index terms in the classification that supersedes them
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phenomenonthe paper's words
methodexpert-consensus
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methodthe paper's words
mechanismsA DIAGNOSIS MADE BY CONSOLIDATION, WHICH IS A SHAPE THIS CORPUS DID NOT HAVE: `The term PPPD is new, but the disorder is not. Its diagnostic criteria were derived by expert consensus from an exhaustive review of 30 years of research on phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness.` Every other naming event we hold splits, renames, retires or revises. This one MERGES four terms from four clinical settings into one
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[0]0.95the tagger's words
mechanismsAND THE BODY PUBLISHES ITS OWN DECISION RULE BEFORE REPORTING ANY DECISION: `The consensus process for decision-making seeks a result that has broad support. It does not require unanimity, but demands more than a simple majority. Were the latter sufficient for developing diagnostic criteria or writing treatment guidelines, then informative aspects of the minority opinion could be lost to practicing clinicians, the scientific community, and general public.` The threshold is stated, and the reason for it is that a bare majority DISCARDS INFORMATION
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mechanisms[1]0.95the tagger's words
mechanismsAND THEN IT NAMES THE SUB-QUESTION THAT FAILED THAT RULE: `Members of the Behavioral Subcommittee and their advisors reached consensus about the diagnostic criteria for PPPD and its relationship to SMD, VV, and CSD, but not PPV.` The boundary of the agreement is published with the agreement - and the corpus has nothing else that draws it this precisely
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mechanisms[2]0.95the tagger's words
mechanismsAND THE VOTE ON THAT QUESTION IS RECORDED, AT A MAJORITY THE COMMITTEE'S OWN RULE CALLS INSUFFICIENT: `In the end, a simple majority of subcommittee members voted against including PPV as a subtype of PPPD` - after two paragraphs printing the arguments in favour (30 years of research, personality and phobic factors that `affect clinical presentation`) and against (`difficult to operationalize`, `may have to be updated`, `could perplex clinicians and investigators`). A body that says a simple majority is not enough, and then reports one
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[3]0.95the tagger's words
mechanismsAND ONE AUTHOR'S OWN EARLIER DEFINITION IS RETIRED BY NAME IN THE SAME PARAGRAPH: `However, the definition of PPPD is better supported; hence, PPPD now fully supplants CSD.` Staab defined chronic subjective dizziness in 2004, defined it `more explicitly in 2007`, and is the first author here
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mechanisms[4]0.95the tagger's words
mechanismsAND THE SUPERSEDED TERMS SURVIVE AS MACHINE-READABLE POINTERS: `The World Health Organization permits related terms to be listed in the ICD-11. Therefore, PPV, SMD, VV, and CSD were retained as index terms for cross-referencing in the ICD-11 beta draft definition of PPPD.` Our `alternatives` layer, in a real classification, decided by a committee - a retired name kept precisely so that the old literature still resolves
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[5]0.95the tagger's words
mechanismsAND A CRITERION SET BY CONSENSUS IN THE ADMITTED ABSENCE OF ANY MEASUREMENT: `There are no data to identify one of these factors as being consistently more troublesome than the others or to determine the sensitivities and specificities of requiring the presence of one, two, or all three factors to make a diagnosis of PPPD. Therefore, the consensus definition of Criterion B requires that affected individuals report at least some difficulty with all three factors.` The strictest of the three options, chosen BECAUSE none of them has been measured
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mechanisms[6]0.95the tagger's words
mechanismsAND A WORD TAKEN BACK FROM ITS OWN TWENTIETH-CENTURY SENSE: `Here functional conditions are considered as they were in the early 19th century as disorders `arising from a change in the mode of action of an organ`, unrelated to structural or cellular deficits ... Quotation withheld.` A definition reverting a term to an older sense and naming the sense it rejects
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[7]0.95the tagger's words
mechanismsAND THE SOCIETY'S OWN CURRENT TERM IS SET ASIDE, DELIBERATELY AND WITH A REASON: `In 2009, the Barany Society adopted the term visually induced dizziness or VID to replace VV in the ICVD nomenclature ... Herein, the historical moniker VV is used to refer to Bronstein's original description and the subsequent body of research on that symptom.` A paper knowingly using a superseded term, because the LITERATURE it is summarising is indexed under the old one
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[8]0.95the tagger's words
mechanismsAND A PRECEDENT FOR WHAT HAPPENS WHEN NOBODY DOES THIS: `As otology, neurology, and psychiatry matured into separate specialties in the early 20th century, Platzschwindel and Platzangst faded from use and agoraphobia became a psychiatric disorder, losing its space and motion context.` Two terms died and a third survived with part of its meaning removed - not by decision, by disciplinary drift. The 1870s syndromes and PPPD describe the same patients
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[9]0.95the tagger's words
mechanismsAND THE DEFINERS WARN AGAINST READING THEIR OWN CRITERIA AS A CHECKLIST: `Clinicians who apply Criteria A and B as simple checklists of symptoms without capturing the dynamic features of their patients' histories (Criterion C) assume a reductionist view of the diagnosis ... Scientists who fail to consider the dynamics of PPPD risk muddling rather than illuminating the nature of the disorder.` The instrument comes with an instruction not to use it as an instrument
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mechanisms[10]0.95the tagger's words
limitationsNO POSITIVE TEST, AND NOT A DIAGNOSIS OF EXCLUSION EITHER: `There are no findings on physical examination, laboratory testing, or diagnostic imaging that are pathognomonic of PPPD ... an abnormal finding on physical examination or laboratory testing does not exclude a diagnosis of PPPD ... Furthermore, PPPD is not a diagnosis of exclusion.` Both doors are shut: nothing confirms it and nothing rules it out, and it may not be given by elimination either
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[0]0.95the tagger's words
limitationsAND WHETHER IT IS ONE DISORDER AT ALL IS PRINTED AS AN OPEN QUESTION: `(a) Is PPPD a single disorder with one principal pathophysiologic process or is it the common manifestation of multiple conditions that produce similar symptoms from different pathophysiologic mechanisms? (b) If PPPD is a single disorder, does it have clinically meaningful and validly distinguishable subtypes?` Two analogies are offered for the two answers - PTSD for one syndrome from many precipitants, hypertension for one number from many diseases
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limitations[1]0.95the tagger's words
limitationsAND A SUBTHRESHOLD CATEGORY WAS REFUSED FOR WANT OF DATA: `Members of the subcommittee concluded that there were not enough published data to define a clinically meaningful probable or subthreshold version of PPPD.` The Barany Society's own vestibular migraine and Meniere criteria carry `probable` tiers; this one declines to, and says why
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limitations[2]0.95the tagger's words
limitationsAND THE EPIDEMIOLOGY IS BORROWED FROM THE FOUR PRECURSORS, NOT MEASURED ON PPPD: `No epidemiologic studies are available for PPPD, but its prevalence and incidence may be estimated from research done on patients with PPV, VV, CSD` - so every frequency in this paper describes populations defined by the terms PPPD replaces
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limitations[3]0.95the tagger's words
controlsrequiring ALL FIVE criteria A-E, and declining to publish a 'probable' or subthreshold tier for patients who meet only some
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eliminates: applying the label to non-specific chronic dizziness - which the paper warns against in the same breath as saying PPPD is NOT a diagnosis of exclusion · outcome: held
controls[0]0.95the tagger's words
controlsrequiring at least some difficulty with ALL THREE exacerbating factors of Criterion B, rather than one or two
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: nothing that has been measured - the paper states outright that the sensitivities and specificities of the one-, two- and three-factor rules are unknown · outcome: partial
controls[1]0.95the tagger's words
controlsa period of prospective monitoring with a symptom log and serial examinations when no precipitant can be identified or symptoms worsen gradually
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: mistaking a slowly emerging degenerative disorder for PPPD · outcome: held
controls[2]0.95the tagger's words
conceptsPPPD
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: PPPD
concepts[0]0.95the paper's words
conceptschronic vestibular disorder
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[1]0.95the paper's words
conceptspersistent postural-perceptual dizziness
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[2]0.95the paper's words
conceptschronic subjective dizziness
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[3]0.95the paper's words
conceptsVID
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: VID
concepts[4]0.95the paper's words
conceptsVV
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: VV
concepts[5]0.95the paper's words
conceptsfunctional
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: functional
concepts[6]0.95the paper's words
conceptspsychogenic
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: psychogenic
concepts[7]0.95the paper's words
conceptsanxiety disorders
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[8]0.95the paper's words
conceptsMdDS
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: MdDS
concepts[9]0.95the paper's words
senses`PPPD` - a chronic FUNCTIONAL vestibular disorder, `not a structural or psychiatric condition`, defined by five criteria all of which must be fulfilled
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[0]0.95the tagger's words
senses`functional` (this paper's sense) - the EARLY 19TH CENTURY sense, `arising from a change in the mode of action of an organ`, explicitly NOT the 20th-century synonym for psychogenic or psychosomatic
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[1]0.95the tagger's words
senses`VV` (visual vertigo) - used here in Bronstein's 1995 sense, in preference to the Barany Society's own 2009 replacement `VID`, because the body of research is indexed under the older name
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[2]0.95the tagger's words
senses`agoraphobia` - Westphal's 1870s sense included space and motion; the modern psychiatric sense LOST that context when the specialties separated
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[3]0.95the tagger's words
claim_relationsextends → thirty years of research on phobic postural vertigo (Brandt & Dieterich 1986), space-motion discomfort (Jacob 1989), visual vertigo (Bronstein 1995) and chronic subjective dizziness (Staab 2004, 2007) - four terms whose common core becomes the criteria
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claim_relations[0]0.95the tagger's words
claim_relationssupersedes → the author's own definition of chronic subjective dizziness, which 'PPPD now fully supplants' because 'the definition of PPPD is better supported'
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claim_relations[1]0.95the tagger's words
claim_relationscritiques → reading diagnostic criteria as checklists - 'Clinicians who apply Criteria A and B as simple checklists ... assume a reductionist view of the diagnosis'
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
claim_relations[2]0.95the tagger's words
concept_edgesPPPD —is-a→ chronic vestibular disorder
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'PPPD IS A CHRONIC…' The ICVD divides by DURATION (acute / episodic / chronic) and by PRESUMED MECHANISM (structural / functional / psychiatric), and PPPD is chronic-functional on both · the relation stated: PPPD is placed in the ICVD's CHRONIC class, and the classification's other axis makes it FUNCTIONAL rather than structural or psychiatric
concept_edges[0]0.95the tagger's words
concept_edgeschronic subjective dizziness —renamed-across-fields→ persistent postural-perceptual dizziness
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'THE TERM PPPD…' CALLED HONESTLY: THIS IS A CONSOLIDATION, NOT A ONE-FOR-ONE RENAMING. Four terms from otoneurology, psychiatry and balance medicine become one, and the corpus has no edge type for many-into-one. 'renamed-across-fields' is the closest the vocabulary offers and the fields really are different - the subcommittee was constituted with an otologist, a neurologist and two psychosomatic/psychiatric members precisely because the four terms came from four clinics · the relation stated: CSD is one of four precursor terms consolidated into PPPD - and the paper says later, in its own words, that 'PPPD now fully supplants CSD' Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span lists chronic subjective dizziness as one of four research strands from which PPPD's criteria were derived; renamed-across-fields is loose.
concept_edges[1]0.95the tagger's words
concept_edgesVV —renamed-across-fields→ VID
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'IN 2009, THE…' The rename is real and eight years old; the authors set it aside because THE EVIDENCE THEY ARE SUMMARISING IS INDEXED UNDER THE OLD NAME. A retired term still doing work, in the same paper that retires CSD · the relation stated: the Barany Society replaced VV with VID in its own ICVD symptom nomenclature in 2009 - and this paper, published by that society, goes on using VV
also in: VV · VID
concept_edges[2]0.95the tagger's words
concept_edgesfunctional —distinct-from→ psychogenic
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'IN THIS CONNOTATION…' The edge records a term being pulled back from a sense it held for eighty years - and the paper dates both senses and cites the field (gastroenterology) that revived the older one · the relation stated: in this paper's sense 'functional' denotes a change in the MODE OF ACTION of an organ and carries NO presumption of psychopathology
concept_edges[3]0.95the tagger's words
concept_edgesPPPD —distinct-from→ anxiety disorders
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'Patients with PPPD may express…' The two conditions are separated by WHAT THE PATIENT IS AFRAID OF - a distinction with no test behind it, in a paper that says no test exists · the relation stated: both produce avoidance; the CONTENT of the concern differs - noxious symptoms versus fear of incapacity, injury or attention
concept_edges[4]0.95the tagger's words
concept_edgesMdDS —distinct-from→ PPPD
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'A MAJOR DIFFERENCE…' A boundary drawn by what the patients do after treatment, in a corpus where boundaries are usually drawn by a marker or a cut-off · the relation stated: distinguished by response to treatment and by the direction of the motion effect - MdDS improves during passive motion, PPPD worsens
also in: MdDS · PPPD
concept_edges[5]0.95the tagger's words
content_tagsA DIAGNOSIS MADE BY CONSOLIDATING FOUR OLDER TERMS: `The term PPPD is new, but the disorder is not ... derived ... from an exhaustive review of 30 years of research on phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[0]0.95the tagger's words
content_tagsAND A COMMITTEE THAT PUBLISHES ITS OWN DECISION RULE: `It does not require unanimity, but demands more than a simple majority` - because otherwise `informative aspects of the minority opinion could be lost`
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content_tags.findings[1]0.95the tagger's words
content_tagsAND THEN REPORTS A DECISION TAKEN AT EXACTLY THE MAJORITY IT CALLS INSUFFICIENT: `In the end, a simple majority of subcommittee members voted against including PPV as a subtype of PPPD` - and `reached consensus ... BUT NOT PPV`
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content_tags.findings[2]0.95the tagger's words
content_tagsAND THE RETIRED TERMS ARE KEPT AS MACHINE-READABLE POINTERS: `PPV, SMD, VV, and CSD were retained as index terms for cross-referencing in the ICD-11 beta draft definition of PPPD`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[3]0.95the tagger's words
content_tagsAND A CRITERION SET IN THE ADMITTED ABSENCE OF MEASUREMENT: `There are no data ... to determine the sensitivities and specificities of requiring the presence of one, two, or all three factors ... Therefore, the consensus definition of Criterion B requires ... all three`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[4]0.95the tagger's words
content_tagsAND A WORD PULLED BACK FROM ITS OWN 20TH-CENTURY SENSE: `functional is not a synonym for psychogenic or psychosomatic as it was throughout most of the 20th century`
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content_tags.findings[5]0.95the tagger's words
content_tagsAND A TERM THAT SURVIVED BY LOSING PART OF ITS MEANING: `Platzschwindel and Platzangst faded from use and agoraphobia became a psychiatric disorder, losing its space and motion context` - drift, not decision
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content_tags.findings[6]0.95the tagger's words
content_tags`a chronic vestibular disorder defined by criteria A-E ... All five criteria must be fulfilled` - one or more of dizziness, unsteadiness or non-spinning vertigo on most days for 3 months or more, exacerbated by upright posture, active or passive motion, and moving or complex visual stimuli
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also in: PPPD
content_tags.definitions[0]0.95the tagger's words
content_tags`disorders ARISING FROM A change in the mode of action of an organ, unrelated to structural or cellular deficits` - the early-19th-century sense, revived in gastroenterology, explicitly NOT the 20th-century psychogenic sense
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: functional
content_tags.definitions[1]0.95the tagger's words
content_tags`Symptoms must be present for more than 15 of every 30 days. Most affected individuals experience symptoms every day or nearly every day` - the threshold is far below where the patients actually sit
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content_tags.quantities[0]0.95the tagger's words
content_tags`making them the most common diagnoses among young adults and the second most common among all adults, trailing only BPPV`
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content_tags.quantities[1]0.95the tagger's words
content_tags`These results indicate that PPPD is likely to develop in a significant proportion of patients afflicted with acute or episodic vestibular syndromes`
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content_tags.quantities[2]0.95the tagger's words
content_tagsthe precipitant is part of Criterion C, and this is the only place its distribution is given
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content_tags.quantities[3]0.95the tagger's words
content_tags`Staab, et al. found that this diagnostic definition was highly sensitive (>85%) and specific (>90%) for detecting CSD` - CSD, not PPPD. The new definition supplants the old one on the strength of numbers measured on the old one, and the paper says elsewhere that the sensitivities of its own Criterion B are unknown
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content_tags.statistics[0]0.95the tagger's words
content_tagsupright posture, active or passive motion, and moving or complex visual stimuli - all three required, with no evidence about requiring one or two instead
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content_tags.variables[0]0.95the tagger's words

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