Chronic subjective dizziness is a balance disorder common in young adults. Symptoms last for hours at a time and persist for months or years. Treatments include medication and therapy.

Chronic subjective dizziness (CSD) is a common condition that causes recurring or long lasting dizziness, particularly due to movement or exposure to visual stimuli.

CSD is a disorder of your vestibular system — part of your inner ear that connects with your brain to control your sense of balance. Experts believe that one of the possible causes of CSD is not properly recovering from a previous event that affected your vestibular system.

In 2017, the International Classification of Vestibular Disorders rolled CSD into a newly defined condition called persistent postural-perceptual dizziness (PPPD). The new definition also includes elements of other related conditions, such as:

  • phobic postural vertigo
  • space-motion discomfort
  • visual vertigo

Regardless of terminology, it’s important to consider the symptoms, causes, and potential treatments associated with this often distressing condition.

Scientists don’t know the exact causes of CSD or PPPD, but they suspect it starts in your brain, where an issue can occur with visual and body position (postural) controls. The initial disruption could be due to:

  • a problem with brain-ear communication
  • a metabolic condition
  • psychological distress

But PPPD causes symptoms even after the initial problem has been resolved. Seemingly benign triggers can later bring on symptoms. Examples of triggers include:

  • sitting upright
  • standing
  • walking
  • being in a crowd
  • watching vehicular traffic

Anyone can develop CSD or PPPD, but it usually affects people ages 30 to 50 and is more common in women. In a 2020 Korean study, PPPD was more common among adults ages 19 to 64 than other kinds of dizziness, which tended to affect older adults.

Research suggests that certain psychological conditions may increase your risk of developing CSD. The new definition of PPPD also understands these factors as possible comorbidities. Such mental health conditions include:

Other conditions that may increase your risk for PPPD include:

People with CSD or PPPD may experience the following symptoms:

  • persistent dizziness
  • balance issues
  • unsteadiness
  • nonspinning vertigo

With CSD or PPPD, dizziness typically last for hours rather than minutes or seconds. You may find that symptoms come and go, and may worsen during times of high anxiety or depressive lows.

When to contact a doctor

Contact a doctor if you have persistent dizziness that doesn’t improve while sitting or lying down. Also, consider talking with a doctor if you’re experiencing chronic dizziness that interferes with work, school, and everyday activities, such as driving or walking.

Seek emergency medical help if you experience sudden dizziness along with other symptoms, such as balance issues, blurry vision, or speech problems. These may be signs of a more serious condition, such as a stroke.

The criteria for diagnosing PPPD incorporate some of the former criteria for CSD. The new guidelines specify five criteria:

  • Symptom timeline: Symptoms are present for more than half of a 90-day period. They can last for hours but may come and go during the day.
  • Triggers: Nothing specific causes your symptoms to start, but they may worsen if you change position or encounter visual stimuli.
  • Previous vestibular problem: You must have had a previous event that affected your vestibular system.
  • Functional impairment: Your symptoms interfere with your daily functions.
  • Other possible causes ruled out: No other condition or disorder can better explain your symptoms.

To make a diagnosis, a doctor will consider your medical history. They may also perform the following tests to help rule out other conditions:

There’s no single treatment for CSD or PPPD. A doctor may consider a combination of medications and therapies, such as:

It’s not clear whether PPPD is a lifelong condition. But treatment with medications and therapies may significantly improve your overall quality of life. Treatment may also help you maintain your current lifestyle and enjoy regular activities.

While PPPD is not a mental health condition, it may increase your risk of developing anxiety or depression, or worsen current symptoms. According to a 2017 review, about 50% of people with vestibular syndromes also have a mental health condition.

Left untreated, other secondary risks may develop. These include:

CSD is a vestibular disorder that causes persistent dizziness. Such chronic symptoms may interfere with daily activities and responsibilities, thereby decreasing quality of life.

Now grouped under the umbrella of PPPD, CSD may improve with a combination of medications and physical and behavioral therapies. The exact cause of PPPD is unknown, but treatment can help improve your quality of life and prevent secondary conditions.

Talk with a doctor if you’re experiencing dizziness on most days of the week. They can help identify whether it’s due to PPPD, medications you take, or another underlying medical condition.