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Psycho-Physiological Dizziness Syndrome (PPDS)

Discussion in 'General Discussion Subforum' started by Gigalos, May 18, 2014.

  1. Gigalos

    Gigalos Beloved Grand Eagle

    A year ago I started a thread on the TMSHelp forum about dizziness. To spread the knowledge that helped me and others recover, I have decided to post the initial post on this forum too. The post is based on an article by Sarah Edelman that is no longer available on the internet sadly. The list of accompanying symptoms and her explanation of the mindbody process that is behind it could help others here to become more convinced that their problems are the result of a mindbody issue too. I have tried to make an abstract of the original article and added a few things myself [...in brackets...]. If someone knows a good link to the Sarah Edelman article, please post it here.

    The original thread: http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=8397 (TMSHelp Forum - Psycho-Physiological Dizziness Syndrome)

    Admin edit: We received permission from Dr. Edelman to post the PDF, here:

    Psycho-physiological dizziness syndrome
    PPDS refers to a cluster of symptoms that arises for some people in the period following either:

    1. a vestibular event (such as vestibular migraine, labyrinthitis, inner ear trauma) OR
    2. a period of stress (with or without panic attacks)
    The syndrome is characterized by episodic dizziness or light-headedness (not spinning), in addition to other symptoms. These vary between individuals and may include:
    • Periods of unsteadiness or a feeling of the ground being unstable. [I personally describe this as a sensation of the floor moving below you or as walking on a waterbed].
    • A feeling of rocking or swaying, or feeling like you are veering to the side when walking.
    • A feeling of ‘fullness’, ‘cloudiness’, ‘fogginess’, or ‘heaviness’ of the head.
    • Dizziness in response to particular movements, such as turning head from side to side, getting up from a chair, looking up, bending over, lying down etc..
    • Tinnitus (ringing, buzzing or hissing sound on one or both ears)
    • Visual disturbances (sensitivity to bright light or to motion stimuli; episodically out of focus)
    • Numbness, tingling or ‘electrical’ sensations in hands, feet, face or scalp (often one-sided)
    • Momentary dizziness or internal ‘shift’ sensations that last for a couple of seconds.
    • Nausea
    • Headaches
    • Feeling hot or flushed
    • Wobbly legs
    • Tightness or clenching of the jaw.
    • Heart palpitations or missed heart beats
    • Body or situations may at times feel different or unreal
    • Frequent fatigue
    • [pain and tightness in the neck, shoulders and/or upper back]...

    As you can see, these are all physical symptoms, the factors that maintain them are primarily psychological. People who visit their doctor with these symptoms are often sent home without a good diagnosis although the symptoms are very real.

    PPDS is caused by a combination of perception (perception of threat), hyper vigilance (selective attention to perceived threat) and autonomic arousal (the body’s biological response to perceived threat).

    Once dizziness is triggered, people enter a self-perpetuating anxiety cycle. The symptoms from autonomic arousal are perceived as a threat, which in turn maintains hyper vigilance, which in turn maintains autonomic arousal, and so causes the symptoms to keep occurring.

    As the syndrome is maintained by a perception of threat, it is more likely to arise among people who score high on the ‘anxiety trait’, although some people are not aware of this aspect of their personality until they develop the syndrome.

    Dizziness can be triggered by situations (social events, busy environments, certain locations like supermarkets or class rooms) or can come up spontaneous (recognition of a threat on an unconscious level).

    Being tired, unwell or in pain usually increases symptoms, because in general it makes people feel more vulnerable.

    The paradox in this syndrome is that trying to control the symptoms simply reinforces the perception that they are a threat and therefore the anxiety cycle is maintained. The key to recovery lies in doing the opposite – learning to perceive the symptoms as harmless and not worthy of any special attention. Once you stop trying to control the symptoms, they lose their power and gradually fizzle out.

    The way to overcome the fear is to deliberately face it. Target the situations that are most likely to trigger symptoms. The goal is NOT to try to avoid the symptoms but to experience the symptoms without the emotional response that they usually evoke. Let the body experience the symptoms without resistance or fear. Better said: surf the symptoms. In time this will slow down the anxiety cycle and often the symptoms will completely disappear.

    It is important therefore to stop avoiding any situations or activities because of dizziness, but the same goes for safety behaviors (lying down when symptoms appear, holding on to things to keep yourself stable, relying on others company when you go to certain places).
    Last edited by a moderator: Nov 10, 2019
  2. leonardo999

    leonardo999 Well known member

    Interesting..... and I could answer yes to all of those symptoms.. on a regular basis....Leo
  3. DanielleMRD

    DanielleMRD Peer Supporter

    I've had episodes of this over the past 3 years...I always felt it was psychological and stress induced. It's tough to shake and frustrating that it comes back. Thanks for sharing!
    MWsunin12, BinLA and laradara like this.
  4. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    I've had bouts of dizziness including the room spinning. I attribute it to anxiety/stress and it goes away real fast.
    My doctor prescribed Bonine, which prevents vertigo and motion sickness and is used by people who are unsteady when flying.
    I found a generic brand called Travel Sickness maunfactured by Rugby that contains the same ingredients as Bonine and cheaper.
    They both contain Meclizine.

    I'm not prescribing it because I'm not a doctor, but just telling what I've used. I definitely think it is TMS caused and can be overcome by TMS and
    totally agree to go ahead and not fear that dizziness will come on if you do some things. I almost never use either of those products if I
    feel dizzy. I just do deep breathing and relax and tell myself it's just temporary because I'm worried about something.
  5. Gigalos

    Gigalos Beloved Grand Eagle

    Nothing wrong with taking something against travel sickness. I think that motion sickness is something you can induce in everyone, so it isn't all TMS. If you only get it from flying, being driven in a car or from sailing, then it is a pretty normal thing to experience, although I suspect a TMS factor that makes you more vulnerable to it. If you also get it from standing up, lying down or walking around, then it's probably all TMS.

    I recommend reading Claire Weekes when you have difficulty shaking it off. Give it time and so important, don't avoid the things that may make the symptoms rise and don't become anxious when they do.
    plum likes this.
  6. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    Just found this post, Gigalos - I like it! I wish I could like it more than once!

    Your advice is spot-on (and yes, I've had almost everything on the list).


    Feb 2019 edit: We received permission from Dr. Edelman to post a PDF of her article on our site. Scroll down to Forest's post to download it.

    Also, I found this technical treatise, which covers the same information in a less-friendly manner:
    https://www.researchgate.net/publication/301303291_A_Cognitive-Behavioral_Model_of_Persistent_Postural-Perceptual_Dizziness ((PDF) A Cognitive-Behavioral Model of Persistent Postural-Perceptual Dizziness)
    Last edited: Feb 17, 2019
    Sofa and laradara like this.
  7. kb617

    kb617 New Member

    Hi all, my name is Kristy and I am very new to TMS and feel compelled to share my story. I am 26 currently working as close to full time as possible while going to nursing school full time to pursuit a career change. Last April I got off of the most terrifying plane ride and felt like I was walking on a boat for 3 weeks solid. It was right at the end of the semester and I eventually went to the Dr. to rule out stroke, clot, etc. After school ended and my Dr. visit it just magically went away and I never thought twice about it. On Halloween weekend, in the middle of an extremely hard semester I woke up one morning just completely dizzy again. I immediately panicked thinking something sinister must be wrong for this to come back. That was a Friday. On Saturday and Sunday I suffered two debilitating panic attacks because I started googling my symptoms, PLUS I was studying nursing and learning about all of these chronic diseases with no cure. I knew that leading up to this I was clenching my jaw at night from stress but thought nothing of it. There is no way stress can cause dizziness. So since the panic attacks, my head and neck muscles have been in chronic spasm. I kept down this dark path, went to an ENT who left me with no advice and the parting words of "I won't tell you not to worry." This set off another downward spiral. So I invested in a brain and IAC MRI which came back completely normal. I overcame my fear of multiple sclerosis, chiari malformation, and brain tumor which had been plaguing me for the past month. All the while I am still clenching my jaw in my sleep. I had about one week of feeling like I was about to kick the dizziness, it was very mild when walking compared to feeling like I was walking on a boat the whole time. I decided to give the ENT one more time and went to a dizziness specialist. He said, "no way is this your ears, do you clench your jaw?" to which I replied "yes." He said I have upset my inner ear by clenching and referred me to a TMJ specialist. The specialist is very convinced that I have very good chance at getting better by wearing a splint to help with relaxing my jaw and prevent the constant clenching. I listened to Dr. Sarno yesterday and realized that I was internalized absolutely everything I was going through emotionally (probably since I was in my teen years) and this manifested in chronic jaw clenching and inflammation which is causing this relentless imbalance. Since my TMJ appointment I have now become so scared that it will never go away, I unfortunately got on google to understand more of the diagnosis and that lead me to a bunch of horror stories. Now I have added eye strain and floaters in my eyes to this dizziness. I never had this until TMJ was put into my mind. I know this sounds like such a sob story but I am writing because I KNOW Dr. Sarno is the answer. I just need help in not being afraid of the dizziness and eye strain. My suboccipital muscles are still spasmed so I develop a tension headache when I go for a run (I love running and triathlons) so I only walk now. Do any of you have any guidance as to how I can develop my confidence that I am only experiencing these symptoms because of everything I repressed. I have the MRI proving that there is nothing wrong with me but I cannot get the picture of my jaw being inflamed out of my head (it's hard when you are surrounded by western medicine as a nurse). I really appreciate you all and just know that your stories are so encouraging to me and you leave me filled with hope!
    Thanks for reading this lengthy story,
    JanAtheCPA likes this.
  8. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    Hi Kristy, and welcome! I suggest that that you start working the Structured Educational Program on TMSwiki.org, pick up a copy of Hope and Help for Your Nerves, by Dr. Claire Weekes, read the success stories on our sub forum, and take note of the number of people who talk about meditation and mindfulness in doing this work successfully. I'm posting on my tablet so I can't insert all the links for you, but these shouldn't be hard to find. There are many ways to do this work, so don't get hung up on doing it just one way, but do what feels right for you. Above all,work on loving and accepting yourself, because you must know in your heart that you deserve to heal.

    Good luck, and keep us posted.

    hecate105 likes this.
  9. Fabi

    Fabi Well known member


    I have been treated for TMJ syndrome for the past 7 years. Splints will help you to keep your teeth enamel unhurt. Your jaw can be a trigger point.
    Resort to all the resources to calm down your nervous system. For me it is mindfulness, this forum, listening to audios, journaling and coping and living day by day.
    I didn´t know about Dr Sarno before I started with my TMJ treatment, so it´s been years of conditioning.
    Don´t allow that to happen. Stand on your feet and relax!!!

    hecate105 and JanAtheCPA like this.
  10. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    ORIGINAL: Thank you for posting this, wonderwoman - it's not only excellent, I think it's 100% right on in every respect.

    The article covers her original list of symptoms, the psychological factors, and recommended treatment (which is pretty simple and encompasses all the things we talk about here).

    I've had at least 12 of the 15 symptoms listed above. Some of them have not happened since I started doing this work in 2011, but others still occur during times of stress or briefly, as she describes, due to certain stimuli. Her coping mechanisms are well worth memorizing, and having a better understanding of the mechanism is also helpful to visualize a different response.
    Last edited: Feb 17, 2019
    Fabi likes this.
  11. Freedom

    Freedom Peer Supporter

    This mentions dizziness in regards to moving or in public places. What about if you are just laying in bed, turning your head to the side?
  12. Gigalos

    Gigalos Beloved Grand Eagle

    I believe the link has gone... if anyone knows of another, please post it.

    Yes, it is mentioned in the first post. Do you recognize more things on the list?
  13. Freedom

    Freedom Peer Supporter

    Jaw pain , stiffness / aches
    I might have heart palpitations, not sure... weird stuff happens in my chest every once in a while
  14. Gigalos

    Gigalos Beloved Grand Eagle

    Like a sudden (serie of) flutter(s)? I recognize all of this with what I experienced and I believe it to be TMS. When I have tension in my jaw, because I grind or something similar, I feel them often especially when I lie down on the couch. If you want to rule out anything serious with your heart, just consult a doctor.
  15. Fernando

    Fernando Peer Supporter

    One by one all of my symptoms and my number one TMS equivalent nowdays, thank you so much for bringing this up. In my case dizziness (not spinning) correlates one by one with neck pain. No stiff neck no dizziness at all.
  16. Gigalos

    Gigalos Beloved Grand Eagle

    cheers Fernando, glad it helps you
    Fernando likes this.
  17. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    I found a new link to a slightly different article by Dr. Edelman, posted by whirledfoundation.org (mostly they are quite focused on physiological causes of dizziness). I edited the posts above to refer to this. It's a direct download of a PDF, and I suggest that everyone download it, in case that link goes away!

    Edit: this also disappeared, but see Forest's post below - Dr. Edelman gave permission for the PDF to be posted by us.

    Interestingly, Dr. Edelman wrote this in 2009, two years after her book on CBT was published: https://www.amazon.com/Change-Your-Thinking-Overcome-Depression/dp/1600940528/ref=sr_1_1?s=books&ie=UTF8&qid=1503693055&sr=1-1&refinements=p_27:Sarah+Edelman
    Last edited: Feb 17, 2019
    Fernando and Gigalos like this.
  18. Gigalos

    Gigalos Beloved Grand Eagle

    Great find Jan!
  19. Forest

    Forest Beloved Grand Eagle

    Hi everyone,

    I was contacted by Dr. Edelman a couple of days ago. She referred to this thread and wrote the following, "The article referred to was written by me, and I’d be very happy for it to be posted on your website. I hope that it will be useful for some of your members. Best wishes, Sarah."

    Thank you for your generosity, Sarah! I've reviewed the PDF you sent it looks very similar to techniques that several of our forum visitors have successfully used to overcome various symptoms. I'd be happy to post it and would welcome you to participate in the forum if you are able to do so.

    I have attached the PDF of the article to this thread.

    Side note to everyone else: occasionally, you may see me write about the importance of optimizing our site for search engines. This, in fact, is one of the reasons why we have the tags at the top of our threads and why I encourage people to selectively add relevant tags to threads that you think others might be helpful. Aside from helping other people with symptoms find our resources, sometimes it also helps us find experts as well. :) I'll add the tags, "Sarah Edelman, PhD," and "Psycho-Physical Dizziness Syndrome (PPDS)" to this thread. It's good to keep a relatively small number of tags like this for each thread.

    Happy reading and best of luck in your recoveries!

    [2019 update: Dr. Edelman has sent me an updated version of the flyer. It is attached.]

    Attached Files:

    Last edited: Jul 1, 2019
    MWsunin12, JanAtheCPA, Lainey and 2 others like this.
  20. Gigalos

    Gigalos Beloved Grand Eagle

    That's great!! Thank you Sarah! I would also love it if she would participate here.
    plum likes this.

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