Psychological Variables Mediate Symptoms in Persistent Postural‐Perceptual Dizziness (PPPD): A Cross‐Sectional Self‐Report Study

ABSTRACT Background Persistent Postural‐Perceptual Dizziness (PPPD) is a prevalent functional neuro‐otologic disorder characterised by non‐spinning vertigo, perceived instability and visual motion sensitivity. Diagnostic criteria currently prioritise physical symptoms; although psychological factors are clinically linked to symptom onset and maintenance. This study investigates psychological factors in vestibular disorders by comparing PPPD patients with healthy controls, and exploratorily, with Bilateral Vestibulopathy (BVP) patients, identifying differentiating constructs and potential treatment targets. Methods We conducted a cross‐sectional study of 164 participants (59 PPPD, 16 BVP, 89 healthy controls), completing questionnaires on negative illness perception, anxiety, cognitive fusion, perceived injustice, balance vigilance, visually induced dizziness (VIMSSQ), dizziness severity (NPQ) and related constructs. Logistic regression and mediation analyses assessed psychological variables mediating dizziness symptoms and differentiating PPPD from controls and BVP. Results Two key insights emerged. First, perceived injustice (IEQ) best differentiated PPPD from healthy controls, surpassing dizziness severity and other psychological constructs. Second, visually induced dizziness (VIMSSQ) most effectively distinguished PPPD from BVP, outperforming even the PPPD‐specific Niigata PPPD Questionnaire (NPQ). Mediation analyses indicated VIMSSQ's predictive strength depended largely on anxiety and perceived injustice. Conclusions Cognitive appraisals such as perceived injustice are critical constructs in PPPD symptomatology. Given limited PPPD‐specific psychometric tools addressing psychological dimensions beyond general anxiety, developing assessments sensitive to these factors is essential for evidence‐based holistic interventions.