EP 120: Unveiling Triple PD: Insights from Dr. Abbie Ross and Dr. Dani Tolman

But like fundamentally from the beginning, what is Triple PD? Triple PD.

Sure.

So 3PD stands for persistent postural perceptual dizziness.

And essentially from a, if we're looking at what it means diagnostically, it means that symptoms are present for at least three months.

They're present on most days.

They can fluctuate in intensity.

They don't need to be constant, but there is that persistent factor there.

It's usually something people will describe as dizziness, unsteadiness, maybe some rocking, some swaying, but not room spinning vertigo.

In addition, people will feel worse in upright position, sometimes just sitting upright, but definitely standing or moving around their house sometimes.

They'll feel worse in active or passive motion, including in the car.

They'll also feel worse in busy environments.

So they could see a busy patterned floor or a spinning ceiling fan or go to the grocery store or a ball game or a busy restaurant, and they can have their symptoms exacerbate.

It is typically preceded by some sort of precipitating event or condition.

In our world, it's often vestibular migraine or BPPV or a neuritis that can trigger the onset of 3PV.

But it could also be something like a panic attack, something that causes similar symptoms.

And really...

One of the biggest things about 3PD is that it is just so limiting.

People feel like their worlds have shrunk.

They don't feel like themselves anymore.

They feel almost homebound because anytime they're inside can be a problem, but it's the safest place that they feel outside can feel completely overwhelming and just symptom provoking to them.

What's tough about triple PD is that it can last for a long time.

The predisposing factors may differ from patient to patient and may not be very easily recognizable right off the bat, especially if somebody is not really familiar about this.

For a while, there was a stigma attached to it because initially there was thought to be some psychosomatic component to it, which we're not finding to be the case.

We're finding it to be a maladaptive issue based on a set of symptoms that kind of drove us to this point in time of chronicity.

So treating it can be very challenging because it's very counterintuitive, right? Why would we do the things that make us feel awful and we stay away from the things that make us feel awful when in reality, we still need to introduce that slowly with a graded exposure type of approach, but also at the patient's pace with an individualized