{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T02:30:07Z","timestamp":1791772207246,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Persistent Postural\u2010Perceptual Dizziness (PPPD) is a prevalent functional neuro\u2010otologic disorder characterised by non\u2010spinning 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross\u2010sectional 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010specific Niigata PPPD Questionnaire (NPQ). Mediation analyses indicated VIMSSQ's predictive strength depended largely on anxiety and perceived injustice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cognitive appraisals such as perceived injustice are critical constructs in PPPD symptomatology. Given limited PPPD\u2010specific psychometric tools addressing psychological dimensions beyond general anxiety, developing assessments sensitive to these factors is essential for evidence\u2010based holistic interventions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70339","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T13:15:28Z","timestamp":1756127728000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Psychological Variables Mediate Symptoms in Persistent Postural\u2010Perceptual Dizziness (<scp>PPPD<\/scp>): A Cross\u2010Sectional Self\u2010Report Study"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7539-4468","authenticated-orcid":false,"given":"Ariel","family":"Sereda","sequence":"first","affiliation":[{"name":"SENSE Research Unit Queen Square Institute of Neurology  London 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