Trauma in Motion
Complex PTSD, Persistent Postural-Perceptual Vertigo, and Cervicogenic Dizziness
Persistent dizziness and balance disturbances are commonly approached through neurological or mechanical frameworks. However, a growing body of evidence suggests that trauma, particularly Complex Post-Traumatic Stress Disorder (cPTSD), may serve as a critical underlying or compounding factor in conditions such as Persistent Postural-Perceptual Vertigo (PPPV) and cervicogenic (cervical) vertigo. Although traditionally treated as distinct diagnostic entities, these disorders frequently overlap both in symptom presentation and underlying mechanisms. This paper examines how trauma-induced nervous system dysregulation, chronic muscular tension patterns, and somatic hypervigilance may contribute to the onset and persistence of PPPV and cervical vertigo. It argues for a trauma-informed, biopsychosocial approach to their assessment and treatment.
Understanding PPPV and Cervical Vertigo
Persistent Postural-Perceptual Vertigo (PPPV) is a chronic functional vestibular disorder characterized by persistent dizziness, subjective unsteadiness, and spatial disorientation lasting longer than three months (Staab, 2016). Unlike structural vestibular damage, PPPV is not caused by an identifiable lesion but is thought to result from maladaptive neural processing of motion and balance cues. It often emerges after an acute vestibular event such as vestibular neuritis, benign paroxysmal positional vertigo (BPPV), or a traumatic neurological event. It is maintained by heightened visual dependence, postural rigidity, and hypervigilant attention to bodily sensations (Bittar & von Graefe, 2014).
Cervical vertigo (also known as cervicogenic dizziness) refers to dizziness associated with dysfunction in the cervical spine. It may arise from neck trauma, degenerative changes, or chronic muscle tension, and is believed to result from abnormal proprioceptive input from the upper cervical joints and musculature (Wrisley et al., 2000). Cervical vertigo often presents with dizziness exacerbated by head movement, neck pain, or restricted mobility and is commonly reported after whiplash injuries or in individuals with chronic postural strain.
The Role of Complex PTSD in Vestibular Dysregulation
Complex PTSD is a trauma-related condition associated with prolonged or repeated interpersonal trauma, particularly in childhood. It extends beyond the core symptoms of PTSD, such as re-experiencing and avoidance, to include affect dysregulation, negative self-concept, and disturbances in relationships (Herman, 1992). Neurobiologically, cPTSD is associated with chronic dysregulation of the autonomic nervous system (ANS), characterized by fluctuations between sympathetic hyperarousal (fight/flight) and parasympathetic shutdown (freeze/collapse) (Van der Kolk, 2014).
This state of persistent dysregulation interferes with vestibular function and balance in several ways. First, chronic hypervigilance may heighten sensitivity to internal bodily signals, including those related to motion and equilibrium, thereby amplifying the subjective experience of dizziness (Popkirov et al., 2018). Second, trauma survivors often exhibit maladaptive postural strategies, such as muscle bracing and reduced head movement, which may contribute to persistent cervical tension and altered proprioceptive input, key factors in cervicogenic vertigo (Dehner et al., 2022). Third, trauma impairs sensory integration and may disrupt the body’s internal model of spatial orientation, increasing susceptibility to PPPV and reducing the brain’s ability to recalibrate after vestibular events (Staab & Ruckenstein, 2007).
Somatic Memory and Muscle Tension as Carriers of Trauma
The body holds trauma in non-verbal, physiological ways. Muscle guarding and chronic tension, especially in the neck and shoulders, are common somatic expressions of unresolved trauma. This muscular bracing can interfere with proprioceptive signalling from the cervical spine, potentially contributing to the development or perpetuation of cervical vertigo (Reid & Rivett, 2005). Many trauma survivors live in a state of embodied defence, with subtle but constant muscular activation designed to prevent further harm, yet this very tension becomes a source of pain, dizziness, and disorientation.
Moreover, traumatic dissociation may further distort one’s sense of physical grounding and spatial orientation. Survivors of cPTSD may experience intermittent dissociation from bodily sensations or adopt a hyper-alert attunement to them, both of which destabilize their vestibular processing. This paradox of both over-connection and disconnection from the body complicates the presentation and treatment of dizziness-related disorders in trauma-affected individuals (Ogden et al., 2006).
Toward a Trauma-Informed, Integrated Treatment Approach
Given the complex interplay between trauma, vestibular processing, and musculoskeletal tension, a trauma-informed biopsychosocial approach is essential. Standard treatments for PPPV, such as vestibular rehabilitation therapy (VRT), may be ineffective or even retraumatizing without appropriate psychological support. Likewise, interventions for cervical vertigo that focus only on physical alignment and muscle tone may neglect the emotional and neurological drivers of muscular bracing.
Effective treatment must address both the somatic and psychological dimensions of trauma. Somatic-based therapies such as Sensorimotor Psychotherapy, Somatic Experiencing, or trauma-informed yoga can help survivors reconnect safely with their bodies and release chronic tension patterns. Concurrently, trauma-informed psychotherapeutic approaches like eye movement desensitization and reprocessing (EMDR) can support emotional integration and regulation. Neurofeedback, mindfulness, and vagus nerve stimulation have also shown promise in regulating the ANS and reducing dizziness symptoms (Schore, 2012; Fisher, 2014).
Conclusion
Persistent dizziness, often viewed through a narrow neurological or biomechanical lens, may be the somatic echo of trauma. Complex PTSD may underlie or exacerbate both PPPV and cervical vertigo through pathways of autonomic dysregulation, sensory mismatch, and muscular tension. Recognizing the role of trauma in balance disorders for traumatic accident and incident survivors is not only critical to effective treatment but also validates the lived experience of survivors whose suffering often defies purely structural explanation. Healing, in such cases, involves more than retraining the body; it requires re-establishing a safe and trusting relationship with it.
⸻
References
Bittar, R. S. M., & von Graefe, K. M. (2014). Functional dizziness: Diagnosis and treatment. Current Opinion in Neurology, 27(1), 111–115. https://doi.org/10.1097/WCO.0000000000000053
Dehner, L., Ernst, A., & Todt, I. (2022). Cervical vertigo: Myth or reality? HNO, 70(10), 783–789. https://doi.org/10.1007/s00106-022-01258-z
Fisher, J. (2014). Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. Routledge.
Herman, J. L. (1992). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton & Company.
Popkirov, S., Staab, J. P., & Stone, J. (2018). Persistent postural-perceptual dizziness (PPPD): A common, characteristic and treatable cause of chronic dizziness. Practical Neurology, 18(1), 5–13. https://doi.org/10.1136/practneurol-2017-001819
Reid, S. A., & Rivett, D. A. (2005). Manual therapy treatment of cervicogenic dizziness: A systematic review. Manual Therapy, 10(1), 4–13. https://doi.org/10.1016/j.math.2004.05.005
Schore, A. N. (2012). The science of the art of psychotherapy. W. W. Norton & Company.
Staab, J. P. (2016). Chronic subjective dizziness. Continuum: Lifelong Learning in Neurology, 22(4, Neuro-otology), 1271–1289. https://doi.org/10.1212/CON.0000000000000345
Staab, J. P., & Ruckenstein, M. J. (2007). Expanding the differential diagnosis of chronic dizziness. Archives of Otolaryngology–Head & Neck Surgery, 133(2), 170–176. https://doi.org/10.1001/archotol.133.2.170
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Wrisley, D. M., Sparto, P. J., Whitney, S. L., Furman, J. M., & Marchetti, G. F. (2000). Cervicogenic dizziness: A review of diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy, 30(12), 755–766. https://doi.org/10.2519/jospt.2000.30.12.755