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Good discussion. I have found that the structural plus MBS explanation for BPPV fits best. Like others who have posted, I have seen this problem typically in the context of a host of other complaints (back to the circumstantial assessment, ROS, pain chart, etc, where other MBS diagnoses are frequently present). With a history of repeat BPPV occurrences, the predictive coding error/rumination-fixation and buy in to the structural (and perceived as dangerous) explanation have typically gotten entrenched. Better long term results seem to occur (anecdotally) with a 1st time BPPV presentation and successful Epley procedure, where there is later opportunity to address the other complaints, especially where one’s credibility is established after resolving the problem early on, regardless of its cause. Ruminative sorts who comb the internet and fuel their fears,
are particularly vulnerable in these cases ie in search of (often another) diagnosis.