The Sporting Arms and Ammunition Manufacturers Association (SAAMI) sets the standard for maximum allowable pressure for each type of round. That way the manufacturer of a gun knows what pressure he has to design the gun to handle and the ammunition manufacturers know the maximum pressure they can load to. However, standards are just what their name implies. While they provide the confidence that it is safe to fire a particular round in a gun that it made for it (for example you should be able to safe in firing a .38 Special round from a gun designed for and marked .38 Special) it's also possible to build a gun that is stronger than the standard. However once the "standard" limit is exceeded there needs to be a new standard set to again establish a safe pressure limit if anyone other than the original builder is ever going to make ammunition for it.
So, specifically, "+P" allows for a 10% increase in pressure over the normal SAAMI limits for that round. So, for ammunition, the pressure generated by the +P round should be over 100% but no more than 110% of the SAAMI standard. A gun that is designed to be safe at pressure levels generated by firing +P rounds will be marked +P after the caliber marking on the barrel. A gun that is not marked +P is NOT designed for overpressure rounds and is NOT safe to fire +P rounds.
I haven't done any direct work with SAAMI in several years but the last I knew +P+ (Plus P Plus) was not recognized by SAAMI and was simply a marketing device. Hopefully +P+, which implies higher pressures than +P, is still below the +P 110% pressure limit.
Tom