Acrophobia is a persistent and excessive fear of heights. People with acrophobia can experience panic attacks when they are high up off the ground. Read on to learn more about this phobia and how you can deal with it.
What Is Acrophobia?
Acrophobia, derived from the Greek word “ákron” meaning peak and “phóbos” meaning fear, is a pervasive mental disorder and an irrational fear of heights. It is included in the category of specific phobias related to space and motion discomfort. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 1, height is considered a “natural environment type” of fear and phobia. Studies 2 have shown that Acrophobia is the most common of all specific phobia subtypes. Approximately 5% of the global population 3 suffers from this phobia with more women affected by it than men.
Most of us tend to have a natural fear of heights which is related to Basophobia or the fear of falling (FOF). However, individuals with acrophobia may experience severe anxiety and a panic attack when they are high off the ground. This can affect their ability to control their thoughts and emotions and get down safely. Acrophobia can also be triggered by thinking about heights or even when the sufferer is not that high up off the ground. Hence, they may intentionally avoid experiences or circumstances that expose them to heights, like stepping on a balcony, bridge, plane or ladder.
When anticipating or experiencing heights, Acrophobics may trigger their sympathetic nervous system to prepare their mind and body for danger or an emergency. This in turn triggers their fight-or-flight response to either face or escape the threatening situation. This can make them experience nausea, shortness of breath, an upset stomach, increased heart rate, trembling, sweating and anxiety even when there is no actual threat or a danger present.
However, it should be remembered that simply feeling nervous or dizzy while looking down from a great height is not necessarily Acrophobia. When you feel intense fear and anxiety even by imagining yourself high up and it affects your daily lifestyle, then you have a fear of heights.
Acrophobia vs. Vertigo
Although the term “vertigo” is widely used to describe the fear of heights, it is actually incorrect. Vertigo refers to an unpleasant spinning sensation and is often a symptom of Acrophobia. Vertigo can occur when either looking at a tall monument or object or looking down from a height. However, vertigo may be triggered by different kinds of movement or by altering our visual perspective.
When the feeling of vertigo is triggered by heights, it is known as height vertigo 4. This is usually a result of the struggle between vision, the somatosensory sense and the vestibular sense. Studies 5 show that this struggle between the senses can affect balance and result in anxiety and motion sickness.
Symptoms Of Acrophobia
To be identified as a phobia, an individual needs to experience the symptoms related to the fear for at least 6 months, according to the DSM-5 6. There are many physical and emotional symptoms associated with this phobia and some of them are mentioned below.
1. Physical symptoms
An acrophobic person may exhibit the following physical symptoms when they are exposed to heights or thinking about it:
- Shortness of breath
- Feeling sick or lightheaded
- Heart palpitations
- Dry mouth
- Increased heartbeat
- Headaches and dizziness
- Chest pain or tightness
- Shaking and trembling
- Crying or yelling for help
- Feeling paralyzed
- Kneeling or crawling
2. Psychological symptoms
An irrational fear of heights, panic attacks, anxiety and vertigo are some of the most common emotional symptoms of Acrophobia. Sufferers may struggle to trust their sense of balance or cling to something at the thought of exposure to height. Here are some psychological symptoms of Acrophobia:
- Intense & irrational fear
- Panic attacks
- Feelings of losing balance
- Having difficulty to think
- Feelings of being trapped
- Avoiding heights purposefully
Causes Of Acrophobia
Having a fear of heights is natural due to our instinctive fear of falling and getting injured or dying. So it is normal for most of us to avoid extremely high places. However, acrophobic show a hyper-reaction to the natural fear response. Generally, it is believed that acrophobia develops from traumatic experience or conditioning. But studies 7 have found that people suffering from this particular phobia often lack traumatic experiences 8.
Acrophobia may develop during childhood or may lack any clear reason for development. As it may stem without any known or single cause, researchers have come up with various theories for the development of Acrophobia:
1. Evolutionary theories
Evolution plays a great role in the development of most phobias. As our fear of falling is partially an instinctive feeling, Acrophobia can be an evolutionary survival mechanism. Scientists believe we are naturally programmed to be afraid of certain dangerous things to ensure our long-term survival. As falling from a height may prove fatal and jeopardize our survival, Acrophobia may be an inherent and instinctive feeling.
The Evolved Navigation Theory 9 proposes that specific processes, like the perception of height, have evolved and developed through natural selection. By perceiving the height from a point greater than it actually is, we can reduce the risk of falling and increase our chances of survival. This can also be a reason why some of us suffer from acrophobia more than others.
2. Behaviorist theories
According to behaviorists, we often develop fears and phobias through our interactions and experiences with our surrounding environment. This may be develop due to –
- Observation: A child having a parent or caregiver suffering from Acrophobia may develop a similar phobia.
- Trauma: An individual witnessing another person having a terrible or fatal experience with heights can suffer from Acrophobia.
- Classical Conditioning: If someone has fallen from a height and has been injured in the past, they will unconsciously and automatically associate heights with danger. It is a conditioned response 10 to specific stimuli, which in this case is height.
Due to the learned association 11 between falling from a height and danger, a person may become afraid of heights and may avoid similar encounters in future. Apart from these, Cognitive factors and inability to maintain balance can also contribute to the development of an irrational fear of heights.
Diagnosis Of Acrophobia
Acrophobia is diagnosed using DSM-5 and ICD-10. Apart from these, various tests and questionnaires like Behavioural Avoidance Tests (BAT), Acrophobia Questionnaire (AQ), Height Interpretation Questionnaire (HIQ) and The Attitude Towards Heights Questionnaires (ATHQ) are also used by professionals. However, these are mostly self-analysis tools that are not completely reliable as sufferers may exaggerate or overestimate their condition.
Mental health professionals, like certified psychiatrists, psychologists and counsellors, are trained to diagnose and treat Acrophobia. If you or someone you know is suffering from this phobia, then it is best to consult a healthcare professional immediately. Not only can they effectively diagnose this pervasive mental disorder, they can also assess the severity of the condition and how it may affect your daily life.
Acrophobia can be diagnosed if the sufferer:
- Feels instantaneous & extreme fear and anxiety when exposed to heights or thinking about it
- Intentionally avoids heights or situations that expose them to heights
- Experiences stress and anxiety for longer periods of time anticipating being at a height
- Daily functions and lifestyle are affected by such anxiety and worries
- Experiences symptoms of this phobia for over 6 months
By personally interacting with the sufferer, mental health professionals may analyze their thoughts and emotions regarding their fear of heights. They may also assess previous traumatic experiences of the patient and analyze symptoms related to other mental health conditions.
Treatment Of Acrophobia
Treatment can help someone suffering from Acrophobia and enable them to gain control of their daily lives, especially if they have to encounter heights on a regular basis. Along with dedication and patience, an acrophobic can overcome this phobia with help from a mental health professional.
Here are a few treatments options for Acrophobia:
The following psychotherapy strategies can be recommended for someone affected by this condition:
A. Exposure therapy
Controlled exposure to heights can be a highly effective solution for treating Acrophobia. Exposure therapy requires the patient to slowly expose 12 themselves to the object or situation resulting in their phobia, under the supervision of a therapist. This allows the patient to gradually adapt to it and eventually confront what they are afraid of. This can require a number of therapy sessions depending on the willingness and progress of the patient.
For acrophobia, the patient may begin by viewing images and videos of tall buildings or people standing at a height. According to a 2014 study 13, 3-4 sessions of virtual reality therapy 14 can also help patients treat Acrophobia. Another 2018 study 15 showed that people with Acrophobia claimed that VR exposure therapy 16 was reportedly helpful. VR exposure enables them to encounter heights without actually putting themselves in any actual danger. Eventually, the patient may start climbing up a ladder or stepping onto the balcony to face their fear.
B. Cognitive behavioral therapy (CBT)
CBT or Cognitive-behavioral therapy is a type of psychological treatment that is widely used for specific phobias and mental disorders. It requires the patient to work with a psychologist or a therapist to understand how changing their perception and thoughts can help them overcome their fear of heights. Behavioral techniques like systematic desensitization and flooding are commonly used by professionals. CBT enables sufferers to become aware and identify their irrational fears. This enables them to utilize strategic techniques to replace negative thoughts and emotions with positive and accurate thoughts.
CBT is best suited for individuals who are reluctant about exposure therapy. It also empowers patients to reframe their mindset and attitude towards height, regulate their stress response and gain emotional control.
Hypnosis or hypnotherapy is a therapeutic technique used by professionals for guided relaxation, focused attention, intense concentration and to make suggestions. Hypnotherapy enables the patient to enter a deeply relaxed state. This is when therapists use suggestive techniques and guided visualization and imagery to help the patient cope with their fear response to heights. Although adequate evidence suggests that hypnosis can be effective in treating Acrophobia, further scientific research is required.
There are no specific medications for the treatment of specific phobias. However, certain medications may help with alleviating the symptoms associated with Acrophobia. Some of these medications include:
- Beta-blockers or sedatives – These medicines temporarily reduce our ‘fight-or-flight’ response and reduce stress. Beta-blockers also decrease the risk of heart attacks, lower blood pressure and relieve panic & anxiety.
- D-cycloserine (DCS) 17 -This drug can be specifically helpful in exposure therapy. According to 22 studies 18, DCS has improved the impact of exposure therapy in people coping with various anxiety-related conditions. A 2012 study 19 also found that this medication along with CBT can notably improve results in patients.
- Benzodiazepines – These are also sedatives which help to reduce symptoms related to anxiety.
3. Relaxation techniques
Various relaxation exercises like yoga, meditation, tai chi, qi gong, breathing exercises, progressive muscle relaxation and even regular physical exercise can also prove to help cope with stress and anxiety-related with Acrophobia. According to a 2019 study 20, such relaxation techniques can significantly help people with anxiety disorders and phobias.
Acrophobia Is Treatable
The fear of heights is one of the most common phobias. There are various treatment options for Acrophobia and seeking help from mental health professionals that can enable you to overcome the symptoms and start living a normal, healthier life.
Speak with your doctor and ask them for a referral to a mental health professional who will be able to guide you through the right therapy and medications for your condition. Talk to your friends and family and seek support as it can allow you to effectively manage your fear of heights.References:
- Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.11, DSM-IV to DSM-5 Specific Phobia Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t11/
- Donker, T., Van Esveld, S., Fischer, N., & Van Straten, A. (2018). 0Phobia – towards a virtual cure for acrophobia: study protocol for a randomized controlled trial. Trials, 19(1), 433. https://doi.org/10.1186/s13063-018-2704-6
- Misiewicz, Z., Hiekkalinna, T., Paunio, T., Varilo, T., Terwilliger, J. D., Partonen, T., & Hovatta, I. (2016). A genome-wide screen for acrophobia susceptibility loci in a Finnish isolate. Scientific reports, 6, 39345. https://doi.org/10.1038/srep39345
- Willem Bles, Theo S. Kapteyn, Thomas Brandt & Friedrich Arnold (1980) The Mechanism of Physiological Height Vertigo: II. Posturography, Acta Oto-Laryngologica, 89:3-6, 534-540, DOI: 10.3109/00016488009127171
- Redfern, M. S., Yardley, L., & Bronstein, A. M. (2001). Visual influences on balance. Journal of Anxiety Disorders, 15(1-2), 81-94. https://doi.org/10.1016/s0887-6185(00)00043-8
- Psychiatry online. (n.d.). Psychiatry Online | DSM Library. https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
- Coelho, C. M., Waters, A. M., Hine, T. J., & Wallis, G. (2009). The use of virtual reality in acrophobia research and treatment. Journal of Anxiety Disorders, 23(5), 563-574. https://doi.org/10.1016/j.janxdis.2009.01.014
- Menzies, R. G., & Clarke, J. (1995). The etiology of acrophobia and its relationship to severity and individual response patterns. Behaviour Research and Therapy, 33(7), 795-803. https://doi.org/10.1016/0005-7967(95)00023-q
- Jackson, R.E., Cormack, L.K. Evolved navigation theory and the descent illusion. Perception & Psychophysics 69, 353–362 (2007). https://doi.org/10.3758/BF03193756
- Rehman I, Mahabadi N, Sanvictores T, Rehman CI. Classical Conditioning. 2020 Aug 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262194.
- Rofé, Y. (2015). Fear and Phobia: A Critical Review and the Rational-Choice Theory of Neurosis. International journal of psychological studies, 7, 37.
- Raeder, F., Merz, C.J., Margraf, J. et al. The association between fear extinction, the ability to accomplish exposure and exposure therapy outcome in specific phobia. Sci Rep 10, 4288 (2020). https://doi.org/10.1038/s41598-020-61004-3
- Bouchard, S., Wiederhold, B. K., & Bossé, J. (2014). Fear of heights (acrophobia): Efficacy and lessons learned from psychophysiological data. In B. K. Wiederhold & S. Bouchard (Eds.), Series in anxiety and related disorders. Advances in virtual reality and anxiety disorders (p. 119–144). Springer Science + Business Media. https://doi.org/10.1007/978-1-4899-8023-6_6
- North MM, North SM, Coble JR. Virtual reality therapy: an effective treatment for psychological disorders. Stud Health Technol Inform. 1997;44:59-70. PMID: 10175343.
- Freeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., Denne, M., Brown, P., Slater, M., & Nickless, A. (2018). Automated psychological therapy using immersive virtual reality for treatment of fear of heights: A single-blind, parallel-group, randomised controlled trial. The Lancet Psychiatry, 5(8), 625–632. https://doi.org/10.1016/S2215-0366(18)30226-8
- Botella, C., Fernández-Álvarez, J., Guillén, V. et al. Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review. Curr Psychiatry Rep 19, 42 (2017). https://doi.org/10.1007/s11920-017-0788-4
- Hofmann S. G. (2014). D-cycloserine for treating anxiety disorders: making good exposures better and bad exposures worse. Depression and anxiety, 31(3), 175–177. https://doi.org/10.1002/da.22257
- Mataix-Cols D, Fernández de la Cruz L, Monzani B, et al. D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data. JAMA Psychiatry. 2017;74(5):501–510. doi:10.1001/jamapsychiatry.2016.3955
- Bontempo A, Panza KE, Bloch MH. D-cycloserine augmentation of behavioral therapy for the treatment of anxiety disorders: a meta-analysis. J Clin Psychiatry. 2012 Apr;73(4):533-7. doi: 10.4088/JCP.11r07356. PMID: 22579153; PMCID: PMC3625928.
- Saeed SA, Cunningham K, Bloch RM. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019 May 15;99(10):620-627. PMID: 31083878.