Acrophobia (Fear of Heights)

Cleveland Clinic / Editorial intro by John Riley

Hello everyone, we apologize for missing a few days this week with our daily blog but we are working on something really great involving Virtual Reality and emersion therapy. Currently I am modeling and designing a fear of heights simulator in VR for next year to be used as a therapy exercise. I’ll do my best to keep up with the blogs while making this awesome project and I hope you are having a great week!

People with acrophobia have an intense fear of situations that involve heights such as being in a tall building or using a ladder. Like other specific phobias, acrophobia is treatable with a psychological therapy called exposure therapy.

What is acrophobia?

Acrophobia is a mental health condition in which the individual experiences an intense fear of heights. It’s a type of anxiety disorder. A person with acrophobia experiences intense fear and anxiety when they think of tall heights or are positioned at a significant height. They often avoid situations or places that involve heights.

A certain amount of concern around heights is normal for all people, and most people are more cautious than usual when they are at a significant height. Most of us may feel uneasy or a bit shaky if we look down from a tall height, such as from a bridge. But people with acrophobia experience intense and unreasonable fear when they’re faced with heights, including everyday tasks such as climbing a flight of stairs, standing near a balcony, or parking a car in a multiple-floor parking garage.

Who does acrophobia affect?

Like other phobias, acrophobia can affect anyone at any age. Specific phobias, like acrophobia, are more likely to develop in children and become apparent in adolescents and young adults. Females are more likely to develop specific phobias.

What kind of heights are people with acrophobia afraid of?

Types of heights or situations that people with acrophobia may fear include:

Walking up a flight of stairs.
Being on a ladder.
Using a multi-level parking garage.
Being on or crossing over a bridge.
Being on a rollercoaster.
Standing near a balcony or at the top of a building.
Looking out a window of a tall building.

Since there are many kinds of phobias, they can be a little challenging to diagnose. People who have acrophobia generally fear more than one kind of height or high place. There are other phobias that are characterized by a fear of a situation that happens to involve a significant height, but the height isn’t the main aspect of the fear. As an example, if you have an intense fear of flying on airplanes (which happens at a significant height) specifically, you may have aerophobia, the fear of flying, and not acrophobia. If you’re experiencing intense fear that limits your life and experiences, it’s important to see your healthcare provider so you can get a proper diagnosis and treatment.

How common is acrophobia?

Acrophobia is one of the most common phobias. Approximately 3% to 6% of people have acrophobia.

SYMPTOMS AND CAUSES

What are the signs and symptoms of acrophobia?

The main symptom of acrophobia is feeling intense anxiety and fear of heights. Some people with acrophobia fear significant heights such as a tall bridge while others also fear shorter heights such as being on a ladder.

Psychological symptoms

Feeling intense fear and anxiety when thinking about, looking at or being in high places.
Fearing that something negative will happen in a high place such as falling or being trapped in a high place.
Feeling a strong desire to escape if you’re in a high place.

Physical symptoms and signs

Experiencing a rapid heartbeat when thinking of or looking at heights.
Feeling dizzy and lightheaded when thinking of or looking at heights.
Feeling queasy.
Trembling.
Having shortness of breath.

What causes acrophobia?

Researchers aren’t sure what exactly causes acrophobia. They believe that having acrophobia can stem from our natural human concern of falling from a high place and hurting ourselves. Dwelling on and worrying about the possible pain you could experience from falling from a significant height could contribute to developing acrophobia. Researchers also think that a negative or traumatic experience that involved a significant height may contribute to a person developing acrophobia.

DIAGNOSIS AND TESTS

How is acrophobia diagnosed?

Acrophobia is diagnosed through a thorough series of questions about the person’s history, experiences and symptoms. Usually, you have to have had experienced persistent fear and anxiety of heights for at least six months in order to be diagnosed with acrophobia.

Your healthcare provider will likely use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a publication by the American Psychiatric Association, to diagnose acrophobia. Your provider will also rule out any other physical or mental health conditions that could be causing your symptoms.

In general, phobias have at least four criteria for diagnosis, including:

Intense and unreasonable fear: The fear of the object or situation is persistent and out of proportion to an appropriate level of fear.
Anticipatory anxiety: An individual who has a phobia tends to dwell on or dread future situations or experiences that will involve the object or situation they are afraid of.
Avoidance: Many people who have a phobia will actively avoid the feared object or situation. Some go to extreme lengths to avoid the thing they are afraid of.
The phobia interferes with day-to-day activities: The fear the individual experiences has to limit their everyday life in some way in order for it to be diagnosed as a phobia.

MANAGEMENT AND TREATMENT

How is acrophobia treated?

Acrophobia can usually be treated with psychological treatment (psychotherapy) such as exposure therapy, virtual reality exposure therapy and/or cognitive behavioral therapy. Sometimes people need medications that temporarily relieve symptoms of fear and anxiety to cope with fear while they are participating in therapy.

Exposure therapy: Exposure therapy is a common form of psychological treatment used to treat specific phobias. People with phobias usually avoid situations that involve the thing they are afraid of. Because of this, they aren’t able to learn that they can manage their fear when presented with their specific phobia or that their feared outcomes often do not happen. Therapists and psychologists use exposure therapy for people who have a phobia to slowly encourage them to enter situations that cause them anxiety, and to try to stay in that situation so that they can learn to cope.

Virtual reality exposure therapy (VRET): Virtual reality exposure therapy is a type of psychological treatment that uses technology to show the person realistic — but fake — situations to help them cope with stressful and anxiety-inducing situations. If you have acrophobia, you may use a virtual reality (VR) headset that will show you simulations of situations that involve heights. This way, you can be exposed to heights in a way that’s completely safe and feels, real but isn’t. Research has shown that virtual reality exposure therapy is effective in treating acrophobia.

Cognitive behavioral therapy (CBT): CBT is a form of psychological treatment. Through talking and asking questions, your therapist or psychologist helps you gain a different perspective. As a result, you learn to respond better to and cope with the stress and anxiety you feel when you are exposed to things that cause you fear.

What medications are used to treat acrophobia?

Medications aren’t usually used to treat specific phobias like acrophobia. Sometimes people with acrophobia might take medications to temporarily help them relieve symptoms of fear and anxiety to treat their phobia when they’re going through psychological therapy or in situations that are unavoidable. Medications sometimes used to help treat acrophobia include:

Beta blockers: Some beta-blockers are used to treat or prevent physical symptoms of anxiety, such as a fast heart rate.
Relaxants (benzodiazepines): Medications like benzodiazepines, which are used to help you relax, can temporarily reduce the amount of anxiety you feel.

PREVENTION

What are the risk factors for developing acrophobia?

Healthcare professionals still aren’t sure of the exact cause of acrophobia. So far, they’ve found that the risk factors for developing acrophobia can include:

Falling from a significant height or watching someone else fall from a significant height.
Experiencing a negative event, such as a panic attack, while in a high place.
Having a family history of anxiety disorders.

OUTLOOK / PROGNOSIS

What is the prognosis (outlook) for acrophobia?

Only about 10% to 25% of people who have a specific phobia, such as acrophobia, seek treatment for their condition because many can avoid the situation that they fear. If you have acrophobia, avoiding situations that involve heights can prevent you from completing everyday tasks such as walking up a flight of stairs or crossing a bridge and can lower your overall quality of life. Having acrophobia can also be potentially dangerous if you experience a panic attack while at a significant height, such as while on a ladder. This is why it’s important to seek treatment.

Research has shown that exposure therapy, especially virtual reality exposure therapy, is successful in treating acrophobia. People who have acrophobia and don’t seek treatment are two times more likely to develop a generalized anxiety disorder or depression that’s unrelated to their specific phobia.

Is there a cure for acrophobia?

There is currently no cure for acrophobia, but exposure therapy, a form of psychological therapy, is successful in treating it. Exposure therapy is considered the first-line treatment for specific phobias in general.

LIVING WITH

How can I take care of myself if I have acrophobia?

If you’re in a high place there are some things you can do to try to decrease your anxiety. If you can safely do any of the following actions while in a high place, try:

Fixing your view/sight on the horizon.
Looking at stationary objects near you.
Siting or laying down.
Pausing or stop movement.
Doing cognitive distractions, such as naming items from a certain category.

It can be uncomfortable, but it’s important to talk to your healthcare provider if you’re experiencing the signs and symptoms of acrophobia. Therapy can help you overcome your phobia.

If you’ve already been diagnosed with acrophobia, there are some things you can do to manage your symptoms, including:

Getting enough sleep and exercise.
If you are participating in psychological therapy to treat your acrophobia, be sure to see your therapist regularly.
Practicing mindfulness activities such as mediation.
Practicing relaxation techniques such as deep breathing and yoga.
Reaching out to family and friends for support.
Joining a support group for people who have acrophobia or specific phobias in general.

What questions should I ask my doctor?

Talking about your mental health can be uncomfortable and scary. Your mental health is just as important as your physical health, so it’s important to talk to your healthcare provider about your symptoms. The following questions may be helpful to ask your provider if you have acrophobia:

What kind of treatment do you recommend?
Should I see a therapist, psychologist and/or psychiatrist?
Do you have any recommendations for psychologists, psychiatrists or therapists that I could see?
How long will treatment take?
Do you know of any support groups for acrophobia or phobias in general?
Do you have any learning resources on acrophobia that I could read?