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While it may not be uncommon to feel a sense of unease when standing and looking down from great heights, some individuals—around a third of the population—experience either height intolerance or acrophobia, which is a fear of heights severe enough to affect one’s quality of life, according to a 2020 research review in the Journal of Neurology.[1]
Read on to learn more about acrophobia and who it affects, as well as its symptoms, causes and treatments.
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What Is Acrophobia?
Acrophobia is a severe fear of heights, either through direct exposure to or thinking about heights, that can lead to symptoms like anxiety, panic attacks and avoiding situations involving heights.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an authoritative handbook used to diagnose mental health conditions, categorizes acrophobia as an anxiety disorder specific to one’s environment. Criteria for a diagnosis of acrophobia include experiencing a pronounced fear or anxiety of heights that disrupts an individual’s ability to function.
Who Experiences Acrophobia?
Acrophobia is one of the most common specific phobias alongside fear of animals and fear of thunder. About 3% to 6% of those with a fear of heights actively suffer from acrophobia. Statistically, acrophobia affects around twice as many women as men, according to a study in the European Archives of Psychiatry and Clinical Neuroscience.[2] Those individuals who are afraid of heights but don’t experience acrophobia may experience a less disabling condition called visual height intolerance—anxiety that occurs with direct exposure to heights.
“Acrophobia is similar to any specific phobia, but the impact can be more substantial if people live and work in big cities with tall buildings or in industries that require travel,” says David H. Rosmarin, Ph.D., associate professor at Harvard Medical School and founder of the Center for Anxiety, an organization focused on helping people with extreme anxiety based in New York, Massachusetts and New Jersey.
Acrophobia Causes
The origins of an individual’s acrophobia may be biological and/or psychological.
“From a biological standpoint, genetic factors are key,” says Ashwini Nadkarni, M.D., instructor at Harvard Medical School and associate vice chair for wellness in psychiatry at Brigham and Women’s Hospital in Boston. “People with a family history of anxiety disorders or phobia might develop one themselves.”
“Variables related to motion discomfort…can also play a role,” she adds. Vertigo is a prime example, which may be a contributing factor to acrophobia.
In terms of psychology, Dr. Nadkarni adds that people who fall from a significant height as a child or at an earlier time in their life—or who witness something similar happen to someone they know—may develop acrophobia or visual height intolerance. Additionally, some individuals may have even seen acrophobia modeled by a parent or relative when growing up, which can create a pattern of fear.
Acrophobia Symptoms
The most common symptoms of acrophobia include anxiety, vertigo, difficulty walking and feeling weak in the knees or heavy in the legs, as well as an increased heart rate, shortness of breath, sweating or drowsiness during exposure to heights. In more serious cases, individuals may experience panic attacks, which is a defining indicator of acrophobia.
Psychologically, individuals affected by acrophobia may experience anxiety when thinking about being in high places or believe that something terrible will happen when they’re at a great height.
Acrophobia may lead individuals to avoid places or situations that may expose them to heights, such as entering tall office buildings, driving or walking across bridges or climbing ladders, which may affect one’s daily life. If someone finds their life is being interrupted by their fear of heights, they should consult with a mental health provider, according to Dr. Nadkarni.
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Treatments for Acrophobia
The most popular and effective treatment for acrophobia is exposure therapy, a type of behavior therapy which, as its name suggests, exposes the affected individual directly to their specific fear or phobia, according to experts.
“In acrophobia, we would start [exposure therapy] by identifying local heights to look down from—bridges, overpasses, elevators, buildings, etc. Then the patient and therapist would work together to face each one,” he explains. “With repeated exposure, the patient’s anxiety [should lessen] over time.”
Exposure therapy may pair well with relaxation therapy, which helps desensitize and retrain people’s brains to experience calm instead of fear when exposed to heights, says Dr. Nadkarni. Continuous exposure to heights along with implementing additional techniques drawn from meditation, such as deep breathing, can help someone with acrophobia associate quietude,instead of distress, with heights.
Recently, technological advances in the health care field have created new ways to build on exposure therapy through virtual reality. “In virtual reality therapy, exposure is achieved through a virtual environment or with a device that achieves an interactive, immersive and realistic 3D-graphic experience,” says Dr. Nadkarni. While preliminary trials find virtual reality therapy to be helpful in treating phobias, including acrophobia, limited large-scale trials exist. Furthermore, barriers to implementing virtual reality therapy, such as cost and negative attitudes among clinicians, exist, according to a 2021 study in Frontiers in Psychology.[3]
When to See a Health Care Provider
“In general, phobias are defined as producing significant personal, social or occupational impairment,” says Dr. Nadkarni. “So if someone finds that their acrophobia is keeping them from functioning in a significant way, it’s time to seek help.”
A mental health professional, such as a well-trained therapist or psychologist, can help individuals experiencing the symptoms of acrophobia, enhancing their mental wellness.
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