What is Acrophobia?

In the United Kingdom (and elsewhere in the world), phobias are the most common anxiety disorder. There are around 10 million people in the UK who have some sort of phobia. These affect anyone regardless of their sex, age or social background.

In general, there are two types of phobias: simple and complex.

Simple phobias include things like the fear of going to the dentist. These tend to start in early childhood (between four and eight years of age) and they can often disappear as the child matures. Simple phobias don’t usually cause issues in adulthood.

Complex phobias, on the other hand, typically begin later and can continue for many years. Social phobias tend to start during puberty and agoraphobia (the fear of going out) usually begins in early adulthood.

Acrophobia (a fear of heights) is among the most common phobias and it affects between 3% and 6% of people. In this article, we’ll tell you everything you need to know about acrophobia, including what it is, how it affects people, and how it’s treated.

What is acrophobia?

According to the Merriam-Webster dictionary, acrophobia is the “abnormal dread of being in a high place” and a “fear of heights”. It is not specific to certain places. For example, aerophobia is the fear of flying, and while someone with acrophobia probably also has aerophobia, someone who has aerophobia won’t necessarily have acrophobia too.

Acrophobia is considered to be a mental health condition and type of anxiety disorder.

It is normal to be cautious and concerned when at a significant height: this is an innate way of protecting us from potential injury and death. However, people with acrophobia feel this concern to an elevated degree.

Most of us might experience feeling uneasy when looking down from a high bridge, for example, but someone with acrophobia might feel so uneasy that they can’t even go onto the bridge in the first place.

Depending on the severity of the phobia, people might not even be able to climb a ladder, a flight of stairs, or go onto a hotel balcony such is their unreasonable and intense fear.

Similar conditions

While discussing acrophobia, it’s important to mention a couple of similar or confused conditions.

Many people falsely think a fear of heights is vertigo. Vertigo is a different condition that causes dizziness and a spinning sensation. It is not related to heights and is usually caused by problems in the ear.

Similar to acrophobia is bathmophobia. This is specifically the fear of stairs and slopes. People with this might also have acrophobia.

Climacophobia is another phobia linked to acrophobia. This phobia is almost the same as bathmophobia but it only happens when you have to climb up a steep set of stairs. You are typically not afraid of them as long as you can stay at the bottom.

How would acrophobia affect someone?

Like all medical conditions, people are often affected to different degrees.

Typical situations that people with acrophobia may fear include:

• Walking up some stairs.
• Being up a ladder.
• Using a multistorey car park.
• Being on a bridge.
• Going on a rollercoaster.
• Standing on or near a balcony.
• Being at the top of a building.
• Looking out of a window in a tall building.

In general, people with acrophobia will fear different types of heights and high places – it won’t be specific to a certain place. So, if someone is afraid of flying because of the height, they won’t necessarily have acrophobia, it may be aerophobia instead.

Intense fears and phobia can limit a person’s life and their experiences so it’s important that they seek advice and help from their healthcare provider in order to get a diagnosis and treatment.

What causes acrophobia?

No one knows the exact causes of acrophobia. Most people think that it stems from the natural concern all humans have about falling from height and being injured.

Research has shown that it’s not only humans that have this natural reluctance to be around heights. In 1960, Eleanor J. Gibson and Richard D. Walk conducted an experiment called the Visual Cliff Experiment. This involved crawling human infants and other young species refusing to cross a glass panel over a steep fall.

Thus, it seems that a small amount of acrophobia is partially ingrained as a survival mechanism from an evolutionary point of view. Nevertheless, most people do not go on to develop acrophobia.

Overthinking and dwelling on the possible repercussions of a fall from a height could contribute to the acrophobia developing. It is also believed that a traumatic or negative experience with heights can trigger it. Finally, it seems to be a hyper-reaction to the normal fear response. This could be brought on also by another person’s (a parent’s) nervousness too, for example.

Who does acrophobia affect?

Like all phobias, acrophobia isn’t discriminate. Anyone of any age, gender, race, etc. can develop the condition.

It does seem, however, that acrophobia can start in childhood and develop in adolescence and young adulthood. It’s also more common in females.

How common is acrophobia?

According to research, between 2% and 5% of the population has this condition and there are twice as many women affected as men.

A milder, related form of the condition is called vHI, or visual height intolerance, which up to one-third of the population has. This condition impacts people much less and not many people seek help for it.

What are the signs and symptoms of acrophobia?

The main symptoms are intense fear and anxiety about heights. Some acrophobia suffers will fear large heights like tall bridges, while others will fear any heights, including being on a ladder.

Here are the general symptoms one might expect from someone suffering from acrophobia:

Psychological symptoms

• Intense anxiety and fear when somewhere high, looking at a height or thinking about a height.
• A fear of something bad happening somewhere high, e.g., being trapped up high or falling from a height.
• A strong desire to escape when somewhere high.
• Feeling panic.
• Feeling unable to trust your own balance and seeking something to cling to.
• Feeling dread about upcoming events that could involve heights (e.g., having a hotel room on a high floor).
• Avoiding people who have homes with balconies or picture windows.

Physical symptoms

• A rapid heartbeat when looking at a height or thinking about a height.
• Feeling lightheaded or dizzy when looking at a height or thinking about it.
• Feeling nauseous.
• Shaking or trembling.
• Feeling short of breath.

How is acrophobia diagnosed and treated?

DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and ICD-10 (the International Statistical Classification of Diseases and Related Health Problems, 10^th revision) are used alongside an AQ (Acrophobia Questionnaire) that assesses 40 things, including avoidance and anxiety levels. Some diagnosticians also use the ATHQ (Attitude Towards Heights Questionnaires) and BAT (Behavioural Avoidance Tests) too.

When it comes to self-reporting, people with acrophobia often have biases as they will overestimate danger.

The questions will go through the person’s experiences, history and symptoms. Typically, people have to have had the anxiety and fear of heights for six months or more to receive a diagnosis.

Doctors will also rule out other mental health or physical conditions that might be influencing the symptoms.

There are usually four criteria to be diagnosed.

These include:

• An unreasonable, intense fear: The fear of heights is out of proportion and persistent.
• Anticipatory anxiety: The person will dread or dwell on potential future experiences or situations.
• Avoidance: The person will avoid heights at all costs and will likely go to extreme measures to avoid them.
• The acrophobia interferes with daily life: The fear means individuals can’t go about their day as normal.

How is acrophobia treated?

There are many treatments for acrophobia, including psychotherapy like exposure therapy, VR exposure therapy (virtual reality), and CBT (cognitive behavioural therapy).

Sometimes patients will take medication to relieve their symptoms of anxiety and fear to help them cope as they participate in the therapy.

Exposure therapy

This is a common type of psychotherapy that treats the specific phobia. When people have acrophobia, they usually avoid heights at all costs. This means they can’t learn how to manage fears and can’t learn that their feared outcome (i.e., falling) won’t happen.

Exposure therapy is a slow treatment that will carefully expose patients to the situation to allow them to build coping strategies.

VRET – Virtual Reality Exposure Therapy

VR exposure therapy is a recent invention and it uses new technology to expose a person to a realistic scenario in safety. This can teach them how to deal with the anxiety and stress of being at a height.

A VR headset is used to show a simulation of you being at height. It’s a great way to start exposure therapy as it feels real but you know it’s not.

The big advantage of virtual reality exposure therapy is that there are both cost savings and time savings. You don’t need to travel anywhere to find a big bridge or tall building. Once purchased, a VR headset can be used with lots of different patients and lots of different simulations.

CBT – Cognitive Behavioural Therapy

Cognitive behavioural therapy is a form of psychotherapy that involves asking and answering questions to gain a new perspective.

CBT teaches people to cope with the anxiety and stress they feel when exposed to heights. You’re taught how to regain control and stop panic.

Relaxation and mindfulness

Relaxation and mindfulness can help people cope with the anxiety and stress associated with acrophobia. Things like deep breathing, yoga, progressive muscle relaxation and meditation are all known to calm down the body. Normal exercise can help as well.

Medication

Sometimes medication is given to alleviate and improve the symptoms of stress, anxiety and panic associated with acrophobia. There are no acrophobia-specific medicines. Rather, medication is given to relieve associated phobia symptoms like palpitations, racing heart rate, etc.

Some drugs that are prescribed include:

• Beta-blockers (these treat physical symptoms like palpitations or a racing heart rate).
• d-cycloserine (this is a promising treatment for phobias).
• Relaxants like benzodiazepines (these reduce anxiety and induce a sense of calm).

What about hypnotherapy?

As well as typical lines of treatment, many people seek hypnotherapy to help them deal with their fear. For many, they want a ‘quick fix’ and see hypnotherapy as this.

Many hypnotherapists believe they can cure phobias in a few sessions and acrophobia is one of the most commonly treated.

Hypnosis involves a therapist using techniques, words and phrases to help the patient enter an altered state of consciousness. It often involves music, visualisation, self-talk and relaxation. The idea is that a person’s brainwaves are altered, which allows them to use their own resources – ones that aren’t available to them when they are fully conscious.

According to Medical News Today, hypnosis can reduce phobias by lowering blood pressure and easing the person’s mind into a calm and relaxed state. Once under hypnosis, the person can then redirect the mind from the fear.

Final thoughts on acrophobia

Many people who have a phobia won’t seek treatment for the condition. Instead, they will avoid whatever it is they fear. For people with acrophobia, it can sometimes be difficult to avoid heights. However, it depends on how severe the phobia is.

Some people with the condition will avoid going over bridges or walking up a flight of stairs. This fear can lower your quality of life if you avoid situations that include heights. It can also be dangerous if, for example, you were to experience a panic attack up a ladder.

For these reasons, seeking treatment is a good idea. What’s more, people who have the condition and don’t seek help are twice as likely to get depression or GAD (generalised anxiety disorder) unrelated to acrophobia.

Research has shown that many of the treatments on offer for acrophobia are very effective, especially VR exposure therapy.