Acrophobia

For the online game, see Acrophobia (game). For the amusement park ride, see Acrophobia (ride).

Acrophobia (from the Greek: ἄκρον, ákron , meaning "peak, summit, edge" and φόβος, phóbos, "fear") is an extreme or irrational fear of heights, especially when one is not particularly high up. It belongs to a category of specific phobias, called space and motion discomfort that share both similar etiology and options for treatment.

Most people experience a degree of natural fear when exposed to heights, especially if there is little or no protection.^{[citation needed]} On the other hand, those who have little fear of such exposure are said to have a head for heights. A head for heights is needed by those hiking or climbing in mountainous terrain and also in certain jobs e.g. steeplejacks.

Acrophobia sufferers can experience a panic attack in a high place and become too agitated to get themselves down safely. Between 2 and 5 percent of the general population suffer from acrophobia, with twice as many women affected as men.^[1]

"Vertigo" is often used (incorrectly) to describe a fear of heights, but it is more accurately a spinning sensation that occurs when one is not actually spinning. It can be triggered by looking down from a high place, or by looking straight up at a high place or tall object, but this alone does not describe vertigo. True vertigo can be triggered by almost any type of movement (e.g. standing up, sitting down, walking) or change in visual perspective (e.g. squatting down, walking up or down stairs, looking out of the window of a moving car or train). Vertigo is qualified as height vertigo when referring to dizziness triggered by heights.^{[citation needed]}

Causes

Traditionally, acrophobia has been attributed, like other phobias, to conditioning or a traumatic experience involving heights. Recent studies have cast doubt on this explanation;^[2] fear of falling, along with fear of loud noises, is one of the most commonly suggested inborn or non-associative fears. The newer non-association theory is that fear of heights is an evolved adaptation to a world where falls posed a significant danger. The degree of fear varies and the term phobia is reserved for those at the extreme end of the spectrum. Researchers have argued that fear of heights is an instinct found in many mammals, including domestic animals and humans. Experiments using visual cliffs have shown human infants and toddlers, as well as other animals of various ages, to be reluctant in venturing onto a glass floor with a view of a few meters of apparent fall-space below it.^[3] While an innate cautiousness around heights is helpful for survival, an extreme fear can interfere with the activities of everyday life, such as standing on a ladder or chair, or even walking up a flight of stairs.

A possible contributing factor is dysfunction in maintaining balance. In this case the anxiety is both well founded and secondary. The human balance system integrates proprioceptive, vestibular and nearby visual cues to reckon position and motion.^[4][5] As height increases, visual cues recede and balance becomes poorer even in normal people.^[6] However, most people respond by shifting to more reliance on the proprioceptive and vestibular branches of the equilibrium system.

An acrophobic, on the other hand, continues to over-rely on visual signals whether because of inadequate vestibular function or incorrect strategy. Locomotion at a high elevation requires more than normal visual processing. The visual cortex becomes overloaded resulting in confusion. Some proponents of the alternative view of acrophobia warn that it may be ill-advised to encourage acrophobics to expose themselves to height without first resolving the vestibular issues. Research is underway at several clinics.^[7]

Treatment

There have been a number of promising studies into using virtual reality as a treatment for acrophobia.^[8]

Many different types of medications are used in the treatment of phobias like fear of heights, including traditional anti-anxiety drugs such as benzodiazepines, and newer options like antidepressants and beta-blockers.

Drugs can seem very effective in the short term, but they are not a cure. Anxiety medication can provide temporary relief, but it doesn’t treat the underlying cause of the disorder.