What Is Acrophobia?

Acrophobia is a persistent and intense fear of heights. People with acrophobia will experience panic and sudden anxiety in a variety of situations involving heights. These situations could include standing on a bridge, looking over a cliff, being on the top floor of a skyscraper, riding in an airplane, and more.

It's important to understand, diagnose, and treat acrophobia. When left untreated, acrophobia can cause extreme distress, and significantly impair a person's life through avoidance behaviors.

For instance, someone with acrophobia might refuse to fly in an airplane, go hiking on a mountain, ride in an elevator, or visit a friend who lives in a top-floor apartment.

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Definition

Acrophobia is the fear of heights. This fear is excessive to the situation, persistent, and can cause a person to avoid situations where they might be exposed to heights. Acrophobia is a type of specific phobia, and is categorized as an anxiety disorder in the "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)."

Specific phobias occur when someone experiences excessive and instantaneous fear and anxiety, when exposed to a specific situation, experience, or trigger.

It's estimated that about 12.5% of adults in the United States will experience a specific phobia, like acrophobia, in their lifetime. There are many types of specific phobias, but acrophobia is one of the most common. Research indicates that the lifetime prevalence of acrophobia is about 6.4%, with more women experiencing it than men.

Symptoms

The main, defining symptom of acrophobia is fear of heights. Acrophobia is a fear of heights in general. A person with acrophobia could experience symptoms in a variety of situations, ranging from looking out a skyscraper window to walking along a cliff.

A person with acrophobia will experience a sudden onset of anxiety, and a range of symptoms as set out in the DSM-5. These symptoms include:

• Excessive and overwhelming fear and anxiety
• Shallow breathing or hyperventilation
• Shaking or trembling
• Dry mouth
• Sweating
• Numbness or tingling in the hands, feet, or lips
• Tachycardia or heart palpitations
• Chest pain
• Fear of losing control
• Derealization or depersonalization
• Fear of dying

A person with acrophobia may also experience dizziness, lightheadedness, or vertigo when exposed to heights or just thinking about heights.

Diagnosis

Like other specific phobias, acrophobia can be diagnosed through a conversation with your primary care provider, psychiatrist, or other mental health professional. They may ask questions about situations that trigger your fear, how long this fear persists, and any avoidance behaviors.

There is also a very recent measure called The Granger Causality Convolutional Neural Network (GCCNN) method that attempts to diagnose acrophobia more objectively. Using electroencephalogram (EEG) signals, this classifies acrophobia as moderate or severe.

However, due to the equipment required and limited research, this diagnosis and classification method is likely not accessible to many.

General vs. Specific Fear of Heights

Acrophobia is the general fear of heights.

There are other specific phobias toward more distinct high places or situations. Among others, these include:

• Aerophobia: Fear of flying
• Cremnophobia: Fear of cliffs and precipices
• Bathmophobia: Fear of slopes
• Gephyrophobia: Fear of crossing a bridge

For example, someone who is afraid of flying, but fine with standing on a skyscraper or cliff, might be diagnosed with aerophobia. Someone who is afraid of flying, and also afraid of cliffs, looking out top story windows, driving over bridges, and other situations, could potentially be diagnosed with acrophobia.

It is important to receive the correct diagnosis so your treatment can be the most effective.

Diagnostic Criteria

To receive an acrophobia diagnosis, a person must meet the diagnostic criteria for specific phobia, as set forth in the DSM-5. This criteria includes:

• Excessive and disproportionate fear of a specific situation or trigger: For people with acrophobia, this includes a variety of situations involving heights.
• Sudden and instantaneous anxiety response when exposed to heights
• Avoidance behaviors such as avoiding possible encounters with heights
• Persistence of fear for at least six months
• Life impairment due to avoidance behaviors, dread, anxiety, and fear

A defining aspect of specific phobias is that the fear is irrational, and the anxiety and fear is disproportionate to the situation. Most people with a specific phobia know that their fear is irrational, but they feel unable to control it. However, this insight isn't necessary to be diagnosed with acrophobia, or any other specific phobia.

As of 2013, when the fifth edition of the DSM was published, a person no longer needs to have insight into the irrationality of their fear. Some people with acrophobia may believe their fear is justified and keeps them safe, and feel no motivation to seek treatment.

Causes

Like all anxiety disorders and specific phobias, acrophobia is caused by a complex interplay of factors. Scientists don't know exactly what causes acrophobia in some people and not others. The answer is likely to be a combination of genetic and environmental factors.

Genetics

There is emerging scientific evidence that a variety of specific phobias are linked to corresponding genes. This is supported by demographic studies that show an average 30% heritability rate of specific phobias.

A 2016 study attempted to identify chromosomal regions associated with acrophobia, using a genetic isolate from Finland. The study concluded that the genetics behind acrophobia are incredibly complex.

Although the study did not find one specific gene that causes acrophobia, it did find chromosomes 4q28, 8q24, and 13q21-q22 could be linked to genetic predisposition for acrophobia. More research, however, is needed to determine the extent of the genetics behind acrophobia heritability and predisposition.

Learned Experience

Like other specific phobias, acrophobia could also be caused by a person's environment. Specifically, this could include traumatic experiences involving heights, or learned experiences such as witnessing a parent with a fear of heights.

Having a fall from a height as a child, experiencing violent turbulence on a plane, or witnessing someone else fall from a height could all create an associated panic response when a person is exposed to heights later on in life.

Distance Perception

By the definition of specific phobias in the DSM-5, it is assumed that phobias are an abnormal fear response to a non-dangerous stimulus. Evolved Navigation Theory (ENT) offers a different explanation for the cause of acrophobia.

When it comes to heights and distances, it is important to know that not everyone perceives heights in the same way. Two people, for instance, may look at the same height and one person may perceive it as higher than the other.

ENT, therefore, posits that acrophobia is a rational response to an abnormal stimulus; people who experience acrophobia are more likely to have disproportionate distance perception, and therefore perceive the risk and impact of a fall as much greater.

Vestibular Disorders

Vestibular disorders can also increase the risk of developing acrophobia. Your vestibular system controls your sense of balance through mechanisms in the inner ear. People with vestibular disorders experience postural instability, and are at a greater risk of falling.

These conditions, which impair balance, may predispose people to develop acrophobia.

Treatment

There are a variety of treatments that are effective at treating specific phobias. Some treatment methods, such as vestibular physical therapy and virtual reality, have been specifically studied regarding acrophobia.

Exposure Therapy

Exposure therapy is the most effective and widest studied treatment for specific phobias. In exposure therapy, a person is exposed to their feared stimuli. Traditionally, this exposure was done "in vivo" (in person), which for acrophobia could involve walking out on a cliff edge or a roof.

One method of exposure therapy is called flooding, where a person may be exposed to the highest level of their fear all at once. Exposure therapy can also be done gradually, over multiple sessions.

For someone with acrophobia, an example course of gradual exposure therapy could involve looking out a second-floor window from 10 feet back, then looking out a second-floor window from 2 feet back, then looking out a fifth-floor window from 2 feet back, and then walking on a top floor balcony.

This therapy is done alongside a licensed mental health professional. Through exposing someone to their feared stimuli in a safe environment, the goal of exposure therapy is the extinction of the fear response.

This is achieved through habituation (repeated exposure to heights without negative consequences), and self-efficacy (a person learning that they are capable of being in a situation with heights, and surviving it).

Virtual Reality

In recent decades, exposure therapy has also been studied through virtual reality methods. Virtual reality creates more opportunities for grading exposure before exposing a person to the stimuli in vivo. Someone with acrophobia might begin by looking at photos of heights, and then use a virtual reality headset to simulate high-height scenarios.

Another benefit of virtual reality for exposure therapy is that it reduces the risks if a person was to experience panic in an in vivo situation. It is much safer for a mental health professional to expose a client to virtual reality than to take them to the edge of a cliff, for example.

Vestibular Physical Therapy

Some people may experience acrophobia as a result of a vestibular disorder. These people have increased reliance on visual cues for their balance, because their vestibular system, which helps most people maintain balance, is impaired.

Through vestibular physical therapy, a person rehabilitates their vestibular system and develops compensatory strategies to promote balance. This therapy reduces fall risk, but also may reduce fear of falling, including acrophobia.

A 2009 comparative study assessed balance, including dynamic posturography and manual tracking, of 31 participants with acrophobia compared to 31 participants with no phobia.

The acrophobic group demonstrated significantly poorer balance, and the researchers concluded that this implicates a role for vestibular physical therapy in treating acrophobia.

Seromycin (cycloserine) 

Seromycin (cycloserine) is an antibiotic that is approved by the FDA to treat tuberculosis. Research in both rodents and humans indicates that it could also be effective at treating specific phobias, including acrophobia, when used as an adjunctive treatment to exposure therapy.

Recent research, however, warns that while Seromycin can assist in fear extinction, it can also enhance fear memory, therefore making bad exposure experiences worse.

It is therefore recommended that a person undergo exposure therapy first before a decision is reached regarding Seromycin use. This way, response to exposure therapy can first be assessed, and risks of negative experiences can be mitigated.

Coping

A fear of heights can seriously impact a person's life. Not only is the panic response when exposed to heights distressing, but attempting to avoid heights can be extremely limiting and even create functional disability for some people.

Avoidance behaviors could lead to not flying home to see family for holidays, quitting a job in a high altitude profession like construction or a tall office building, refusing to go to certain restaurants or sights located in skyscrapers, and so much more.

If you find yourself avoiding previously enjoyed experiences, or limiting your life activities, it's probably time to speak to your healthcare provider about diagnosis and treatment options.

You can also cope with acrophobia and exposure experiences through relaxation methods, such as deep breathing, yoga, visualization, and mantras.

Getting regular exercise, reducing caffeine intake, eating a balanced diet, and talking about your feelings with a trusted person can also help you cope with acrophobia, and its impacts on your daily life.

A Word From Verywell

Acrophobia can be extremely distressing, isolating, and life-limiting, but it may help you to know that you are not alone. There is help available if you are living with acrophobia.

Speak to your healthcare provider about diagnosis, lifestyle changes, and effective treatment options such as exposure therapy, virtual reality therapy, medication, vestibular therapy, or other types of psychotherapy. Together, you can come up with the right diagnosis and treatment plan that fits your lifestyle and goals.