Fear Of Heights
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Acrophobia is an extreme or irrational
fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...
or
phobia A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...
of heights, especially when one is not particularly high up. It belongs to a category of
specific phobia Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the o ...
s, called space and motion discomfort, that share both similar causes and options for treatment. Most people experience a degree of natural fear when exposed to heights, known as the
fear of falling The fear of falling (FOF), also referred to as basophobia (or basiphobia), is a natural fear and is typical of most humans and mammals, in varying degrees of extremity. It differs from acrophobia (the fear of heights), although the two fears ar ...
. On the other hand, those who have little fear of such exposure are said to have a
head for heights To have a head for heights means that one has no acrophobia, an irrational fear of heights, and is not particularly prone to fear of falling or suffering from vertigo, the spinning sensation that can be triggered, for example, by looking down fro ...
. A head for heights is advantageous for those hiking or climbing in mountainous terrain and also in certain jobs such as
steeplejack A steeplejack is a craftsman who scales buildings, chimneys, and church steeples to carry out repairs or maintenance. Steeplejacks erect ladders on church spires, industrial chimneys, cooling towers, bell towers, clock towers, or any other hi ...
s or wind turbine mechanics. People with acrophobia can experience a
panic attack Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing ...
in high places and become too agitated to get themselves down safely. Approximately 2–5% of the general population has acrophobia, with twice as many women affected as men. The term is from the el, ἄκρον, , meaning "peak, summit, edge" and , , "fear".


Confusion with vertigo

"
Vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...
" is often used 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, by looking straight up at a high place or tall object, or even by watching something (i.e. a car or a bird) go past at high speed, 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 called ''height vertigo'' when the sensation of vertigo is triggered by heights. Height vertigo is caused by a conflict between vision,
vestibular The Vestibular (from pt, vestíbulo, "entrance hall") is a competitive examination and is the primary and widespread entrance system used by Brazilian universities to select the students admitted. The Vestibular usually takes place from Novem ...
and
somatosensory In physiology, the somatosensory system is the network of neural structures in the brain and body that produce the perception of touch (haptic perception), as well as temperature (thermoception), body position (proprioception), and pain. It i ...
senses. This occurs when
vestibular The Vestibular (from pt, vestíbulo, "entrance hall") is a competitive examination and is the primary and widespread entrance system used by Brazilian universities to select the students admitted. The Vestibular usually takes place from Novem ...
and
somatosensory In physiology, the somatosensory system is the network of neural structures in the brain and body that produce the perception of touch (haptic perception), as well as temperature (thermoception), body position (proprioception), and pain. It i ...
systems sense a body movement that is not detected by the eyes. More research indicate that this conflict leads to both
motion sickness Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea, vomiting, cold sweat, headache, dizziness, tiredness, loss of appetite, and increased salivation. Complications may rarely include d ...
and anxiety.


Causes

Traditionally, acrophobia has been attributed, like other phobias, to
conditioning Conditioning may refer to: Science, computing, and technology * Air conditioning, the removal of heat from indoor air for thermal comfort ** Automobile air conditioning, air conditioning in a vehicle ** Ice storage air conditioning, air condition ...
or a traumatic experience. Recent studies have cast doubt on this explanation. Individuals with acrophobia are found to be lacking in traumatic experiences. Nevertheless, this may be due to the failure to recall the experiences, as memory fades as time passes. To address the problems of self report and memory, a large cohort study with 1000 participants was conducted from birth; the results showed that participants with less fear of heights had more injuries because of falling. Psychologists
Richie Poulton Richie Graham Poulton (born October 1962) is a New Zealand psychologist and the director of the University of Otago's Dunedin Multidisciplinary Health & Development Research Unit, which runs the Dunedin Multidisciplinary Health and Development S ...
, Simon Davies, Ross G. Menzies, John D. Langley, and Phil A. Silva sampled subjects from the Dunedin Multidisciplinary Health and Development Study who had been injured in a fall between the ages of 5 and 9, compared them to children who had no similar injury, and found that at age 18, acrophobia was present in only 2 percent of the subjects who had an injurious fall but was present among 7 percent of subjects who had no injurious fall (with the same sample finding that typical basophobia was 7 times less common in subjects at age 18 who had injurious falls as children than subjects that did not). More studies have suggested a possible explanation for acrophobia is that it emerges through accumulation of non-traumatic experiences of falling that are not memorable but can influence behaviours in the future. Also, fear of heights may be acquired when infants learn to crawl. If they fell, they would learn the concepts about surfaces, posture, balance, and movement. Cognitive factors may also contribute to the development of acrophobia. People tend to wrongly interpret visuo-vestibular discrepancies as dizziness and nausea and associate them with a forthcoming fall. A traumatic conditional event of falling may not be necessary at this point. A fear of falling, along with a fear of loud noises, is one of the most commonly suggested inborn or "non-associative" fears. The newer non-association theory is that a fear of heights is an evolved adaptation to a world where falls posed a significant danger. If this fear is inherited, it is possible that people can get rid of it by frequent exposure of heights in habituation. In other words, acrophobia could be attributed to the lack of exposure in early times. The degree of fear varies and the term
phobia A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...
is reserved for those at the extreme end of the spectrum. Researchers have argued that a fear of heights is an instinct found in many mammals, including domestic animals and humans. Experiments using
visual cliff The visual cliff is an apparatus created by psychologists Eleanor J. Gibson and Richard D. Walk at Cornell University to investigate depth perception in human and other animal species. It consists of a sturdy surface that is flat but has the appe ...
s have shown human
infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
s and
toddler A toddler is a child approximately 12 to 36 months old, though definitions vary. The toddler years are a time of great cognitive, emotional and social development. The word is derived from "to toddle", which means to walk unsteadily, like a child ...
s, 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. Although human infants initially experienced fear when crawling on the visual cliff, most of them overcame the fear through practice, exposure and mastery and retained a level of healthy cautiousness. 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 A ladder is a vertical or inclined set of rungs or steps used for climbing or descending. There are two types: rigid ladders that are self-supporting or that may be leaned against a vertical surface such as a wall, and rollable ladders, such a ...
or
chair A chair is a type of seat, typically designed for one person and consisting of one or more legs, a flat or slightly angled seat and a back-rest. They may be made of wood, metal, or synthetic materials, and may be padded or upholstered in vario ...
, or even walking up a flight of
stairs Stairs are a structure designed to bridge a large vertical distance between lower and higher levels by dividing it into smaller vertical distances. This is achieved as a diagonal series of horizontal platforms called steps which enable passage ...
. Still, it is uncertain if acrophobia is related to the failure to reach a certain developmental stage. Besides associative accounts, a diathetic-stress model is also very appealing for considering both vicarious learning and hereditary factors such as personality traits (i.e., neuroticism). Another possible contributing factor is a dysfunction in maintaining balance. In this case the anxiety is both well founded and secondary. The human balance system integrates
proprioceptive Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...
,
vestibular The Vestibular (from pt, vestíbulo, "entrance hall") is a competitive examination and is the primary and widespread entrance system used by Brazilian universities to select the students admitted. The Vestibular usually takes place from Novem ...
and nearby visual cues to reckon position and motion. As height increases, visual cues recede and balance becomes poorer even in normal people. However, most people respond by shifting to more reliance on the
proprioceptive Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...
and
vestibular The Vestibular (from pt, vestíbulo, "entrance hall") is a competitive examination and is the primary and widespread entrance system used by Brazilian universities to select the students admitted. The Vestibular usually takes place from Novem ...
branches of the equilibrium system. Some people are known to be more dependent on visual signals than others. People who rely more on visual cues to control body movements are less physically stable. An acrophobic, however, 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 The visual cortex of the brain is the area of the cerebral cortex that processes visual information. It is located in the occipital lobe. Sensory input originating from the eyes travels through the lateral geniculate nucleus in the thalamus and ...
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. Recent studies found that participants experienced increased anxiety not only during elevation in height, but also when they were required to move sideways in a fixed height. A recombinant model of the development of acrophobia is very possible, in which learning factors, cognitive factors (e.g. interpretations), perceptual factors (e.g. visual dependence), and biological factors (e.g.
heredity Heredity, also called inheritance or biological inheritance, is the passing on of traits from parents to their offspring; either through asexual reproduction or sexual reproduction, the offspring cells or organisms acquire the genetic inform ...
) interact to provoke fear or habituation.


Assessment

ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
and
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
are used to diagnose acrophobia. Acrophobia Questionnaire (AQ) is a self report that contains 40 items, assessing anxiety level on a 0–6 point scale and degree of avoidance on a 0–2 point scale. The Attitude Towards Heights Questionnaires (ATHQ) and Behavioural Avoidance Tests (BAT) are also used. However, acrophobic individuals tend to have biases in self-reporting. They often overestimate the danger and question their abilities of addressing height relevant issues. A Height Interpretation Questionnaire (HIQ) is a self-report to measure these height relevant judgements and interpretations. The Depression Scale of the Depression Anxiety Stress Scales short form (DASS21-DS) is a self report used to examine validity of the HIQ.


Treatment

Traditional treatment of phobias is still in use today. Its underlying theory states that phobic anxiety is conditioned and triggered by a conditional stimulus. By avoiding phobic situations, anxiety is reduced. However, avoidance behaviour is reinforced through
negative reinforcement In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher freq ...
. Wolpe developed a technique called
systematic desensitization Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both c ...
to help participants avoid "avoidance". Research results have suggested that even with a decrease in therapeutic contact, densensitization is still very effective. However, other studies have shown that
therapist Therapist is a person who offers any kinds of therapy. Therapists are trained professionals in the field of any types of services like psychologists, social workers, counsellors, life coachers and others. They are helpful in counselling individuals ...
s play an essential role in acrophobia treatment. Treatments like reinforced practice and
self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura. Self-efficacy affects every area of human endea ...
treatments also emerged. There have been a number of studies into using
virtual reality therapy Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological o ...
for acrophobia. Botella and colleagues and Schneider were the first to use VR in treatment. Specifically, Schneider utilised inverted lenses in binoculars to "alter" the reality. Later in the mid-1990s, VR became computer-based and was widely available for therapists. A cheap VR equipment uses a normal PC with
head-mounted display A head-mounted display (HMD) is a display device, worn on the head or as part of a helmet (see Helmet-mounted display for aviation applications), that has a small display optic in front of one (monocular HMD) or each eye ( binocular HMD). An H ...
(HMD). In contrast,
VRET Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological o ...
uses an advanced computer automatic virtual environment (CAVE). VR has several advantages over ''
in vivo Studies that are ''in vivo'' (Latin for "within the living"; often not italicized in English) are those in which the effects of various biological entities are tested on whole, living organisms or cells, usually animals, including humans, and ...
'' treatment: (1) therapist can control the situation better by manipulating the stimuli, in terms of their quality, intensity, duration and frequency; (2) VR can help participants avoid public embarrassment and protect their confidentiality; (3) therapist's office can be well-maintained; (4) VR encourages more people to seek treatment; (5) VR saves time and money, as participants do not need to leave the consulting room. Many different types of medications are used in the treatment of phobias like fear of heights, including traditional anti-anxiety drugs such as
benzodiazepines Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, i ...
, and newer options such as
antidepressant Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
s and
beta-blocker Beta blockers, also spelled β-blockers, are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack after a first heart attack (secondary prevention). They are al ...
s.


Prognosis

Some desensitization treatments produce short-term improvements in symptoms. Long-term treatment success has been elusive.


Epidemiology

Approximately 2–5% of the general population has acrophobia, with twice as many women affected as men. A related, milder form of visually triggered fear or anxiety is called visual height intolerance (vHI). Up to one-third of people may have some level of visual height intolerance. Pure vHI usually has smaller impact on individuals compared to acrophobia, in terms of intensity of symptoms load, social life, and overall life quality. However, few people with visual height intolerance seek professional help.


Society and culture

In the
Alfred Hitchcock Sir Alfred Joseph Hitchcock (13 August 1899 – 29 April 1980) was an English filmmaker. He is widely regarded as one of the most influential figures in the history of cinema. In a career spanning six decades, he directed over 50 featur ...
film ''
Vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...
'', John "Scottie" Ferguson, played by
James Stewart James Maitland Stewart (May 20, 1908 – July 2, 1997) was an American actor and military pilot. Known for his distinctive drawl and everyman screen persona, Stewart's film career spanned 80 films from 1935 to 1991. With the strong morality h ...
, has to resign from the police force after an incident which causes him to develop both acrophobia and vertigo. The word "vertigo" is only mentioned once, while "acrophobia" is mentioned several times. Early on in the film, Ferguson faints while climbing a stepladder. There are numerous references throughout the film to fear of heights and falling.


See also

*
Acclimatization Acclimatization or acclimatisation ( also called acclimation or acclimatation) is the process in which an individual organism adjusts to a change in its environment (such as a change in altitude, temperature, humidity, photoperiod, or pH), ...
*
Fear of falling The fear of falling (FOF), also referred to as basophobia (or basiphobia), is a natural fear and is typical of most humans and mammals, in varying degrees of extremity. It differs from acrophobia (the fear of heights), although the two fears ar ...
*
Head for heights To have a head for heights means that one has no acrophobia, an irrational fear of heights, and is not particularly prone to fear of falling or suffering from vertigo, the spinning sensation that can be triggered, for example, by looking down fro ...
*
List of phobias The English suffixes -phobia, -phobic, -phobe (from Greek φόβος ''phobos'', "fear") occur in technical usage in psychiatry to construct words that describe irrational, abnormal, unwarranted, persistent, or disabling fear as a mental diso ...


Citations


General and cited sources

*


External links


"The scariest path in the world?"
a direct test, video shot on El Camino del Rey, approaching Makinodromo
"Fear of Heights"
A comprehensive guide with useful resources on Acrophobia known as Fear of Heights. {{Medical resources , DiseasesDB = , ICD10 = {{ICD10, F, 40, 2, f, 40 , ICD9 = {{ICD9, 300.29 , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeshID = , ICD10CM = {{ICD10CM, F40.241 Height Phobias