Acrophobia

Acrophobia (from the Greek: ἄκρον, ákron, meaning "peak, summit, edge" and φόβος, phóbos, "fear") is an extreme or irrational fear or phobia 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 causes and options for treatment.

Most people experience a degree of natural fear when exposed to heights, known as the fear of falling. 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 advantageous for those hiking or climbing in mountainous terrain and also in certain jobs e.g. steeplejacks or wind turbine mechanics.

The fear of heights is most commonly know as vertigo due to the Latin name vertig which in English is vertical hence the fear of heights.

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

Causes

Traditionally, acrophobia has been attributed, like other phobias, to conditioning or a traumatic experience. Recent studies have cast doubt on this explanation;^[2] 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. The degree of fear varies and the term phobia 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 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 a 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, 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 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 studies into using virtual reality therapy 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.

Confusion with vertigo

"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 called height vertigo when the sensation of vertigo is triggered by heights.

Prognosis

Some desensitization treatments produce short-term improvements in symptoms.^[9] Long-term treatment success has been elusive.^[9]

Epidemiology

True acrophobia is uncommon.

A related, milder form of visually triggered fear or anxiety is called visual height intolerance.^[10] Up to one-third of people may have some level of visual height intolerance.^[10]

Media treatment

In the Alfred Hitchcock film Vertigo, John "Scottie" Ferguson, played by James Stewart, 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

• Fear of falling
• Acclimatization
• Head for heights
• List of phobias
• Vertigo

References

External links

• "The scariest path in the world?", a direct test, video shot on El Camino del Rey, approaching Makinodromo