It is common to feel discomfort in high places. Many people are nervous or dizzy when they look down from an extreme height. However, individuals with acrophobia have an intense or irrational fear of heights that goes beyond these standard feelings. In most cases, the dread is strong enough to affect a person's daily life, and merely thinking about heights may trigger an intense reaction. Though research suggests that acrophobia is one of the most common phobias, much about the condition remains unknown.

Acrophobia Reactions

Most people with acrophobia have an intense fear of heights that may be accompanied by panic attacks or severe anxiety. If this reaction occurs when the individual is high up, he or she may become too upset to get down safely. While some people may only react when physically at high altitudes, others may fear any degree of height, even if they are only looking up at a high point or required to climb stairs, pass a window, or drive on an overpass. The physical effects of acrophobia include sweating, chest pain, nausea, lightheadedness, dizziness, and trembling. The phobia may lead to excessive worrying about encountering heights in the future, which then causes the individual to avoid heights at all costs.

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Physiological Effects

When a person with acrophobia is in a high area or anticipates being there, their sympathetic nervous system becomes overactive and triggers the body's fight-flight-or-freeze response. Normally, this system acts as an adaptive measure to prepare for a dangerous situation. In a person with acrophobia, this response occurs even when there is no immediate danger. This is particularly interesting because there is little a person can do about heights other than leaving for a lower area.

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Causes of Acrophobia

Two main perspectives attempt to explain how acrophobia develops. Many experts divide phobias and fears into two categories: learned and innate. Learned fears occur following trauma or a triggering event. For example, a person with acrophobia may learn to fear heights after falling and injuring themselves. Innate fears are instinctual, genetic, or evolutionary. Proponents of this theory believe a person can be born with a fear of heights despite never having had a traumatic experience.

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Evolved Navigation Theory

Another possible explanation for acrophobia is the evolved navigation theory. According to this concept, certain human processes have become integral due to natural selection. For example, many ancient ancestors may have died from falls due to being unable to properly judge height and vertical distance. Those who survived would then be able to have children, passing on their better perception and preventative fears. Having a healthy fear of heights has protective benefits as it lowers the risk of injury.

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Vertical Perception

Some experts suggest that a fear of heights is universal and that the problem lies in the perception of height. People with acrophobia tend to view even small heights as being more extreme than they are. However, any individual should feel afraid at extreme heights. One study asked participants to estimate the height of a building while standing at its bottom and top. All but one individual overestimated height, though estimations from the bottom were more accurate. Additionally, those who reacted strongly to heights gave significantly less accurate guesses. This suggests that acrophobia may stem from a perception issue.

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Acrophobia vs. Vertigo

Many people mistakenly use the term vertigo to refer to a fear of heights. Vertigo is more accurately a spinning sensation that a person feels while standing still. There are many possible triggers for this, including looking down from a high place or straight up at a tall object. When the triggers are height-associated, experts use the term height vertigo. Vertigo that results from movement or position changes such as standing up, sitting down, or walking is true vertigo.

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Most phobias, including acrophobia, require an examination from a mental health professional to diagnose. The doctor will usually start by asking what kind of reaction occurs when in a high area. They may ask how the individual feels while thinking about heights. It is important to be honest during this process, and those seeking a diagnosis should also mention any other mental health symptoms. Experts may diagnose acrophobia if the person actively avoids heights, spends time worrying about heights, reacts with fear when encountering heights, and has a history of these symptoms. The fear a person with acrophobia feels is extreme enough to interfere with their life and cause anxiety.

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Exposure Therapies

One of the most popular treatment approaches for phobias is exposure therapy. An expert gradually introduces the patient to greater and greater heights. Typically, this begins with looking at images of tall objects and buildings. In some cases, it may involve watching videos from the point of view of a person inside a tall building. Eventually, the goal is to allow the patient to stand on a stepladder or other tall object without feeling afraid. Throughout this process, counselors teach coping techniques to help patients manage their acrophobia. The gradual introduction to greater height allows the nervous system to desensitize slowly and the fear of heights to lessen.

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Virtual Reality Therapy Treatment

Innovations in technology have brought about an exciting new version of exposure therapy. The rise of virtual reality (VR) gaming has also made VR headsets much cheaper and accessible. Because of this, counselors allow their patients to experience much greater heights without ever being in actual danger. A 2018 study suggests that VR is more effective than normal exposure therapy while also causing less discomfort. The study authors note that the availability of VR headsets may mean that people with acrophobia can treat themselves from the comfort of their own home. However, it is always best to consult with a professional in the field before beginning self-treatment.

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If a person has severe acrophobia, doctors may prescribe medications to temporarily relieve panic and anxiety, usually beta-blockers or sedatives. Some research indicates that a combination of medications and therapy is the most effective way to manage a phobia. However, some meta-analyses question this. As it stands, more research is necessary to determine whether or not medications are truly helpful beyond managing symptoms in the short-term.

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