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By Sasha de Beausset Aparicio, MSc

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What is Acrophobia?

Acrophobia is a psychological disease that manifests itself through an irrational and extreme fear of heights. The name comes from the Greek “Akron,” which means edge or summit, and “phobia” which means fear. The condition is part of a larger category of disorders called phobias, particularly space and motion discomfort or SMD. The disease falls into the Anxiety Disorders category and is described as a specific phobia.

The disease is usually associated with a panic attack or panic disorder associated episode, which makes those who suffer from this condition become overwhelmed and debilitated. The condition is recognized by the medicinal world as highly serious, and treatment options are widely available today. It is estimated that 5% of the United States population suffers from acrophobia, with approximately twice as much more women than men experiencing symptoms of this disease.

The exact definition of the disorder as The Diagnostic and Statistic Manual of Mental Disorders mentions it is “the fear of clearly circumscribed situations or objects.” The patient will manifest symptoms when exposed to the phobic object, and reactions will be extreme. The patient is conscious of the irrationality of the phobia and generally avoids the phobic situation.
To some level, the fear of heights is natural, because of the body’s self-preservation and survival instincts. Diagnosis hence takes into account whether the fear interferes with the patient’s day to day functioning and whether the phobia causes a significant amount of distress for the patient.


Currently, there are two theories that attempt to explain the causality of this disorder. First, the associative or conditioned theory states that the phobia is linked to some traumatic event in the patient’s past that has to do with heights. Similarly, it can be an event you see on TV or are exposed to a traumatic experience that happens to another persona that you later relate to. These events may happen consciously or unconsciously.

The second, more recent, theory claims that the disease is a non-associative fear, and explains the fear as a modern-day adaptation of the ancient falling fear, which posed a serious danger to our ancestors. The extent to which this natural fear is felt varies from person to person, and the condition is only present in those at the extreme end of the spectrum, beyond which the instinctual fear becomes a phobia. It is this phobia that interferes with normal everyday activities and cause discomfort when performing even the smallest height-involving activities such as climbing the stairs or standing on a chair.

The disease may also be triggered and intensified by a balance dysfunction caused by vestibular impairment, an important element of the balance system. Height increases need much more concentration from visual, vestibular, and proprioceptive sensors in order to maintain vertical position and balance. As visual sensors fail to work properly, the human body shifts to an increased reliance in the other two branches of the equilibrium system. Several research studies have concluded that people suffering from acrophobia may in fact rely more on visual signals because of vestibular improper functioning, hence resulting in some sort of overload and the well-known confusion and panic that accompany an acrophobic episode.

These understandings of the condition further determine potential treatment schemes that may alleviate symptoms of the condition. Further research regarding causality is on the way, as numerous research centers are concerned with finding a cure for this disease.

Signs & Symptoms

Acrophobia symptoms may manifest differently from patient to patient, as long as a common general framework of symptoms can be identified, which includes: uncontrollable anxiety when thinking about heights, inability to function normally when in proximity of heights or when the prospect of being exposed to heights occurs, uncontrollable feelings of height avoidance, and the awareness that your feelings are exaggerated, accompanied by an impossibility to control these thoughts and feelings.

A large spectrum of physical, mental, and emotional symptoms summarizes and helps fully diagnose and understand this condition. The mental symptoms include obsessive thoughts when exposed to even the mere perception of height, the feeling of not being able to control oneself, fear of fainting as a consequence of extreme panicking symptoms, feelings of unreality, fear of going crazy, and inability to stay in touch with the reality of the situation and others.

Emotional symptoms include elevating feelings of terror and anxiety, set off by anticipation or actual exposure to heights (phobia object). A desire to flee will most often accompany this emotional distress, whereas an intense feeling to run from the situation is present, to the point of obsession and irrational solution findings. Less common, symptoms of anger, sadness, hurt, and guilt are experienced by some patients when thinking back on an acrophobic episode.

In addition to the mental and emotional symptoms, physical manifestations may also be present.

These include palpitations and a pounding heart, accelerated heart rhythm, dizziness, shaking, shortness of air, sweating excessively, feelings of choking, nausea, faint-like symptoms, stomach distress, hot flashes, cold flashes, numbness, unsteady feet, tingling sensation, and others.

Diagnosing Acrophobia

Diagnosing the disease is usually a process that has to determine whether the fear interferes with the day to day activities of the patient, preventing him to lead a normal life. The therapist/specialist should be able to identify phobia episodes and diagnose in order to begin treatment. Diagnosing phobias is not easy, particularly because patients may feel shame in admitting to their disease.

Treatment for Acrophobia

Treatment usually implies a series of component that approach the disease from various angles. Psychoeducation is a first stage of the treatment, and implies a clear explanation to the patent of all aspects of the disease, including anxiety, fear, and panic attacks. The fear is addressed from a conceptual point of view, so that the patient becomes aware of the condition’s particularities and further relates to these notions and concepts in a more rational way.

Breathing retraining is another component of the therapeutic process. Anxiety is, in general, associated with disruptive breathing patterns, commonly known as hyperventilation. Shortness of breath further accentuates physical and emotional reactions creating a further amplification of the symptoms. Patients are thought to consciously control their breathing through slow breathing techniques.

Cognitive therapy is another stage of the process, where patients are instructed to think about their condition in a different way. Interpreting the situation when exposed to the phobia object determines how the patient thinks and reacts to the situation itself. Various cognitive techniques help the patients evaluate if his or her feelings are right or wrong, rational or irrational and further determines alternative ways of addressing the issues that arise.

Exposing the patient to Virtual Reality experiences is one final component of the therapy and should follow the three previously described stages. The patient is put in the situation of fear itself and monitored until the fear progressively diminishes to a controllable state. Through the means of a computer, reality is recreated in a safer way, both for the patient and for the therapist, and repeated until a positive response is obtained. The VR scenarios can be replicated and tailored to the needs of each patient.