Overview

Acrophobia causes people to feel extremely fearful and anxious about situations that involve being far off the ground such as in elevated parking garages or on bridges, or when thinking about being high off the ground. Some persons with acrophobia experience a panic attack in triggering situations, and many affected individuals actively avoid such situations altogether.Acrophobia can usually be treated with psychological treatment (psychotherapy) such as exposure therapy, virtual reality exposure therapy and/or cognitive behavioral therapy. Sometimes people need medications that temporarily relieve symptoms of fear and anxiety to cope with fear while they are participating in therapy.

Possible causes

The cause of acrophobia is unclear. The condition may have an underlying genetic component. acrophobia may run in families; when a family member has acrophobia or an anxiety disorder, others in the family may experience similar fear and anxiety. Another possible cause of acrophobia is examined in navigation theory, which suggests that a person may perceive something as being higher than it actually is, triggering panic about a harmful fall; this misperception of height is thought to be a result of adaptation through natural selection. 

Symptoms

Symptoms of acrophobia are often physical and psychological in nature. Physical symptoms may include sweating, shaking or trembling, dizziness, light-headedness, tightness or pain in the chest, increased heart rate, or a feeling of sickness. Psychological symptoms may include feelings of panic and extreme fear and a desire to flee the situation.

Behavioral signs: Active avoidance of high places (such as balconies, glass elevators, bridges, or upper floors), freezing in place, or feeling an intense urge to get down immediately.

Cognitive distress: Anticipatory anxiety about encountering heights or a fear of losing impulse control (such as worrying one might jump, despite having no desire to do so).

Diagnosis

Acrophobia typically is diagnosed by a mental health professional, such as a psychiatrist. The provider asks about the individual’s personal history and symptoms 

In general, phobias have at least four criteria for diagnosis, including:

• Intense and unreasonable fear: The fear of the object or situation is persistent and out of proportion to an appropriate level of fear.
• Anticipatory anxiety: An individual who has a phobia tends to dwell on or dread future situations or experiences that will involve the object or situation they are afraid of.
• Avoidance: Many people who have a phobia will actively avoid the feared object or situation. Some go to extreme lengths to avoid the thing they are afraid of.
• The phobia interferes with day-to-day activities: The fear the individual experiences has to limit their everyday life in some way in order for it to be diagnosed as a phobia.

Treatment Options

Acrophobia can usually be treated with psychological treatment (psychotherapy) such as exposure therapy, virtual reality exposure therapy and/or cognitive behavioral therapy. Sometimes people need medications that temporarily relieve symptoms of fear and anxiety to cope with fear while they are participating in therapy.

Exposure Therapy: Gradually and repeatedly confronting feared heights in a safe, controlled way helps the brain habituate and lower anxiety.

Virtual Reality Exposure Therapy (VRET): Using immersive virtual reality headsets to simulate heights is proven to be a highly effective and safe way to practice coping tools

Cognitive Behavioral Therapy (CBT): Helps reframe catastrophic thoughts and build emotional control

Medication: Short-term anti-anxiety medications or beta-blockers may be prescribed to manage acute physical symptoms during therapy

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