Acrophobia is a persistent and intense fear of heights. People with acrophobia will experience panic and sudden anxiety in a variety of situations involving heights. These situations could include standing on a bridge, looking over a cliff, being on the top floor of a skyscraper, riding in an airplane, and more.

It’s important to understand, diagnose, and treat acrophobia. When left untreated, acrophobia can cause extreme distress, and significantly impair a person’s life through avoidance behaviors.

For instance, someone with acrophobia might refuse to fly in an airplane, go hiking on a mountain, ride in an elevator, or visit a friend who lives in a top-floor apartment.

Causes

Phobias typically develop in childhood. There is no single cause of acrophobia, but researchers have developed several theories as to why this fear might develop:

Evolutionary

Evolutionary theories of phobias suggest that people are predisposed to fear certain things that might be dangerous. In this instance, falling from a height threatens survival. For this reason, evolutionary theorists believe that the fear of heights may be innate.

Behaviorist theories

Behaviorist theories relating to phobias suggest that people develop a fear through interactions with their environment. For instance:

Observation: A child who observes their parents or caregivers experiencing fear around heights may develop the same fear.

Trauma: A person who has had or witnessed someone else have a bad experience with heights may develop acrophobia.

Classical Conditioning: If a person has a bad experience, such as falling out of a tree, they may associate this experience with heights. The person then learns to associate heights with falling, leading them to feel scared the next time they face a similar situation.

As a result of this learned association between height and falling, the behaviorist perspective suggests that a person would be afraid during future encounters with heights.

Symptoms of Acrophobia

Some people use the word “vertigo” when describing their fear of heights, but vertigo, or the unpleasant sensation of spinning, is really just one symptom of acrophobia. Other symptoms can include:

• Feeling the need to crawl on all fours, kneel, or descend immediately when you are high off the ground
• Shaking
• Sweating
• Feeling terrified or paralyzed
• Experiencing heart palpitations
• Crying or yelling
• A full-blown panic attack complete with breathlessness
• Headaches and dizziness when you are high off the ground

Diagnosis

Like other specific phobias, acrophobia can be diagnosed through a conversation with your primary care provider, psychiatrist, or other mental health professional. They may ask questions about situations that trigger your fear, how long this fear persists, and any avoidance behaviors.

There is also a very recent measure called The Granger Causality Convolutional Neural Network (GCCNN) method that attempts to diagnose acrophobia more objectively.³ Using electroencephalogram (EEG) signals, this classifies acrophobia as moderate or severe.

However, due to the equipment required and limited research, this diagnosis and classification method is likely not accessible to many.

General vs. Specific Fear of Heights

Acrophobia is the general fear of heights.

There are other specific phobias toward more distinct high places or situations. Among others, these include:

• Aerophobia: Fear of flying
• Cremnophobia: Fear of cliffs and precipices
• Bathmophobia: Fear of slopes
• Gephyrophobia: Fear of crossing a bridge

For example, someone who is afraid of flying, but fine with standing on a skyscraper or cliff, might be diagnosed with aerophobia. Someone who is afraid of flying, and also afraid of cliffs, looking out top story windows, driving over bridges, and other situations, could potentially be diagnosed with acrophobia.

It is important to receive the correct diagnosis so your treatment can be the most effective.

Diagnostic Criteria

To receive an acrophobia diagnosis, a person must meet the diagnostic criteria for specific phobia, as set forth in the DSM-5. This criteria includes:

• Excessive and disproportionate fear of a specific situation or trigger: For people with acrophobia, this includes a variety of situations involving heights.
• Sudden and instantaneous anxiety response when exposed to heights
• Avoidance behaviors such as avoiding possible encounters with heights
• Persistence of fear for at least six months
• Life impairment due to avoidance behaviors, dread, anxiety, and fear

A defining aspect of specific phobias is that the fear is irrational, and the anxiety and fear is disproportionate to the situation. Most people with a specific phobia know that their fear is irrational, but they feel unable to control it. However, this insight isn’t necessary to be diagnosed with acrophobia, or any other specific phobia.

How is it treated?

Phobias don’t always require treatment. For some, avoiding the feared object is relatively easy and doesn’t have a big impact on their daily activities.

But if you find that your fears are holding you back from doing things you want or need to do — such as visiting a friend who lives on the top floor of a building — treatment can help.

Exposure therapy

Exposure therapy is considered to be one of the most effective treatments for specific phobias. In this type of therapy, you’ll work with a therapist to slowly expose yourself to what you’re afraid of.

For acrophobia, you might start by looking at pictures from the point of view of someone inside a tall building. You might watch video clips of people crossing tightropes, climbing, or crossing narrow bridges.

Eventually, you might go out onto a balcony or use a stepladder. By this point, you’ll have learned relaxation techniques to help you conquer your fear in these moments.

Cognitive behavioral therapy (CBT)

CBT may help if you don’t feel ready to try exposure therapy. In CBT, you’ll work with a therapist to challenge and reframe negative thoughts about heights.

This approach may still include a bit of exposure to heights, but this is generally only done within the safe setting of a therapy session.

A Word From Health Queries

Acrophobia can be extremely distressing, isolating, and life-limiting, but it may help you to know that you are not alone. There is help available if you are living with acrophobia.

Speak to your healthcare provider about diagnosis, lifestyle changes, and effective treatment options such as exposure therapy, virtual reality therapy, medication, vestibular therapy, or other types of psychotherapy. Together, you can come up with the right diagnosis and treatment plan that fits your lifestyle and goals.