Most people are a little afraid of heights, but for some this fear can become debilitating, which may indicate that they are struggling with acrophobia. Because people with acrophobia experience intense anxiety or panic attacks when they are exposed to high places, they tend to avoid them. Like all phobias, acrophobia is treatable with therapy or a combination of medication and therapy.
What Is Acrophobia?
Acrophobia is a specific phobia, or a type of anxiety disorder where the fear is centered around a specific feared object or situation. For people with acrophobia, their anxiety shows up in response to heights. People with this condition tend to experience severe anxiety and panic attacks when exposed to high places, and they tend to avoid them out of fear.1,2,3
According to Jennifer Hames, Assistant Clinical Professor and Director of Clinical Services for the Notre Dame Psychological Services Center, “Fear of heights is a common and debilitating anxiety-related concern. While nearly one in five individuals experience a significant fear of heights, approximately one in twenty individuals meet clinical criteria for acrophobia.4 Being fearful of heights is adaptive and helpful in that it prevents us from falling from high places and engaging in reckless behaviors. However, in some people, fear of heights can lead them to avoid objectively safe places and significantly interfere with their quality of life. This is when we want to intervene and treat it with exposure therapy.”
Someone who has a fear of heights but is rarely exposed to high places may not be diagnosed or treated unless their circumstances change and they are exposed to heights on a more regular basis. Acrophobia only develops when a general anxiety about heights causes regular discomfort or distress, or when it begins to interfere with the person’s ability to function and follow their routine.1,3 Many acrophobic people will experience other fears, phobias, and symptoms that coincide with their fear of heights.
Symptoms that often coincide with acrophobia are:1,3
- Visual height intolerance (VHI): Being unable to tolerate looking at high places or down from high places, both of which tend to trigger anxiety
- Vertigo: Extreme dizziness, sometimes caused by looking down from high places and feeling anxious
- Bathmophobia: A fear of stairs or steep slopes
- Climacophobia: An intense fear and intolerance of climbing
- Aerophobia: The specific fear of flying or air travel
Normal Fear of Heights vs. Acrophobia
Experts say that nearly one in five individuals experience a significant fear of heights, making this a highly common fear. However, roughly one in twenty individuals meet clinical criteria for acrophobia, which highlights the fact that there is a difference between a fear and phobia.
While being afraid of heights is adaptive and serves a purpose (it prevents us from falling from high places and engaging in reckless behaviors), there are people who have an irrational, excessive fear of heights. They experience so much anxiety about heights that it begins to interfere with their quality of life and ability to function. This is a phobia vs. a normal fear, and it typically requires treatment.
Signs & Symptoms of Acrophobia
All phobias describe specific fears that cause intense symptoms of anxiety and lead to avoidant behaviors. The same criteria are used to diagnose all specific phobias, and are drawn from the DSM-5, a reference guide clinicians use to diagnose all mental health conditions.3
According to the DSM-5, signs and symptoms of acrophobia include:3
- Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (in this case, heights or high places)
- Heights or high places almost always provoke immediate fear or anxiety
- The fear or anxiety is out of proportion to the actual danger posed by heights or high places and to the sociocultural context
- Heights or high places are actively avoided or endured with intense fear or anxiety
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The fear, anxiety, or avoidance is persistent, typically lasting six months or more
- The disturbance is not better explained by the symptoms of another mental disorder like generalized anxiety disorder, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD)
- Feeling panicked when being high off the ground
- Sweating, shortness of breath, dizziness, or racing heart when in high places
- Feeling nauseous or having an upset stomach when exposed to heights
- Feeling nervous, worried, or tense before being in high places
- Changing one’s schedule or routine to avoid heights or high places
- Panicking or having an anxiety attack when in high places
Impacts of a Fear of Heights
Most people who are diagnosed and treated for acrophobia report significant impacts and impairments as a result of their fear of heights. Often, this is because their lifestyle, job, or living environment causes them to have regular exposure to heights. Phobias often result in avoidant behaviors, which are often closely related to the negative impacts people with these conditions report experiencing.
Hames states, “Those with fear of heights or acrophobia may avoid stairs, balconies, ladders, bridges, and ascending tall buildings. Given the range of feared and avoided situations in everyday life, it is not surprising that acrophobia can lead to high levels of social and functional impairment. Someone with a significant fear of heights may avoid taking a job in a tall building, driving or walking certain routes that involve bridges or overlooks, or changing a lightbulb that requires climbing a ladder. Over time, this avoidance can prevent them from doing the things they would like to do in life.”
What Causes Fear of Heights?
Phobias develop in response to specific experiences, especially negative or traumatic experiences. For example, falling down and breaking a bone while skiing could result in acrophobia. These kinds of scary and negative experiences can cause people to form a negative association with heights, prompting an intense fear response when they encounter them again.5,6,7
Some people also develop phobias as part of a learned childhood response. For example, growing up in a home with people who were afraid of heights may cause a child to develop this fear themselves.7 Genetics can also play a role in determining a person’s risk for anxiety disorders, meaning that people with a family history of anxiety or phobias may be more likely to develop this condition.5
On some level, being afraid of heights is normal; it’s part of our normal survival instincts that lead us to fear situations that could result in harm, injury or death.8 Still, this fear can become excessive, leading to irrational feelings, thoughts, and behaviors. Unfortunately, the more a person avoids their fear, the worse their phobia may become, which is why phobias often get worse when left untreated.
Treatment of Acrophobia
Like all anxiety disorders, acrophobia is a highly treatable condition.8,9,10 Many people are able to reduce or even resolve their symptoms with therapy alone, but some prefer to receive a combination of therapy and medication. Phobias are easy to treat when they are caught early, and even severe phobias respond well to treatment. Below are some of the most commonly used and effective forms of treatment for acrophobia.10
Therapy
Hames recommends, “By far, the most effective therapy for all fears and phobias, including fear of heights, is cognitive-behavioral therapy (CBT) with exposure (also called exposure therapy). In this therapy, someone works closely with a therapist to gradually learn to approach rather than avoid the types of height-related situations that cause them distress. The goal of this therapy is to help the client learn that the outcomes they fear are unlikely to happen in the situations they have been avoiding and to learn that they can tolerate the level of distress they experience when in height-related situations.”
At first, a person may be asked to visualize or think of a high place, and as they are able to tolerate this thought, may be prompted to look at a photo or video shot from a high place. Recently, there has been an increased use of virtual reality technology in exposure therapy, which can provide an imaginal experience that has more realistic qualities.8,10
Medication
Some people who are struggling with acrophobia may want to receive medication to help with their symptoms of anxiety. While medication can help alleviate symptoms of anxiety, it is not considered an effective standalone treatment for phobias, and is only recommended in conjunction with therapy or other formal treatment.
10 Steps to Overcome a Fear of Heights
People who are struggling with a fear of heights often benefit from finding a therapist and starting treatment. In addition to getting therapy, there are ways for people to work on overcoming their fear of heights on their own.
Here are ten steps to work on overcoming your fear of heights:11
- Challenge irrational fears and beliefs by finding actual statistics and facts about how likely it is that you would fall, your plane would crash, etc.
- Positive visualization techniques can help counteract the worst-case scenario thinking patterns that feed into anxiety. They involve using your imagination to visualize detailed situations, places, or experiences that are positive and enjoyable
- Don’t go out of your way to avoid heights as this can actually worsen your phobia and make you more anxious the next time you are in a high place
- Don’t rely solely on alcohol, drugs, or even a prescribed anti-anxiety medication to cope with your fear. Doing so can foster an unhealthy dependence and make you less confident in your ability to face your fear without the substance
- Use mindfulness skills to bring your attention to something in the present moment that helps you feel safe, stable, and grounded, like focusing on your feet on the ground, your hand on the rail, etc.
- Distract yourself if you’re on long plane trips by bringing books, music, and devices to keep your mind active and engaged
- Talk openly about your feelings and fears with someone who is with you, and rely on them for some support and encouragement instead of bottling or trying to hide your fears
- Build up your courage by starting out with small, easy situations where you are exposed to heights and building up to more difficult exposures
- Manage your stress levels by practicing good self-care, getting adequate nutrition and rest, and working to keep yourself healthy and balanced
- Find ways to enjoy high places by taking pictures, trying skiing or snowboarding, or doing another fun activity that involves heights
Final Thoughts on Acrophobia
While it’s normal to be a little scared of heights, excessive fear that causes regular distress and avoidance may be a sign of acrophobia. Fortunately, all anxiety disorders, including acrophobia, can be treated. People who receive treatment are often able to manage and control their symptoms.10 If you or a loved one is struggling with acrophobia, find a therapist here.
Additional Resources
- Anxiety & Depression Association of America has a free screening tool for specific phobias
- Overcoming Fear of Heights: How to Conquer Acrophobia and Live and Life Without Limits by Martin Anthony, PhD, and Karen Rowa, PhD
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
