The distressing phenomenon of visual height intolerance (vHI) occurs when a visual stimulus causes apprehension of losing control of balance and falling from some height. Epidemiological data of this condition in the general population are lacking. Assignment of prevalence, determinants, and compensation of vHI was performed in a cross-sectional epidemiological study of 3,517 individuals representing the German population. Life-time prevalence of vHI is 28 % (females 32 %). A higher prevalence is associated independently with a family history of vHI, anxiety disorders, migraine, or motion sickness susceptibility. Women aged 50–59 have a higher prevalence than younger women or men of all ages. Initial attacks occur most often (30 %) in the second decade; however, attacks can manifest throughout life. The main symptoms are fearfulness, inner agitation, a queasy-stomach feeling, subjective postural instability with to-and-fro vertigo, and weakness in the knees. Climbing a tower is the first most common precipitating stimulus; the spectrum of such stimuli widens with time in more than 50 % of afflicted individuals. The most frequent reaction to vHI is to avoid the triggering stimuli (>50 %); 11 % of susceptible individuals consult a doctor, most often a general practitioner, neurologist, ENT doctor, or psychiatrist. In brief, visual height intolerance affects one-third of the general population, considerably restricting the majority of these individuals in their daily activities. The data show that the two terms do not indicate a categorical distinction but rather a continuum from slight forms of visual height intolerance to the specific phobia of fear of heights.
Visual height intolerance Fear of heights Acrophobia Height vertigo Epidemiology
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The authors thank Judy Benson for copyediting the manuscript. The study was supported by the German Ministry of Education and Research, the IFBLMU, and the Hertie Foundation.
Conflicts of interest
All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
American Psychiatric Association, Committee on Nomenclature and Statistics (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Press, Washington, DCGoogle Scholar
Balaban CD, Jacob RG (2001) Background and history of the interface between anxiety and vertigo. J Anxiety Disord 15:27–51PubMedCrossRefGoogle Scholar
Bauer M, Huppert D, Brandt T (2012) Fear of heights in ancient China. J Neurol 259:2223–2225 Google Scholar
Becker ES, Rinck M, Türke V et al (2007) Epidemiology of specific phobia subtypes: findings from the Dresden Mental Health Study. Eur Psychiatry 22:69–74PubMedCrossRefGoogle Scholar
Bles W, Kapteyn TS, Brandt T, Arnold F (1980) The mechanism of physiological height vertigo. II. Posturography. Acta Otolaryngol 89:534–540PubMedCrossRefGoogle Scholar
Brandt T, Arnold F, Bles W, Kapteyn TS (1980) The mechanism of physiological height vertigo. I. Theoretical approach and psychophysics. Acta Otolaryngol 89:513–523PubMedCrossRefGoogle Scholar
Coelho CM, Wallis G (2010) Deconstructing acrophobia: physiological and psychological precursors to developing a fear of heights. Depress Anxiety 27:864–870PubMedCrossRefGoogle Scholar
Curtis GC, Magee WJ, Eaton WW, Wittchen HU (1998) Specific fears and phobias. Epidemiology and classification. Br J Psychiatry 173:212–217PubMedCrossRefGoogle Scholar
Darwin E (1803) Zoonomia or, the laws of organic life, Volume I. Reprint of initial issue (2009), Scholars Publishing, CambridgeGoogle Scholar
De Girolamo G, Polidori G, Morosini P et al (2006) Prevalence of common mental disorders in Italy. Results from the European Study of the Epidemiology of Mental Disorders (ESENeD). Soc Psychiatry Psychiatr Epidemiol 41:853–861PubMedCrossRefGoogle Scholar
Depla MF, ten Have ML, van Balkom AJ, de Graaf R (2008) Specific fears and phobias in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 43:200–208PubMedCrossRefGoogle Scholar
Furman JM, Balaban CD, Jacob RG, Marcus DA (2005) Migraine-anxiety related dizziness (MARD): a new disorder? J Neurol Neurosurg Psychiatry 76:1–8PubMedCrossRefGoogle Scholar
LeBeau RT, Glenn D, Liao B et al (2010) Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSM-V. Depress Anxiety 27:148–167PubMedCrossRefGoogle Scholar
Neuhauser H, Ellert U, Ziese T (2005) Chronic back pain in the general population in Germany 2002/2003: prevalence and highly affected population groups. Gesundheitswesen 67:685–693PubMedCrossRefGoogle Scholar
Öst LG (2009) Spezifische Phobien. In: Margraf J (ed) Lehrbuch der Verhaltenstherapie, vol 2. Springer, Berlin Heidelberg New York, pp 29–42Google Scholar
Oosterink F, de Jongh A, Hoogstraten J (2009) Prevalence of dental fear and phobia relative to other fear and phobia types. Eur J Oral Sci 117:135–143PubMedCrossRefGoogle Scholar
Rennert H (1990) Höhenschwindel, Höhenangst und Höhenphobie. Psychiatr Neurol Med Psychol (Leipzig) 42:333–339Google Scholar
Salassa JR, Zapala DA (2009) Love and fear of heights: the pathophysiology and psychology of height imbalance. Wilderness Environ Med 20:378–382PubMedCrossRefGoogle Scholar
Stefanucci JK, Proffitt DR (2009) The roles of altitude and fear in the perception of height. J Exper Psychol Hum Percept Perform 35:424–438CrossRefGoogle Scholar
Steyerberg EW, Eijkemans MJ, Harrell FE Jr et al (2001) Prognostic modeling with logistic regression analysis: in search of a sensible strategy in small data sets. Med Decis Making 21:45–56PubMedCrossRefGoogle Scholar
Stinson F, Dawson D, Chou S et al (2007) The epidemiology of DSM-IV specific phobia in the USA: result from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 37:1047–1059PubMedCrossRefGoogle Scholar
Teachman BA, Stefanucci JK, Clerkin EM, Cody MW, Proffitt DR (2008) A new mode of fear expression: perceptual bias in height fear. Emotion 8:296–301PubMedCrossRefGoogle Scholar
von Brevern M, Neuhauser H (2011) Epidemiological evidence for a link between vertigo and migraine. J Vest Res 21:299–304Google Scholar
Walk RD, Gibson EJ, Tighe TJ (1957) Behaviour of light-and-dark-reared rats on a visual cliff. Science 126:80–81PubMedCrossRefGoogle Scholar
Walk RD, Gibson EG (1961) A comparative and analytical study of visual depth perception. Psychol Monogr 75 (15, whole no. 519)Google Scholar
Williams SL, Dooseman G, Kleifeld E (1984) Comparative effectiveness of guided mastery and exposure treatments for intractable phobias. J Consult Clin Psychol 52:505–518PubMedCrossRefGoogle Scholar
World Health Organisation (1993) The ICD-10 Classification of Mental and Behavioral Disorders, Clinical Description and Diagnostic Guidelines. WHO, GenevaGoogle Scholar