Visual height intolerance and acrophobia: clinical characteristics and comorbidity patterns

  • Hans-Peter KapfhammerEmail author
  • Doreen Huppert
  • Eva Grill
  • Werner Fitz
  • Thomas Brandt
Original Paper


The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case–control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière’s disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed. The lifetime prevalence of vHI was 28.5 % (women 32.4 %, men 24.5 %). Initial attacks occurred predominantly (36 %) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5 % of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of acrophobia was 6.4 % (women 8.6 %, men 4.1 %), and point prevalence was 2.0 % (women 2.8 %; men 1.1 %). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia. VHI affects nearly a third of the general population; in more than 20 % of these persons, vHI occasionally develops into panic attacks and in 6.4 %, it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.


Visual height intolerance Acrophobia Specific phobia Comorbidity 



H.P. Kapfhammer and W. Fitz had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All other authors contributed to literature search, study design, and discussion of the results. They also had full access to all the data in the study. The study was supported by the German Ministry of Education and Research (German center for vertigo and balance disorders, IFBLMU), and the Hertie Foundation. The authors thank Judy Benson for copyediting the manuscript.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Hans-Peter Kapfhammer
    • 1
    Email author
  • Doreen Huppert
    • 2
  • Eva Grill
    • 3
  • Werner Fitz
    • 1
  • Thomas Brandt
    • 2
  1. 1.Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
  2. 2.Institute for Clinical Neurosciences and German Center for Vertigo and Balance DisordersLudwig-Maximilians UniversityMunichGermany
  3. 3.Institute for Medical Information Processing, Biometrics and Epidemiology (IBE) and German Center for Vertigo and Balance DisordersLudwig-Maximilians UniversityMunichGermany

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