Skip to main content


Log in

Down on heights? One in three has visual height intolerance

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Agras S, Sylvester D, Oliveau D (1969) The epidemiology of common fears and phobia. Compr Psychiatry 10:151–156

    Article  PubMed  CAS  Google Scholar 

  2. American Psychiatric Association, Committee on Nomenclature and Statistics (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Press, Washington, DC

    Google Scholar 

  3. Balaban CD, Jacob RG (2001) Background and history of the interface between anxiety and vertigo. J Anxiety Disord 15:27–51

    Article  PubMed  CAS  Google Scholar 

  4. Bauer M, Huppert D, Brandt T (2012) Fear of heights in ancient China. J Neurol 259:2223–2225

    Google Scholar 

  5. Becker ES, Rinck M, Türke V et al (2007) Epidemiology of specific phobia subtypes: findings from the Dresden Mental Health Study. Eur Psychiatry 22:69–74

    Article  PubMed  Google Scholar 

  6. Bles W, Kapteyn TS, Brandt T, Arnold F (1980) The mechanism of physiological height vertigo. II. Posturography. Acta Otolaryngol 89:534–540

    Article  PubMed  CAS  Google Scholar 

  7. Brandt T, Arnold F, Bles W, Kapteyn TS (1980) The mechanism of physiological height vertigo. I. Theoretical approach and psychophysics. Acta Otolaryngol 89:513–523

    Article  PubMed  CAS  Google Scholar 

  8. Brandt T, Benson J, Huppert D (2012) What to call “non-phobic” fear of heights? Br J Psychiatry 190:81. doi:10.1192/bjp.190.1.81a

    Google Scholar 

  9. Brandt T, Strupp M, Huppert D (2012) Height intolerance: an underrated threat. J Neurol 259:759–760

    Article  PubMed  Google Scholar 

  10. Coelho CM, Wallis G (2010) Deconstructing acrophobia: physiological and psychological precursors to developing a fear of heights. Depress Anxiety 27:864–870

    Article  PubMed  Google Scholar 

  11. Curtis GC, Magee WJ, Eaton WW, Wittchen HU (1998) Specific fears and phobias. Epidemiology and classification. Br J Psychiatry 173:212–217

    Article  PubMed  CAS  Google Scholar 

  12. Darwin E (1803) Zoonomia or, the laws of organic life, Volume I. Reprint of initial issue (2009), Scholars Publishing, Cambridge

  13. 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 41:853–861

    Article  PubMed  Google Scholar 

  14. 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 43:200–208

    Article  PubMed  Google Scholar 

  15. Furman JM, Balaban CD, Jacob RG, Marcus DA (2005) Migraine-anxiety related dizziness (MARD): a new disorder? J Neurol Neurosurg Psychiatry 76:1–8

    Article  PubMed  CAS  Google Scholar 

  16. 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 27:148–167

    Article  PubMed  Google Scholar 

  17. 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 67:685–693

    Article  PubMed  CAS  Google Scholar 

  18. Öst LG (2009) Spezifische Phobien. In: Margraf J (ed) Lehrbuch der Verhaltenstherapie, vol 2. Springer, Berlin Heidelberg New York, pp 29–42

    Google Scholar 

  19. 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 117:135–143

    Article  PubMed  Google Scholar 

  20. Rennert H (1990) Höhenschwindel, Höhenangst und Höhenphobie. Psychiatr Neurol Med Psychol (Leipzig) 42:333–339

    CAS  Google Scholar 

  21. Salassa JR, Zapala DA (2009) Love and fear of heights: the pathophysiology and psychology of height imbalance. Wilderness Environ Med 20:378–382

    Article  PubMed  Google Scholar 

  22. Stefanucci JK, Proffitt DR (2009) The roles of altitude and fear in the perception of height. J Exper Psychol Hum Percept Perform 35:424–438

    Article  Google Scholar 

  23. 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 21:45–56

    Article  PubMed  CAS  Google Scholar 

  24. 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 37:1047–1059

    Article  PubMed  Google Scholar 

  25. Teachman BA, Stefanucci JK, Clerkin EM, Cody MW, Proffitt DR (2008) A new mode of fear expression: perceptual bias in height fear. Emotion 8:296–301

    Article  PubMed  Google Scholar 

  26. von Brevern M, Neuhauser H (2011) Epidemiological evidence for a link between vertigo and migraine. J Vest Res 21:299–304

    Google Scholar 

  27. Walk RD, Gibson EJ, Tighe TJ (1957) Behaviour of light-and-dark-reared rats on a visual cliff. Science 126:80–81

    Article  PubMed  CAS  Google Scholar 

  28. Walk RD, Gibson EG (1961) A comparative and analytical study of visual depth perception. Psychol Monogr 75 (15, whole no. 519)

  29. Williams SL, Dooseman G, Kleifeld E (1984) Comparative effectiveness of guided mastery and exposure treatments for intractable phobias. J Consult Clin Psychol 52:505–518

    Article  PubMed  CAS  Google Scholar 

  30. World Health Organisation (1993) The ICD-10 Classification of Mental and Behavioral Disorders, Clinical Description and Diagnostic Guidelines. WHO, Geneva

    Google Scholar 

Download references


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


Ethical standard

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.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Thomas Brandt.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 72 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huppert, D., Grill, E. & Brandt, T. Down on heights? One in three has visual height intolerance. J Neurol 260, 597–604 (2013).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: