Acrophobia

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Acrophobia
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Some jobs require working at heights
Specialty Psychiatry

Acrophobia is an extreme or irrational fear or phobia of heights, especially when one is not particularly high up. It belongs to a category of specific phobias, called space and motion discomfort, that share both similar causes and options for treatment.

Fear Basic emotion induced by a perceived threat

Fear is a feeling induced by perceived danger or threat that occurs in certain types of organisms, which causes a change in metabolic and organ functions and ultimately a change in behavior, such as fleeing, hiding, or freezing from perceived traumatic events. Fear in human beings may occur in response to a certain stimulus occurring in the present, or in anticipation or expectation of a future threat perceived as a risk to body or life. The fear response arises from the perception of danger leading to confrontation with or escape from/avoiding the threat, which in extreme cases of fear can be a freeze response or paralysis.

Phobia An anxiety disorder defined by a persistent and excessive fear of an object or situation

A phobia is a type of anxiety disorder, defined by a persistent and excessive fear of an object or situation. The phobia typically results in a rapid onset of fear and is present for more than six months. The affected person goes to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the feared object or situation cannot be avoided, the affected person experiences significant distress. With blood or injury phobia, fainting may occur. Agoraphobia is often associated with panic attacks. Usually a person has phobias to a number of objects or situations.

A specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations. As a result, the affected person tends to avoid contact with the objects or situations and, in severe cases, any mention or depiction of them. The fear can, in fact, be disabling to their daily lives.

Contents

Most people experience a degree of natural fear when exposed to heights, known as the fear of falling. On the other hand, those who have little fear of such exposure are said to have a head for heights. A head for heights is advantageous for those hiking or climbing in mountainous terrain and also in certain jobs such as steeplejacks or wind turbine mechanics. Some people may also be afraid of the high wind, as an addition of falling. This is actually known as added ancraophobia.

Fear of falling A natural fear typical of most mammals

The fear of falling (FOF), also referred to as basophobia, is a natural fear and is typical of most humans and mammals, in varying degrees of extremity. It differs from acrophobia, although the two fears are closely related. The fear of falling encompasses the anxieties accompanying the sensation and the possibly dangerous effects of falling, as opposed to the heights themselves. Those who have little fear of falling may be said to have a head for heights. Basophobia is sometimes associated with astasia-abasia, the fear of walking/standing erect.

Head for heights

To have a head for heights means that one has no acrophobia, an irrational fear of heights, and is not particularly prone to fear of falling or suffering from vertigo, the spinning sensation that can be triggered, for example, by looking down from a high place.

Steeplejack profession

A steeplejack is a craftsman who scales buildings, chimneys, and church steeples to carry out repairs or maintenance.

People with acrophobia can experience a panic attack in high places and become too agitated to get themselves down safely. Approximately 2–5% of the general population has acrophobia, with twice as many women affected as men. [1] The term is from the Greek : ἄκρον, ákron, meaning "peak, summit, edge" and φόβος, phóbos, "fear".

Panic attack period of intense fear of sudden onset

Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something bad is going to happen. The maximum degree of symptoms occurs within minutes. Typically they last for about 30 minutes but the duration can vary from seconds to hours. There may be a fear of losing control or chest pain. Panic attacks themselves are not typically dangerous physically.

Greek language Language spoken in Greece, Cyprus and Southern Albania

Greek is an independent branch of the Indo-European family of languages, native to Greece, Cyprus and other parts of the Eastern Mediterranean and the Black Sea. It has the longest documented history of any living Indo-European language, spanning more than 3000 years of written records. Its writing system has been the Greek alphabet for the major part of its history; other systems, such as Linear B and the Cypriot syllabary, were used previously. The alphabet arose from the Phoenician script and was in turn the basis of the Latin, Cyrillic, Armenian, Coptic, Gothic, and many other writing systems.

Causes

Traditionally, acrophobia has been attributed, like other phobias, to conditioning or a traumatic experience. Recent studies have cast doubt on this explanation; [2] a fear of falling, along with a fear of loud noises, is one of the most commonly suggested inborn or "non-associative" fears. The newer non-association theory is that a fear of heights is an evolved adaptation to a world where falls posed a significant danger. The degree of fear varies and the term phobia is reserved for those at the extreme end of the spectrum. Researchers have argued that a fear of heights is an instinct found in many mammals, including domestic animals and humans. Experiments using visual cliffs have shown human infants and toddlers, as well as other animals of various ages, to be reluctant in venturing onto a glass floor with a view of a few meters of apparent fall-space below it. [3] While an innate cautiousness around heights is helpful for survival, an extreme fear can interfere with the activities of everyday life, such as standing on a ladder or chair, or even walking up a flight of stairs.

Classical conditioning refers to a learning procedure in which a biologically potent stimulus is paired with a previously neutral stimulus. It also refers to the learning process that results from this pairing, through which the neutral stimulus comes to elicit a response that is usually similar to the one elicited by the potent stimulus.

Psychological trauma is a type of damage to the mind that occurs as a result of a distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope, or integrate the emotions involved with that experience. Trauma may result from a single distressing experience or recurring events of being overwhelmed that can be precipitated in weeks, years, or even decades as the person struggles to cope with the immediate circumstances, eventually leading to serious, long-term negative consequences.

Visual cliff

The visual cliff apparatus was created by psychologists Eleanor J. Gibson and Richard D. Walk at Cornell University to investigate depth perception in human and animal species. This apparatus allowed them to experimentally adjust the optical and tactile stimuli associated with a simulated cliff while protecting the subjects from injury. The visual cliff consists of a sheet of Plexiglas that covers a cloth with a high-contrast checkerboard pattern. On one side the cloth is placed immediately beneath the Plexiglas, and on the other, it is dropped about four feet (1.2 m) below. Since the Plexiglas supports the weight of the infant this is a visual cliff rather than a drop off. Using a visual cliff apparatus, Gibson and Walk examined possible perceptual differences at crawling age between human infants born preterm and human infants born at term without documented visual or motor impairments.

A possible contributing factor is a dysfunction in maintaining balance. In this case the anxiety is both well founded and secondary. The human balance system integrates proprioceptive, vestibular and nearby visual cues to reckon position and motion. [4] [5] As height increases, visual cues recede and balance becomes poorer even in normal people. [6] However, most people respond by shifting to more reliance on the proprioceptive and vestibular branches of the equilibrium system.

The vestibular system, in vertebrates, is part of the inner ear. In most mammals, the vestibular system is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance. Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of the inner ear in most mammals. As movements consist of rotations and translations, the vestibular system comprises two components: the semicircular canals which indicate rotational movements; and the otoliths which indicate linear accelerations. The vestibular system sends signals primarily to the neural structures that control eye movements, and to the muscles that keep an animal upright and in general control posture. The projections to the former provide the anatomical basis of the vestibulo-ocular reflex, which is required for clear vision; while the projections to the latter provide the anatomical means required to enable an animal to maintain its desired position in space.

An acrophobic, however, continues to over-rely on visual signals whether because of inadequate vestibular function or incorrect strategy. Locomotion at a high elevation requires more than normal visual processing. The visual cortex becomes overloaded, resulting in confusion. Some proponents of the alternative view of acrophobia warn that it may be ill-advised to encourage acrophobics to expose themselves to height without first resolving the vestibular issues. Research is underway at several clinics. [7]

Diagnosis

Confusion with vertigo

"Vertigo" is often used (incorrectly) to describe a fear of heights, but it is more accurately a spinning sensation that occurs when one is not actually spinning. It can be triggered by looking down from a high place, by looking straight up at a high place or tall object, or even by watching something (i.e. a car or a bird) go past at high speed, but this alone does not describe vertigo. True vertigo can be triggered by almost any type of movement (e.g. standing up, sitting down, walking) or change in visual perspective (e.g. squatting down, walking up or down stairs, looking out of the window of a moving car or train). Vertigo is called height vertigo when the sensation of vertigo is triggered by heights.

Treatment

There have been a number of studies into using virtual reality therapy for acrophobia. [8] [9]

Many different types of medications are used in the treatment of phobias like fear of heights, including traditional anti-anxiety drugs such as benzodiazepines, and newer options like antidepressants and beta-blockers. [ citation needed ]

Prognosis

Some desensitization treatments produce short-term improvements in symptoms. [10] Long-term treatment success has been elusive. [10]

Epidemiology

True acrophobia is uncommon.

A related, milder form of visually triggered fear or anxiety is called visual height intolerance. [11] Up to one-third of people may have some level of visual height intolerance. [11]

Society and culture

In the Alfred Hitchcock film Vertigo , John "Scottie" Ferguson, played by James Stewart, has to resign from the police force after an incident which causes him to develop both acrophobia and vertigo. The word "vertigo" is only mentioned once, while "acrophobia" is mentioned several times. Early on in the film, Ferguson faints while climbing a step-ladder. There are numerous references throughout the film to fear of heights and falling.

See also

Related Research Articles

Ménières disease disorder of the inner ear

Ménière's disease (MD) is a disorder of the inner ear that is characterized by episodes of feeling like the world is spinning (vertigo), ringing in the ears (tinnitus), hearing loss, and a fullness in the ear. Typically, only one ear is affected initially; however, over time both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears can become constant over time.

Agoraphobia A specific anxiety about being in a place or situation where escape is difficult or where help may be unavailable.

Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include open spaces, public transit, shopping centers, or simply being outside their home. Being in these situations may result in a panic attack. The symptoms occur nearly every time the situation is encountered and last for more than six months. Those affected will go to great lengths to avoid these situations. In severe cases people may become completely unable to leave their homes.

A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating. Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception. Degeneration or loss of function in any of these systems can lead to balance deficits.

Labyrinthitis otitis interna which involves inflammation of the labyrinths

Labyrinthitis, also known as vestibular neuritis, is the inflammation of the inner ear. It results in a sensation of the world spinning and also possible hearing loss or ringing in the ears. It can occur as a single attack, a series of attacks, or a persistent condition that diminishes over three to six weeks. It may be associated with nausea, vomiting, and eye nystagmus.

Fear of needles, known in medical literature as needle phobia, is the extreme fear of medical procedures involving injections or hypodermic needles.

Vertigo Type of dizziness where a person feels as if they or the objects around them are moving

Vertigo is a symptom where a person feels as if they or the objects around them are moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties walking. It is typically worse when the head is moved. Vertigo is the most common type of dizziness.

Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, PTSD, and specific phobias.

Social anxiety is nervousness in social situations. Some disorders associated with the social anxiety spectrum include anxiety disorders, mood disorders, autism, eating disorders, and substance use disorders. Individuals higher in social anxiety avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining conversation. Trait social anxiety, the stable tendency to experience this nervousness, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Nearly 90% of individuals report feeling symptoms of social anxiety at some point in their lives. Half of the individuals with any social fears meet criteria for social anxiety disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

Blood-injection-injury (BII) type phobia is a type of specific phobia characterized by the display of excessive, irrational fear in response to the sight of blood, injury, or injection, or in anticipation of an injection, injury, or exposure to blood. Blood-like stimuli may also cause a reaction.

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by a significant amount of fear in one or more social situations, causing considerable distress and impaired ability to function in at least some parts of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluation from other people.

Fear of flying phobia of flying

Fear of flying is a fear of being on an aeroplane, or other flying vehicle, such as a helicopter, while in flight. It is also referred to as flying anxiety, flying phobia, flight phobia, aviophobia or aerophobia.

Roller coaster phobia is a colloquial and slang term describing an individual's fear of roller coasters and other rides which involve excessive heights, restraints or g-forces on the body. While roller coasters are a popular theme park attraction, certain people feel nauseated, afraid, dizzy, or unsafe when riding roller coasters. In many cases, this fear is related to other phobias – such as acrophobia, claustrophobia or emetophobia – a condition like vertigo, or to a traumatic event. While not an officially recognized phobia, some cases have been treated successfully with a specialized therapy program.

A driving phobia, also called vehophobia or a fear of driving, can be severe enough to be considered an intense, persistent fear or phobia. Many people have driving anxiety, which is a form of anxiety that can range in severity. In some cases, the anxiety is constant and the person feels hesitant to drive. In more severe cases, the anxiety is overwhelming and paralyzing to the point that the person completely refuses to drive at all. In the case where driving anxiety is intense and severe enough that a person refuses to drive at all, it becomes driving phobia. A fear of driving may escalate to a phobia during difficult driving situations, such as freeway driving or congested traffic.

Vestibular rehabilitation Form of physical therapy for vestibular disorders

Vestibular rehabilitation (VR), also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy used to treat vestibular disorders or symptoms, characterized by dizziness, vertigo, and trouble with balance, posture, and vision. These primary symptoms can result in secondary symptoms such as nausea, fatigue, and lack of concentration. All symptoms of vestibular dysfunction can significantly decrease quality of life, introducing mental-emotional issues such as anxiety and depression, and greatly impair an individual, causing them to become more sedentary. Decreased mobility results in weaker muscles, less flexible joints, and worsened stamina, as well as decreased social and occupational activity. Vestibular rehabilitation therapy can be used in conjunction with cognitive behavioral therapy in order to reduce anxiety and depression resulting from an individual's change in lifestyle.

References

  1. Juan, M. C.; et al. (2005). "An Augmented Reality system for the treatment of acrophobia" (PDF). Presence. 15 (4): 315–318. doi:10.1162/pres.15.4.393 . Retrieved 2015-09-12.
  2. Menzies, RG; Clarke, JC. (1995). "The etiology of acrophobia and its relationship to severity and individual response patterns". Behaviour Research and Therapy. 33 (31): 499–501. doi:10.1016/0005-7967(95)00023-Q. PMID   7677717. 7677717.
  3. Eleanor J. Gibson; Richard D. Walk. "The "Visual Cliff"" . Retrieved 2013-05-13.Cite journal requires |journal= (help)
  4. Furman, Joseph M (May 2005). "Acrophobia and pathological height vertigo: indications for vestibular physical therapy?". Physical Therapy. Archived from the original on 2007-09-26. Retrieved 2007-09-10.
  5. Jacob, Rolf G; Woody, Shelia R; Clark, Duncan B.; et al. (December 1993). "Discomfort with space and motion: A possible marker of vestibular dysfunction assessed by the situational characteristics questionnaire". Journal of Psychopathology and Behavioral Assessment. 15 (4): 299–324. doi:10.1007/BF00965035. ISSN   0882-2689.
  6. Brandt, T; F Arnold; W Bles; T S Kapteyn (1980). "The mechanism of physiological height vertigo. I. Theoretical approach and psychophysics". Acta Otolaryngol. 89 (5–6): 513–523. doi:10.3109/00016488009127169. PMID   6969515.
  7. Whitney, SL; Jacob, Rolf G; Sparto, BG (May 2005). "Acrophobia and pathological height vertigo: indications for vestibular physical therapy?". Physical Therapy. 85 (5): 443–458. ISSN   0031-9023. PMID   15842192.
  8. Coelho, Carlos; Alison Waters; Trevor Hine; Guy Wallis (2009). "The use of virtual reality in acrophobia research and treatment". Journal of Anxiety Disorders. 23 (5): 563–574. doi:10.1016/j.janxdis.2009.01.014. PMID   19282142.
  9. Emmelkamp, Paul; Mary Bruynzeel; Leonie Drost; Charles A. P. G van der Mast (1 June 2001). "Virtual Reality Treatment in Acrophobia: A Comparison with Exposure in Vivo". CyberPsychology & Behavior. 4 (3): 335–339. doi:10.1089/109493101300210222. PMID   11710257.
  10. 1 2 Arroll, Bruce; Wallace, Henry B.; Mount, Vicki; Humm, Stephen P.; Kingsford, Douglas W. (2017-04-03). "A systematic review and meta-analysis of treatments for acrophobia". The Medical Journal of Australia. 206 (6): 263–267. doi:10.5694/mja16.00540. ISSN   1326-5377. PMID   28359010.
  11. 1 2 Huppert, Doreen; Grill, Eva; Brandt, Thomas (2013-02-01). "Down on heights? One in three has visual height intolerance". Journal of Neurology. 260 (2): 597–604. doi:10.1007/s00415-012-6685-1. ISSN   1432-1459. PMID   23070463.
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