Acrophobia (fear of heights): meaning, vertigo, causes, how common it is and how to overcome it

Acrophobia is the fear of heights: an intense, lasting fear of high places, out of proportion to the real danger, that leads people to avoid balconies, bridges, ladders, glass lifts or mountain paths. It is a specific phobia of the natural environment type, and in some surveys the most common one. If you are wondering what the fear of heights is called, the answer is acrophobia; in everyday speech many people call it “vertigo”, which is actually something else (see below).

This article is general information, not medical advice. If a fear of heights affects your daily life, talk to a doctor or a therapist trained in cognitive behavioural therapy (CBT). If you feel dizzy or the room spins even when you are not high up, see a doctor.

What does acrophobia mean?

Acrophobia means “fear of heights”. The Online Etymology Dictionary traces it to the Greek akros, “at the end, topmost”, plus -phobia, “fear”. The word was coined in 1887 by the Italian physician Andrea Verga, who had the condition himself.

How do you pronounce acrophobia?

Say it ak-ruh-FOH-bee-uh, with the stress on “FOH”. The Cambridge Dictionary gives /ˌæk.rəˈfəʊ.bi.ə/ in British English and /ˌæk.rəˈfoʊ.bi.ə/ in American English.

Is acrophobia the same as vertigo?

No. Vertigo is a symptom, not a fear: the NHS describes it as the feeling that you, or everything around you, is moving or spinning, often caused by inner ear problems such as benign paroxysmal positional vertigo (BPPV), labyrinthitis, vestibular neuritis or Ménière’s disease, or by migraine. It can happen anywhere, not only at heights.

Acrophobia is a fear of heights. Standing somewhere high can make anyone feel unsteady, and people with a fear of heights often feel dizzy, weak in the knees or as if they might fall. That height-triggered unease has its own name, visual height intolerance: in a survey of 3,517 people in Germany, 28% had experienced it at some point in their life, with symptoms such as fearfulness, inner agitation, a queasy stomach, a to-and-fro feeling of vertigo and weak knees (Huppert et al., Journal of Neurology, 2013). The authors describe a continuum from mild height intolerance to the specific phobia, acrophobia.

So when someone says “I have vertigo” about balconies, they usually mean a fear of heights. If dizziness or spinning also happens on flat ground, it is worth seeing a doctor.

What does acrophobia feel like?

Symptoms appear at a height, when looking down, or just from thinking about it. The NHS lists the typical symptoms of a phobia:

• feeling dizzy or light-headed, a pounding or unusual heartbeat, tightness in the chest;
• feeling sick, trembling or shaking;
• severe anxiety, and an intense fear of fainting, losing control or dying.

With heights, people often describe an urge to crouch, grip a railing or step back, and a fear of falling. Then comes avoidance: taking the stairs instead of a glass lift, refusing upper floors, balconies, bridges, ladders or chairlifts.

What causes acrophobia?

There is no single known cause. The MSD Manual states that the causes of phobias are unknown. The NHS notes that many phobias can be linked to a frightening event or a stressful situation, and that a phobia can also be learned from people around you. In the German survey, visual height intolerance was more common in people with a family history of it, an anxiety disorder, migraine or motion sickness, and it most often started in the second decade of life (Huppert et al., 2013).

Whatever started it, avoidance keeps it alive: each time you step back from the edge or skip the trip, the relief teaches you that escaping was necessary. Exposure research by Craske et al. (Behaviour Research and Therapy, 2014) shows that new, safer learning happens when you stay and discover that what you expected does not happen.

How common is acrophobia?

Fear of heights is one of the most common phobias:

• in a Dutch survey of 7,076 adults, specific phobia with a fear of heights was the most common of eight phobia variants studied, at 4.9% (Depla et al., Social Psychiatry and Psychiatric Epidemiology, 2008);
• fears and phobias of heights and of animals are the most common kinds of specific phobia (Eaton et al., The Lancet Psychiatry, 2018);
• milder visual height intolerance affects about one in three people at some point (Huppert et al., 2013).

Is it normal to be afraid of heights?

Some caution at heights is normal and useful. It becomes acrophobia when the fear is out of proportion to the real danger, starts long before you are anywhere near an edge, and makes you avoid ordinary places such as balconies, stairs or bridges.

Do I have acrophobia? A quick self-check

This is not a test and it cannot diagnose anything. It follows the summary of the DSM-5-TR criteria for specific phobia in the MSD Manual, and only helps you decide whether to talk to a professional.

Tick what applies to you

I have felt a marked fear or anxiety about heights for six months or more. Being high up, or even imagining it, almost always triggers that fear straight away. I avoid balconies, bridges, ladders or high floors, or I get through them with intense fear. I feel the fear is out of proportion to the actual danger. The fear or the avoidance causes me real distress or gets in the way of my daily life, work or social life.

This is not a diagnosis. If you ticked most of these boxes, or if the fear bothers you, talk to your doctor or a therapist trained in CBT. Only a professional can assess a phobia.

How to overcome acrophobia

The best-supported way to overcome a fear of heights is gradual exposure, the core of cognitive behavioural therapy: you go up in small, safe steps, stay long enough to learn that the feared outcome doesn’t happen, and repeat until ordinary heights feel manageable. According to the MSD Manual, exposure therapy helps around 85% of people with a specific phobia.

Our step-by-step guide explains how to build a fear ladder, how long to stay, how often to practise and when to get help: How to overcome the fear of heights.

Can virtual reality help with a fear of heights?

Yes: the fear of heights is the phobia with the most VR research.

• With 33 patients, VR exposure was as effective as real-life exposure, and the results held at six months (Emmelkamp et al., Behaviour Research and Therapy, 2002).
• An automated VR program with a virtual coach, with no therapist in the room, sharply reduced fear of heights in 100 adults after about six 30-minute sessions (Freeman et al., The Lancet Psychiatry, 2018).
• A fully self-guided smartphone app with cardboard goggles reduced fear of heights at home over three weeks (Donker et al., JAMA Psychiatry, 2019).

More in Why virtual reality works for phobias.