Acrophobia (Fear of Heights) in Singapore

Acrophobia, more commonly known as the fear of heights, according to some research, is one of the most predominant phobias in the world. Upto one in twenty people suffer from this disorder, an older study states. This fear can cause a lot of anxiety, panic and distress which is strong enough to disrupt a person’s daily functioning. 

Anyone suffering from this phobia would try to avoid places at high altitudes. The differentiator between a normal discomfort felt at height altitudes and acrophobia is the intense panic and anxiety that it comes with which prompts avoidance-based behaviours in the person suffering from it. People with acrophobia thus tend to refuse going out into the balcony of a place, stepping onto a ladder, an airplane, etc. Acrophobia, like most other phobias, is a very limiting disorder as it makes people restrict the places they could go to, and the opportunities they could have in life. 

The first step to learning how to overcome the fear of heights is understanding it fully. Read on further to find out more about acrophobia and its symptoms, causes, treatment and diagnosis. 

Acrophobia Meaning

Acrophobia refers to the intense irrational fear of heights. Even the thought of a high place can cause a lot of anxiety and, in some cases, even a full blown panic attack episode. 

Acrophobia falls under the category of specific phobias. The DSM-5 (Diagnostic and Specific Manual of Mental Disorders) this phobia of heights as a natural environment type of phobia.

Acrophobia Symptoms

The major symptom experienced in this disorder is the feeling of intense anxiety and panic associated with heights. Extreme heights may trigger this fear for some people, while for others, any kind of height can lead to the onset of anxiety episodes and other symptoms.

The symptoms can mainly be categorized into two categories, physical and psychological. They are as follows: 

Physical Symptoms:

  • Increased heartbeat and sweating, chest pain or tightness felt in the chest when in a situation or having a thought that involves being in high places
  • Feeling dizzy and unable to find balance in the physical body when looking down from a height
  • Avoiding heights as much as possible, even if it comes at the cost of limiting one’s life choices
  • Shaking and trembling at the sight of heights
  • Feeling dizzy, nauseous, or lightheaded at the thought of heights or when at a high altitude

Psychological Symptoms: 

  • Feeling panicky when seeing a high place or thinking about being at a height, or having to go up to a high place
  • Excessive worrying about encountering heights 
  • Intense, paralyzing fear of being trapped in a place situated at a high altitude
  • Experiencing feelings of anxiety and fear when having to look out the window, climbing up the stairs, or driving on a fly-over

People can also experience a full blown panic attack when exposed to their triggers when they have a specific phobia. For acrophobia, too, this is the case. Following are the symptoms of a panic attack: 

  • Shortness of breath and hyperventilation
  • Shaking, trembling
  • A feeling of choking
  • Palpitations or increasing heart beat
  • Nausea
  • Diarrhea 
  • Chest pain and discomfort
  • Hot and cold flashes
  • Numbness
  • Tingling sensations in the limbs
  • A feeling of dizziness and light-headedness 
  • Sweating
  • Abdominal pain 
  • Depersonalization: Feeling detached from oneself
  • Derealization: feelings of unreality
  • A fear of going crazy, dying or losing control

Acrophobia Causes

Acrophobia, in most cases, develops when a person goes through a traumatic experience which involves heights, for example; falling from a high place, witnessing someone else fall from a high place, or having a panic attack or any other negative experience while in a high place. 

However, acrophobia can also develop without any known cause. Some risk factors are there which increase the likelihood of someone developing this disorder. They are either environment or genetics related. For instance, if someone in your family has a history of phobias or acrophobia, then you’re more likely to develop this phobia. Moreover, it can also be a learned response picked up from a role model. 

Another theory, called evolved navigation theory, suggests that certain human processes like the perception of height have been adapted due to natural selection. Some people perceive objects as taller which reduces their risk for dangerous falls. 

Acrophobia Diagnosis 

For diagnosis, you should approach a mental health professional as only they can diagnose phobias. You can approach one with the referral of a healthcare provider. 

Some medical causes, firstly, need to be ruled out with a physical examination which is a part of the diagnosis. Then, by some other means and some psychological tests, your mental health care provider would mainly try to confirm the following: 

  • You actively avoid heights and this avoidance-based approach is limiting you to the extent that it disrupts your daily functioning
  • You spend an excessive amount of time worrying about encountering heights in future and this time spent ever so wastefully also negatively impacts your daily life
  • You get very anxious, panicky and a paralyzing fear takes over you when you encounter heights
  • You have been facing a lot of trouble for the past few months due to these symptoms, and these symptoms have been there for at least 5-6 months. 

Acrophobia Treatment

The treatment of all phobias, like acrophobia, can involve therapeutic techniques, medication, or a combination of both. 

Therapies can be of different types depending on the signs and symptoms and their severity of the client. Some of the therapeutic interventions used for treating phobias include eye movement desensitization reprocessing therapy (EMDR) which is based on some concepts of cognitive behavioural therapy (CBT) which is also used for treating phobias, systematic desensitization, and exposure therapy among others.

Medication for phobias includes antidepressants, and anti-anxiety medication to reduce the emotional and physical reactions of fear. 

Why Seeking Help Is Important

If your condition has begun to interfere with your daily functioning and is negatively affecting most or all aspects of your life, seeking help is a crucial step that you must take. Even though it may be difficult to gather the courage to do so, you must see a mental health professional for your phobia(s). Remember that mental health disorders can be treated and are manageable, and your life has the potential to be the most fruitful, wholesome and enjoyable experience. So, joining a support group, going for therapy and taking your prescribed medication (if any) is absolutely critical. The outcome that you’d gain would be a deeper understanding of yourself and your condition,  the ability to form better relationships and find more meaningful connections, and skills that help you manage your condition and excel in life.

Agoraphobia (Fear Of Crowds)

Agoraphobia is a debilitating anxiety disorder in which you experience a debilitating fear of public places, being in large crowds, and avoid places or situations that may cause you to feel panicked, scared, trapped and helpless. It is also more commonly known as the fear of crowds.

This fear can be associated with an actual or an imagined situation, i.e a real or a perceived threat such as going to the general store or using public transport, standing in a queue, being in open or enclosed spaces with large crowds, etc. Often, people with agoraphobia feel the need to rely upon a companion to accompany them for even the most regular outings and in most cases, they avoid going out. This avoidance based behaviour is one of the most distinctive symptoms of agoraphobia. 

Like with other phobias, people with agoraphobia do realize that their fears are irrational, but they feel as though they can’t do anything about it. This interferes with their day to day functioning and regular tasks.

Agoraphobia Symptoms

Following are the signs and symptoms of agoraphobia. If you feel that you experience a few or all of the symptoms enlisted below, then you must consider visiting a mental health professional. 

Agoraphobia causes the patient to feel:

  1. Fear of leaving their home for extended periods of time
  2. Fear of losing control in a public or open space, among large crowds
  3. Fear of being in places where it is difficult to escape, like an elevator, a vehicle, etc. 
  4. Fear of being alone in a social situation or gathering
  5. Feeling detached from others
  6. Feeling anxious or agitated most of the times 

Agoraphobia, like other phobias, can also result in panic attacks. Panic attacks involve the experience of a series of symptoms that occur in phobias as well on exposure to triggers. Following are some of the symptoms of panic attacks: 

  • Shortness of breath and hyperventilation
  • Shaking, trembling
  • A feeling of choking
  • Palpitations or increasing heart beat
  • Nausea
  • Diarrhea 
  • Chest pain and discomfort
  • Hot and cold flashes
  • Numbness
  • Tingling sensations in the limbs
  • A feeling of dizziness and light-headedness 
  • Sweating
  • Abdominal pain 
  • Depersonalization: Feeling detached from oneself
  • Derealization: feelings of unreality
  • A fear of going crazy, dying or losing control

Agoraphobia Causes and Risk Factors

Generally, agoraphobia develops when panic disorder gets aggravated, i.e., it is a complication of panic disorder. Hence, the symptoms of panic disorder and agoraphobia overlap. Agoraphobia can develop when the affected persons associate open places and large crowds with panic attacks, and this tends to happen when they’ve had panic attacks in such situations.

Now, the exact cause of agoraphobia isn’t known yet. However, some risk factors increase the likelihood of a person developing agoraphobia. These are as follows: 

  • A history of physical, emotional, or sexual abuse
  • Substance abuse
  • Family history of agoraphobia
  • Depression
  • Having other phobias, such as social phobia or claustrophobia
  • Having another anxiety disorder, such as generalized anxiety disorder, obsessive compulsive disorder, or post traumatic stress disorder. 

Diagnosis of Agoraphobia

A diagnosis of agoraphobia is generally made if the following is confirmed with the help of a few psychological tests and other means (at the same time it should also be confirmed that some medical causes are ruled out with the help of physical examination): 

  • You feel anxious about being in a place or a situation which involves large crowds or escape is difficult to the extent that it harms your daily functioning. At the same time you experience anticipation anxiety about having a panic attack or feeling panic in the above situations.
  • You tend to display avoidance-based behaviour and avoid the aforementioned situations by not going out, or rely on a companion each time you go out, or endure in these situations while experiencing extreme levels of anxiety.
  • There is no underlying condition that explains such symptoms (which, again, must be ruled out with the help of physical examination as previously stated). 

Agoraphobia Treatment

The treatment of agoraphobia involves therapeutic techniques, medication, or a combination of both. 

Therapies can be of different types depending on the signs and symptoms and their severity of the client. Some of the therapeutic interventions used for treating phobias include eye movement desensitization reprocessing therapy (EMDR) which is based on some concepts of cognitive behavioural therapy (CBT) which is also used for treating phobias, systematic desensitization, and exposure therapy among others.

A part of the therapeutic treatment plan may require the patient to see a psychiatrist, for which, a referral may be arranged. The psychiatrist can decide whether or not medication is required for the treatment depending upon the severity and the range of symptoms. Medication mostly includes antidepressants, and anti-anxiety medication to reduce the emotional and physical reactions of fear. 

A few examples of the kinds of medication used for agoraphobia treatment are:

  • selective serotonin reuptake inhibitors: paxil (paroxetine), and prozac (fluoxetine)
  • Selective serotonin and norepinephrine reuptake inhibitors: effexor (venlafaxine), and cymbalta (duloxetine)
  • Tricyclic antidepressants: elavil (amitriptyline) and pamelor (nortriptyline)
  • Anti Anxiety medications: Xanax (alprazolam) and Klonopin (clonazepam)

FAQ

Q. Is agoraphobia a social phobia?

No, agoraphobia is not a social phobia because the symptoms can occur in situations which do not involve any social interaction. It is distinct from social phobia in the sense that it involves a fear of entrapment which can occur even in isolation. But there is an overlap of symptoms as people often feel social anxiety in agoraphobia.

Q. When was agoraphobia first discovered?

Agoraphobia was first added to the DSM’s third edition in 1980. It has been included in each version since.

Phobias

Phobias are excessive and irrational fears that may or may not be associated with a certain place, object, situation. These fears interfere with a person’s coping ability or lead them to stay away from the object, situation, place of trigger altogether. The triggers may or may not be normally dangerous or frightening for most people, but people suffering from phobias feel a deep sense of dread or paralyzing panic when they encounter the source of fear. 

Phobias can be annoying or disabling to the extent that they severely impact a person’s day-to-day life and the decisions they make as a whole. Often, people suffering from such phobias are aware of the fact that the fears that they have are irrational, but they aren’t able to voluntarily do too much on their own to help themselves. Phobias are a very common mental condition. As a matter of fact, 1 in 10 people experience phobias at some point in their lives. Individuals suffering from phobias mostly act and behave calmly and rationally most of the time but when they are exposed to their triggers, they become paralyzed by their fears.

What Causes Phobias

Like most other mental conditions, there is no specific cause for the development of phobias. However, there are some factors at play here which are studied, identified and confirmed by some researchers. They are as follows: 

  1. Exposure to traumatic events or experience of certain terrifying incidents: 

For example, if you were, for whatever reason, trapped in a confined space when you were young, you might have developed a fear of enclosed spaces called claustrophobia. 

  1. Learned behavior and responses:

Fear, by certain psychological approaches, is defined as a learned (or conditioned) response to stimuli in the environment. It can thus be picked up by certain factors early on in life. For example, you may pick up the same specific phobia that your parent has as a result of observational learning. 

  1. Genetics

Several studies have shown that some people are predisposed to developing phobias and are more likely to do so than others. 

  1. Long-term stress or illness:

Long term stress or an illness can cause feelings of anxiety and depression. It can reduce your ability to cope in some situations. This can make you feel anxious, stressed out and fearful about being in those situations again and, if this goes on for a longer period of time, you could develop a phobia.

Symptoms of Phobia

The fear and anxiety that a person with a phobia suffers can be experienced as both mental and physical symptoms. However the intensity of the same generally differs from one individual to another. 

A person might be involved in trying to avoid the trigger or thinking about what might happen if they encounter the trigger so much that it can cause fatigue and irritability, difficulty concentrating on even the simplest tasks, and make it difficult for such people to fall asleep or have any restful, undisturbed sleep. The physical signs of  such anxiety results are  heavy sweating, difficulty in breathing, irregular heartbeats or palpitations, dizziness or faintness, muscle tension, stomach problems, etc. 

The most disabling symptom or the peak that having a phobia could lead to, is a panic attack. Not all episodes may culminate in a panic attack, but for people with severe phobias, panic attacks can be a frequent occurrence. The symptoms of panic attacks are as follows: 

Mental Symptoms:

  • Depersonalization: Feeling detached from oneself
  • Derealization: feelings of unreality
  • A fear of going crazy, dying or losing control

Physical Symptoms:

  • Shortness of breath and hyperventilation
  • Shaking, trembling
  • A feeling of choking
  • Palpitations or increasing heart beat
  • Nausea
  • Diarrhea 
  • Chest pain and discomfort
  • Hot and cold flashes
  • Numbness
  • Tingling sensations in the limbs
  • A feeling of dizziness and light-headedness 
  • Sweating
  • Abdominal pain

Difference Between Normal Fear And Phobia 

It is important at this point to talk about the difference between fear and phobia as people often can’t discriminate between the two. It is possible that you have a fear of something, and it isn’t a phobia, or maybe you’re confusing an actual phobia with just a fearful sentiment. There is a basic distinction that psychology as a field of study makes between phobias and fears. A fear is an emotional response to a real or a perceived threat. Fears are common, and are considered normal reactions to certain things. Phobias are similar to fears but there’s one basic differentiating characteristic of phobias: the anxiety aroused by the triggers and experienced by the person with the phobia is so severe that it disrupts the person’s quality of life and daily functioning.

Types of Phobia

There are mainly three types of phobias. Along with those, there are some of the most common phobias listed after these. They are as follows: 

Agoraphobia:

Agoraphobia is a fear of places and situations that causes feelings of entrapment, panic, helplessness or embarrassment. The literal meaning of the word is “fear of open spaces.” The one main defining symptom of this phobia is that people with agoraphobia feel panicked in large crowds and trapped outside of their homes. They avoid social events or situations and prefer being inside their homes. 

Social phobia:

Also known as social anxiety disorder, social phobia is an extreme fear of social situations, meeting new people, and public speaking and can lead to self isolation. The simplest of social interactions such as talking to the person at the counter, placing an order on the call, or even small talk over the phone can cause a lot of anxiety and panic. 

Specific Phobias: 

Specific phobias are fears of certain situations or objects and they interfere with a person’s daily life. A few of the most common phobias are:

  • Claustrophobia (fear of closed spaces)
  • Coulrophobia (fear of clowns)
  • Zoophobia (fear of animals)
  • Aerophobia (fear of flying)
  • Xenophobia (fear of driving)
  • Chionophobia (fear of snow)
  • Arachnophobia (fear of spiders)
  • Aichmophobia (fear of needles)
  • Ophidiophobia (fear of snakes)
  • Acrophobia (fear of heights)
  • Gamophobia (fear of commitment) 

The list of  phobias goes on. For more information on the various types of phobias, refer to the list of phobias in DSM-5.

Treatment

The treatment of phobias involves therapeutic techniques, medication, or a combination of both. 

Therapies can be of different types depending on the signs and symptoms and their severity of the client. Some of the therapeutic interventions used for treating phobias include eye movement desensitization reprocessing therapy (EMDR) which is based on some concepts of cognitive behavioural therapy (CBT) which is also used for treating phobias, systematic desensitization, and exposure therapy among others.

Medication for phobias includes antidepressants, and anti-anxiety medication to reduce the emotional and physical reactions of fear. 

Why Seeking Help Is Important

If your condition has begun to interfere with your daily functioning and is negatively affecting most or all aspects of your life, seeking help is a crucial step that you must take. Even though it may be difficult to gather the courage to do so, you must see a mental health professional for your phobia(s). Remember that mental health disorders can be treated and are manageable, and your life has the potential to be the most fruitful, wholesome and enjoyable experience. So, joining a support group, going for therapy and taking your prescribed medication (if any) is absolutely critical. The outcome that you’d gain would be a deeper understanding of yourself and your condition,  the ability to form better relationships and find more meaningful connections, and skills that help you manage your condition and excel in life.

Frequently Asked Questions about Phobias

Q. How to prevent specific phobias?

Many specific phobias can unfortunately not be prevented, but early intervention and treatment can considerably help and reduce the symptoms and instances of any anxiety or panic attack episodes. It can prevent the development of chronic fear associated with the incident.

Q. Which is the most common phobia?

Arachnophobia (Fear of spiders) is the most common phobia in the world, 50% of women and 10% of men have it.

Q. What is the basic diagnostic criteria for phobias?

Phobias are fears that:

  1. Disturb the sufferer’s life in some way, i.e. they degrade the person’s ability to function optimally in day to day life. 
  2. Make the affected person avoid the specific situation, or feared object.
  3. People with phobias are constantly troubled with thoughts about the dreaded object or situation, i.e, there is anticipating anxiety
  4. The exposure to the feared object or situation triggers panic attacks in the patient.

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