Down on heights? One in three has visual height intolerance

Abstract

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.

Fear of Heights and Visual Height Intolerance in Children 8–10 Years Old

“…If the survey on fear of heights includes the less severe form of visual height intolerance as described in the Introduction, the prevalence rate in adults is much higher, i.e. 28% [7].…”

“…Some features are distinctive for children: they generally do not consider the condition a disease or a shameful attribute; avoidance behavior occurs in less than one third, it causes no harmful physical inactivity in the majority of those afflicted, especially no essential constraint in sporting activities; none of the children reported having seen a doctor about this matter. In contrast more than 50% of adult susceptibles exhibited an avoidance behavior that was perceived as having a considerable impact on their daily life activities and interpersonal interactions, i. e., quality of life [8], so much so that 11% had consulted a medical doctor [7].…”

“…In adults the prevalence of vHI is higher in women (32%) than in men (25%) [7]. A higher female susceptibility has also been reported for the specific phobia fear of heights [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…The prepubertal children in the current study showed no gender predominance in susceptibility. The survey in adults [7] revealed that the female preponderance of susceptibility to vHI develops in the third decade. This is very similar to the manifestation of the female preponderance of migraine, which also becomes evident in the third decade [20].…”

“…There is a continuum of severity ranging from acrophobia to a less distressing visual height intolerance (vHI), to which the categorical distinction of a specific phobia does not apply, but which may also cause medically relevant restrictions [4][5][6]. In a cross-sectional epidemiological study on 3,517 individuals representative of the general population the lifetime prevalence of vHI was found to be 28% [7]. It was higher in women (32%) than in men (25%) and increased with age.…”