Down on heights? One in three has visual height intolerance

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.