What is a fear of Heights?
Fear of Heights can present at any age and involves a chronic, persistent fear of heights because of a number of different reasons. This fear can present on its own as in a Specific Phobia or as an obsession in obsessive-compulsive disorder (OCD). It is important to recognize some key differences between OCD, a Specific Phobia, and Generalized Anxiety to better know with which you may struggle.
Let’s first take a look at a case example of someone with OCD who has a fear of heights.
Case Example: OCD
Calvin is a 17 year old, junior in high school, a good student, and a star athlete. He has always been well liked by his peers, and until recently, he seemed like a laid back, confident teenager. While on a recent class trip to the Grand Canyon, Calvin experienced a very scary thought. While he and his friends were hiking the trails and looking over high cliffs one of his friends jokingly said, “Nobody slip! There’s no coming back from a fall here.” Calvin immediately had the thought while looking over the cliff, “You could just jump off right now and you’d be dead.” This thought struck fear into Calvin. He instantly backed away from the cliff and for the rest of the hike, whenever possible he avoided the edge of the path. He also started looking at his feet to make sure before each step he was still on the path. He felt relieved when they finished the hike. Later that night, back at their hotel room he went out on the balcony of the 6th floor room with his friends and looked over, while holding the railing. He thought, “It wouldn’t be that hard to climb over and jump.” Again Calvin backed away from the railing and went back into the hotel room. He couldn’t sleep that night. He kept wondering if they had locked the slider to the balcony. He even got up a couple of times to check it. He worried that he might sleepwalk and jump from the balcony. Calvin couldn’t understand why he was having these thoughts. He told himself over and over “I am not suicidal. I don’t want to die” and “I would never jump.” When Calvin got home the next day he told his mom about his “weird thoughts” while on the trip. She told him it was alright, and reassured him that everyone has strange thoughts sometimes, but it doesn’t mean we will act on them. Calvin felt a little better, but over the next few weeks, Calvin became increasingly anxious in any situation where he was up high. He didn’t like the atrium balcony at school that he had to walk on every day to get to his fourth period. He started walking as fast as he could, not looking over the edge, and even saying a little prayer in his head when he had to walk there. Things continued to worsen. Calvin had a panic attack after going on the escalator in the mall with his parents. He started to read about people who lost control of their mind and committed suicide by jumping off high places. He started to avoid heights at all costs. Everyday Calvin worried at school when he had to walk across the atrium path to get to class. He even considered asking if he could take the elevator reserved for only staff and disabled kids because of his fear. Calvin starts not only avoiding heights, but he is constantly thinking about suicide. He knows he doesn’t want to die, but he keeps having thoughts about jumping off high places. In addition to those thoughts he also starts to obsess about other ways people commit suicide. He asks his mom to lock up the medications because he starts to fear he may take a whole bunch of pills. Calvin also starts to avoid sharp objects like knives in the kitchen. What started out as an intrusive thought in a high place has now developed into a significant fear that he will hurt himself, even though he has no desire to do so.
These fears could be a sign of OCD
According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Obsessive Compulsive Disorder (OCD) is characterized primarily by two components: obsessions and compulsions.
What are Obsessions?
Obsessions are defined as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals caused marked anxiety or distress.” Someone with OCD focused on a fear of heights may experience persistent obsessions about this fear.
Common obsessions experienced by people with a fear of heights in OCD include:
- I’m going to jump off this balcony, mountain, ledge.
- I will lose control and jump even though I don’t want to.
- Strong Urge to jump off a high place.
- Intrusive images of heights/jumping/suicide
- Thoughts about throwing my baby off the balcony
- Urges to push someone from a height
- I will get stuck up high and not be able to come back down.
What are Compulsions?
Compulsions are “repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.” Compulsions are done in an attempt to relieve the anxiety that comes from obsessions or to prevent a feared outcome.
Consider some examples for people with fears of heights:
- Avoiding high places
- Walking along the edge of a balcony walkway
- Not looking over the edge of a high place.
- Watching feet to be sure they are where they should be while up high.
- Praying anytime it is necessary to be up high.
- Seeking reassurance that I am not suicidal from family, friends, other loved ones.
- Researching about how to tell if I’m suicidal.
- Only being in high places if someone is with me and holding my hand.
- Taking alternate, or enclosed routes to avoid bridges, balconies and other high up places.
How can I tell if it’s OCD, anxiety, or something else?
In addition to the presence of obsessions, compulsions, or both, a person with OCD will engage in these behaviors for a significant amount of time. These behaviors will also cause a significant amount of distress and will interfere with a person’s daily life and ability to function.
On the other hand, if a person struggles with a fear of heights but does not engage in compulsive behavior or their symptoms don’t interfere in their life, it may be better described as one of several anxiety disorders, or just general worry.
People often mistakenly believe that phobias are a form of OCD, but this is not the case; Specific Phobia is an entirely distinct diagnosis. According to the DSM-5, a Specific Phobia is a “marked fear or anxiety about a specific object or situation” (e.g., flying, heights, animals, receiving and injection, seeing blood). There are different phobic categories for diagnosis: Animals, Natural environment, Blood-injection-injury, Situational (flying, elevators, enclosed spaces) and other (such as situations that could lead to choking or vomiting).
As with OCD, a person’s life will be affected by their fear, which is usually not proportional to any actual threat. Someone with a Specific Phobia will take steps to avoid their phobic stimulus (heights). Similar to OCD, people with a phobia may seek reassurance about their fears. However, in a Specific Phobia there is usually an absence of intrusive thoughts. A person with a specific phobia with a fear of heights will have a reaction to heights, but there is not a link to the “why” they are afraid of heights
Case Example: Specific Phobia
Mallory has always been afraid of heights since she was a little girl. Her first memory where this presented was when she was at a carnival with her parents and while on the ferris wheel up high, she started to panic. Since that time, Mallory has avoided heights. She closes her eyes when her husband drives over tall bridges, she will not go on escalators, she avoids balconies, will not stay in high up hotel rooms, and avoids anything in nature that is high up. If she does experience a high up place, she gets sweaty, her heart races, she feels like she is going to faint, and her stomach twists and turns and she thinks she may throw up. There are no intrusive thoughts about the high up places. Mallory just knows she doesn’t like them, and experiences fear if she has to be somewhere high.
Another difference between the two disorders is that OCD symptoms often wax and wane from their onset. A person may spend only several months consumed by obsessions and compulsions related to fear of heights, after which their intrusive thoughts and compulsive behavior focus on another theme. In a Specific Phobia, one’s fears and behaviors usually remain consistent in the absence of treatment.
How the fear of heights can be treated
A fear of heights in OCD can be treated with a particular form of therapy called exposure and response prevention (ERP) therapy. This evidence-based treatment has shown to be highly effective in treating all forms of OCD. Most individuals who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears.
By doing ERP therapy with a trained therapist, individuals can find relief from the cycle of OCD. In ERP, people will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with an exposure that is predicted to bring about a low level of fear and anxiety and work up to the harder exposures as confidence is built.
When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety without relying on compulsions or avoidance to feel better.
Example exposures done to treat OCD centered around a fear of heights may include:
- Writing a script about jumping off a balcony
- Looking at pictures of mountains, tall buildings, or high amusement park rides
- Watching video tours of the scariest high places.
- Spending extended amounts of time in high places.
- Sitting on the edge of a cliff with feet dangling over, eating dinner on a balcony, or going on a ferris wheel.
- Resisting the urge to avoid, seek reassurance, or research about suicidal ideation/intent
- While spending time with a friend in a high place, think “I will push them off”.
- Writing “I will jump off my balcony” over and over.
If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.
We look forward to working with you.