Height intolerance between physiological mechanisms and psychological distress: a review of literature and our experience

Height intolerance often includes various clinical conditions ranging from physiological height instability, which is a common condition, to acrophobia, considered to be a specific phobia in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). Visual dependence is commonly reported in patients with height intolerance, and physiological mechanisms may include conflicting information from visual cues on one hand and vestibular-proprioceptive cues on the other. This study examines the physiological mechanisms underlying height intolerance and phobic-cognitive mechanisms leading to more severe clinical manifestations (i.e. acrophobia). Diagnosis mainly relies on history, while the use of specific questionnaires has been proposed in a clinical setting. Treatment includes physical therapy with the purpose of habituation to the condition; on the other hand, psychological disorders should be considered and treated. Finally, our own experience in treating patients with height intolerance is included. In a sample of 164 acrophobic patients with imbalance lasting for at least 6 months, a prevalence of females was found (59.7%); among comorbidities, motion sickness (51.8%), migraine (50.6%) and panic disorders (18.9%) were reported. Interestingly, acrophobia always preceded the first panic attack.