More recently, in the eighteenth century, Erasmus Darwin, the grandfather of Charles Darwin, was the first to hypothesize that sensorimotor mechanisms cause postural and gait imbalance when exposed to heights. A second example can be found in Ovid’s (43 BC–17 AD) ‘Metamorphoses’, in which the characteristic behavior of the partridges, which avoid the height, is explained mythologically by an accident in the world of the antique gods when the goddess Athena caught Perdix (the Latin word for partridge) who was hurled by his uncle from the Acropolis and metamorphosed him into a bird of the same name, the partridge. In his work 'Ab urbe condita', Livius (59 BC–17 AD) described that soldiers dropped down from high ladders when trying to surmount city walls which impeded the conquest of Carthago Nova. Sources for fear at heights can also be found in antique Roman texts. 1), an observation which was rediscovered later in psychophysical experiments. The emperor found out that kneeling down reduces symptoms (Fig. In Chinese medicine of correspondences, the critical stimulus was not considered ‘visual height’, but the life essence Qi, which when cooled with increasing height triggered a dizziness of the eyes as well as winds that were able to penetrate the neck. In chapter 80 of the book Huangdi Neijing Lingshu-written between the second century BC and the second century AD-part of ‘The internal classic of the Yellow Thearch’-the emperor Huang Di described how he often felt uncomfortable and confused when climbing a watchtower observation platform. Historical descriptions of vertigo and fear at heights in Chinese and Roman antiquity Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height.
Anxiety is the critical factor in visual height intolerance and acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Visual exploration is preferably reduced to fixation of the horizon. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. vestibular migraine, Menière’s disease), but not with bilateral vestibulopathy. anxiety and depressive syndromes) and other vertigo syndromes (e.g. A high comorbidity was found with psychiatric disorders (e.g. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including acrophobia in 28% of adults (32% in women 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and acrophobia at the severest end of the spectrum. Historical descriptions of fear at heights date back to Chinese and Roman antiquity.
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