All of us carry out, every day, actions that do not require our attention. One of these acts is walking, which despite being subject to a remarkable degree of motor coordination, tends to be automated from a very early age.

When we walk we shift our weight forward, changing the axis of gravity and positioning both feet so that the body moves in space without hitting the ground or an obstacle. Everything happens without the need to think in detail about what is happening.

This is why many are surprised to discover that it is possible to be afraid of making a mistake in this “simple” process, and suffer a huge fall as a consequence. Such a fear, more common than one might think, is known as basophobia .

In this article we will talk about this specific fear, about its causes and treatments, as well as about which group is most at risk of suffering it.

What is basophobia?

Basophobia is a specific phobia, and therefore can be considered an anxiety disorder. The person who suffers from it refers to a very disabling fear of stumbling and falling while moving from one place to another . The fact that wandering is an absolutely common act, necessary to develop everyday life, turns this fear into a problem that limits in a very notable way the autonomy and participation in activities of daily life.

Symptoms

This fear usually has a number of identifiable causes, which we will discuss in detail in the next section, and tends to be sustained through a process of deliberate avoidance.

There are many people with basophobia who, faced with the experience of this irresistible fear, make the decision to stop walking permanently. Thus, they come to remain for a long time in situations of extreme sedentariness, resenting themselves on a physical level while the fear continues to grow.

It is important to note that most people living with basophobia (also known in the literature as fear of falling) are older adults with additional physical problems, especially in the locomotor system , so it is a problem that can exacerbate the decline of their health or the risk of complications in other organs or systems. This is why its early detection and treatment is of paramount importance.

People with basophobia can also report difficult emotions very often, since the inactivity that results from it implies a succession of important losses (social, occupational, etc.). It is therefore common to have mood disorders or a painful feeling of loneliness.

Causes of basophobia

The following are the main causes of basophobia. Both physical and psychological aspects will be included, which can often occur together or even interact with each other, enhancing each other.

1. Previous history of falls

Most research on basophobia indicates that the history of falls in the past is one of the main reasons why this form of fear can develop . Thus, the memory of tripping and falling would be stored as an emotional imprint in the narrative of life, which would condition the ability to walk normally. Although it is possible to develop the phobia without having experienced a serious fall on one’s own skin, the truth is that most of those who suffer from it report having done so.

A relationship is established in two directions: people who have ever fallen are more afraid of falling than those who have never fallen, but it is also the case that those who fear a fall more intensely are at greater risk of falling than those who feel more secure. As a consequence, a vicious cycle is drawn between experience and expectation , the resolution of which requires a personalized therapeutic procedure.

2. Anxiety and posture control

When the fear of falling is established, the sufferer pays excessive attention to the whole process involved in moving from one place to another, making it lose the normality with which it was developed until that moment. Therefore, this automated coordination would be conditioned by a perception of threat or danger, which would imply a harmful need for control and security.

This monitoring alters the operation of the gear on many levels. We know that people with basophobia adopt greater rigidity in the muscle groups involved in walking ; limiting the range of movement and altering the centre of balance by contracting the anterior tibial muscle, soleus and calf muscles. This variation can increase the risk of a new fall (or the first one in which you never lived before).

Such a deliberate disruption of the walk is a behavior that is difficult to control, by which the person tries to anticipate some unexpected situation that increases the risk of falling: an obstacle in the way, a difference in level on the ground or dizziness. This is why it is more common for people who live with anxious symptoms to worry about what might happen in the future.

Even in an upright position, in which no need to walk is anticipated, people with basophobia feel fearful and see their confidence in their own balance diminished, precipitating an overactivation of the autonomic nervous system (and more specifically of its sympathetic branch). This physiological phenomenon is linked to sensations such as tachycardia, tachypnea, sweating, sensation of unreality and instability ; and increases by itself the risk of falling.

3. Increased cognitive demand

Older people with basophobia have a higher risk of falling, as well as a greater fear that this will happen to them, when wandering is coupled with simultaneous activity that requires cognitive effort. This is why they may feel unsafe in unfamiliar places, because there they must devote much more attention to the properties of the physical environment (presence of obstacles and support elements, for example).

This circumstance also implies that people who suffer some impairment of their cognitive functions have a higher risk of falling than those who have preserved them, since in the first case it is easier to exceed the resources available for information processing. This is one of the reasons why patients with dementia fall more frequently than individuals who do not suffer from these neurodegenerative problems.

4. Poor physical function or need for walking aids

People who perceive themselves as physically limited (by accident, surgery, or pathology) may be at greater risk of developing this phobia. In such a case, self-efficacy for movement may be seriously impaired, with confidence being lost and a general sense of insecurity being shaped. This problem increases when walking assistance, such as crutches or a cane, is required.

Many studies point out that what is really important to explain the fear of falling is not the objective physical state, but the perception that the person has of it. Thus, a subject with less mobility may not have this problem as long as he trusts his own capacity, and considers that his body is in good shape. The institutionalisation of elderly people may increase the risk of suffering from basophobia , especially if the residential centre in which they are staying does not have information about this problem.

5. Drug use

Older people eliminate drugs more slowly than younger people. They also report more (and more intense) side effects than younger people, so caution is needed when giving compounds that may cause dizziness or instability in people with basophobia.

Sometimes, in order to treat the anxiety that is directly associated with basophobia, it is decided to administer benzodiazepines. This is a subgroup of drugs with myorelaxant, hypnotic and anxiolytic properties. Well, in some cases can cause undesirable drowsiness and muscle laxity in those living with this phobic problem (especially first thing in the morning), so their use and effects in these specific cases should be monitored to the extreme.

Treatment of basophobia

Basophobia can be treated through therapeutic programs that include four main components: physical exercises, psychoeducation, exposure and the use of protective or safety measures .

As far as physical exercises are concerned, activities aimed at improving the sense of balance have been proposed. They include sitting and standing movements, taking steps in all directions while maintaining a standing position, tilting the body to explore the limits of stability, lying down and standing up (since orthostatic hypotension sometimes contributes to fear), and team sports (adapted).

As regards psychotherapeutic strategies, the choice is made to use psychoeducation (offering information about the problem that reduces the presence of preconceived and harmful ideas), cognitive restructuring (identification and discussion of irrational ideas) and exposure (both in vivo and in the imagination or through the use of new technologies).

Protective measures involve modifying the physical environment in order to increase the feeling of safety in areas where people normally work, as well as making use of elements that minimise the potential anticipated consequences of a potential fall (protection in areas of the body that the person perceives as vulnerable or fragile, such as the head or knees).

Among all these strategies, the ones that have shown a greater effectiveness are those that combine both physical exercises and psychological intervention , being necessary the elaboration of multidisciplinary programs that approach the reality of the person in its totality. The separate use of one or the other has also shown positive effects, but they tend to dilute rapidly as time goes by.

Bibliographic references:

  • Seonhye, L., Eunmi, O. and Gwi-Ryung, S.H. (2018). Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History. International Journal of Environmental Research and Public Health, 15, 1-12.
  • Stojanovic, Z., Kocic, M., Balov, V., Milenkovic, M., Savic, N. and Ivanovic, S. (2016). Fear of Falling. Medical Practice, 44(3), 61-66.
  • Young, W.R. and Williams, M. (2015). How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations. Gait Posture, 41(1), 7-12.