In the present study, experiences with the high place phenomenon were examined in two German samples. The phenomenon is well known to persons who suffer or have suffered from suicide ideation: About 80% of (lifetime/current) suicide ideators are familiar with the experience of a sudden urge to jump when in a high place. In the context of a suicidal crisis, the high place phenomenon represents only one of many different experiences; as reports of a sudden urge to steer the car into oncoming traffic, or to jump in front of an approaching train, or a sudden urge to injure oneself with a knife, are no rarity in clinical practice as well as in internet chats.
However, the phenomenon is not only well-known to individuals suffering from suicide ideation, but also to individuals not suffering from (lifetime/current) suicide ideation. In the current study, about 45% of participants who had not suffered from suicide ideation in their lifetime, reported experiencing the phenomenon at least once in their lives. Almost identical prevalence figures were reported by Hames and colleagues , who investigated the phenomenon in an American student sample. Taken together, the findings clearly indicate that the high place phenomenon is a common phenomenon that does not refer to a hidden death wish. In fact, it was shown that experiences with the high place phenomenon are associated with increased anxiety sensitivity: In a hierarchical regression analysis, anxiety sensitivity – as well as lifetime suicide ideation – proved to be the sole predictors for experiences with the high place phenomenon. The tendency to be fearful of anxiety-related symptoms and arousal sensations thus seems to be particularly associated with the high place phenomenon. This finding supports the assumption of Hames and colleagues  that the high place phenomenon stems from a misinterpretation of a safety or survival signal (“Back up, you might fall”) and therefore is more likely to be reported by individuals who tend to be more sensitive to such safety signals (i.e., individuals exhibiting heightened levels of anxiety sensitivity). However, neither the present findings nor the findings of Hames et al.  can be interpreted as stringent proof of this assumption. The cross-sectional design of both studies does not allow fine-grained analysis of temporal patterns. It may therefore be the case that individuals exhibiting increased anxiety sensitivity simply remember experiences with the high place phenomenon better in retrospect, as they experienced them as more threatening at the time. Experimental studies, where anxiety sensitivity is recorded in advance and participants are then confronted with height situations, could provide more precise information. Additional physiological measurements would enable the inclusion of physical correlates of the high place phenomenon.
Eventually, the question arises to what extent the coincidence of suicide ideation and the high place phenomenon represents a risk for suicidal behavior: Is a transition from suicide ideation to suicidal behavior more likely if an individual experiences sudden urges to jump from high places? On the one hand, experiences with the high place phenomenon were more common to lifetime suicide attempters than to lifetime suicide ideators in the current study. On the other hand, however, this finding does not imply that suicide attempts immediately follow sudden urges to harm oneself. In general, the idea that people die by suicide “on a whim” has been disputed : It is true that the time span between a decision to die by suicide and its implementation is often short (e.g., ), nonetheless, suicide has regularly been considered far in advance (e.g., ). Future studies should strive to clarify the role of sudden urges to jump in the decision process regarding suicide. Already now, questions on suicidal impulses should be included in suicide risk assessments.
Of note, findings described up to this point were only evident in the online sample and not in the patient sample. In fact, about 45% of the participants in the patient sample also stated that they have experience with the high place phenomenon. Yet, no significant associations between the high place phenomenon and anxiety or suicide ideation were found in the patient sample. This may be related to the fact that the vast majority of participants in the patient sample suffered from a specific flight phobia which is (a.) very specific and isolated (b.) causes comparably low symptom distress (i.e., low variance) and (c.) is to a lesser extent characterized by anxiety sensitivity: At the core of flight phobia is the fear that the plane might crash and not the threat of certain bodily symptoms . Only less than ten percent of the participants were diagnosed with agoraphobia, a disorder that has been evidenced to be associated with enhanced anxiety sensitivity . It would therefore be advisable to give priority to individuals suffering from panic disorders with/without agoraphobia and/or height phobia in future studies on the high place phenomenon (cf., [4, 23]).
The results of the current study should be interpreted with consideration of the following limitations. First, lifetime suicide ideation and lifetime history of suicide attempts were not assessed in the patient sample. Therefore, it was impossible to replicate the findings from the online sample within the patient sample. Furthermore, suicide ideation was only assessed with the respective item of the BDI instead of a more comprehensive method to assess suicide ideation in the patient sample. This might have led to an underestimation of suicidality within the patient sample. However, it has to be noted that symptom distress was low within this sample. Second, the use of a cross-sectional research design and a sample comprised of Caucasians only limits the generalizability of the results and the discussion of temporal/causal relationships between study variables. In general, a representative population sample is be necessary to make a definite statement on the prevalence of the high place phenomenon.
Nonetheless, the current results point out that the high place phenomenon is a widespread experience that can be associated with suicide ideation/behavior but is by no means a sign of a hidden death wish.