A new study finds that spatial disorientation is a “distinct threat” to general aviation due to the high risk of fatalities in these accidents.
According to 2025 research from the FAA’s Civil Aerospace Medical Institute, general aviation accidents caused by spatial disorientation had a 94% fatality rate compared to the 19% fatality rate for all GA accidents.
The study, which looked at 367 fatal general aviation accidents in the National Transportation Safety Board (NTSB) database between 2003 and 2021, found that pilots with less than 500 hours were more likely to be in these accidents.
Also contributing to the high number of fatalities: VFR into IMC flights.
Lastly, the researchers discovered that more and more spatial disorientation flights over the years are associated with positive toxicology findings, particularly for drugs that pose potentially impairing effects.
The findings “highlight the necessity for continued education and awareness efforts for spatial disorientation within GA,” the researchers noted.
The Study
Spatial disorientation is often characterized as an “erroneous sense of one’s position and motion relative to the plane of the earth’s surface” and is a widely known aviation safety risk, the researchers said.
While previous research has focused predominately on military operations, FAA officials note that “general aviation operations may be most at risk” for spatial disorientation.
For the 2025 study, researchers searched the NTSB database for fatal GA accidents in fixed-wing aircraft between 2003 and 2021. Reports were filtered to only include those referencing the term “spatial disorientation” in the factual narrative, probable cause, or text.
Final reports and associated dockets from completed investigations were then reviewed.
A total of 367 fatal GA accidents from 2003 to 2021 included spatial disorientation. The number of accidents each year varied across this 19-year span, from a minimum of nine in 2016 to a maximum of 29 accidents in 2019.
Across this same time span, there were 26,535 GA accidents, with 4,944 being fatal. The overall percentage of fatal GA accidents that involved spatial disorientation was 7.4%.
According to researchers, 714 fatalities were associated with the 367 accidents, including 384 pilots (51.8%), 346 passengers (46.7%), and 11 ground fatalities (1.5%).
“The high cost of life and the high likelihood of fatality underscore the seriousness of experiencing spatial disorientation in flight,” the researchers noted.
Pilot Demographics and Flight Characteristics
The pilots involved in fatal spatial disorientation accidents represented a wide spectrum of ages and levels of experience, the researchers discovered. The average age for pilots was 54.4, with over half of the pilots between 50 and 69 years old.
Average flight time was 1,799 hours. However, the researchers discovered a “cluster” of accidents in pilots with less than 500 hours.
More than 75% of fatal spatial disorientation GA accidents in the study involved IMC, while 44% involved a pilot entering IMC while intending to fly under VFR.
Most of the pilots involved in these VFR to IMC accidents did not hold an instrument rating.
“Importantly, many of these pilots were briefed or were aware of the weather conditions before the flight and still chose to operate under VFR regardless, indicating that these accidents were not due to oversights or sudden changes in weather,” the researchers said. “This is an important area for potential outreach and education within the pilot community that could potentially minimize future spatial disorientation accidents.”
Drugs
To evaluate the incidence of potentially impairing drugs, the researchers matched data from the NTSB database with test results from CAMI’s Forensic Sciences toxicology database.
They found that 90 out of the 367 pilots — 24.5% — had a positive toxicology result, with 86 including at least one potentially impairing drug. The most frequently identified substances included sedating antihistamines, antidepressants, tetrahydrocannabinol or its metabolites (THC), and sedating pain relievers.
While 31 were positive for ethanol, only four of the cases were conclusively attributable to preflight alcohol consumption. These alcohol consumption cases included one with an ethanol blood concentration between 20 and 39 mg/dL (0.02-0.039%) and three with ethanol blood concentrations over 40 mg/dL (0.04%). Blood concentrations over 0.04% are in violation of FAA regulations (14 CFR § 120.37).
Overall, 27 accidents — 25% — included positive toxicology findings for two or more potentially impairing substances, while 14 pilots tested positive for an illicit substance.
While a majority of the pilots had valid FAA medicals on file or met BasicMed requirements, most pilots without valid FAA medicals had positive toxicology results, the researchers discovered.
The Good News
Overall, the incidence of fatal GA accidents related to spatial disorientation has decreased since an initial CAMI analysis in 1978, likely associated with increased education and awareness efforts, according to the researchers.
From 1970 to 1975, 15.6% of fatal GA accidents were related to spatial disorientation. From 1976 to 1992, this percentage dropped to 13.2%, with a clear downward trend that culminated in 9.7% in 1992.
By 2003, the average incidence of fatal GA accidents related to spatial disorientation had dropped to 7.4%, mirroring “an overall decrease in the total number of fatal GA accidents from previous analyses,” the researchers said.
However, while the average for the 2003 to 2021 study was lower than previous studies, there was an upward trend across the 2003 to 2021 period, with a maximum of 12.8% spatial disorientation GA fatal accidents in 2021.
“This highlights the need for continued education efforts,” they added.
“Overall, more research into spatial disorientation is necessary to understand the true incidence of spatial disorientation in GA and to tailor awareness and education efforts to this dangerous occurrence,” the researchers concluded.
You can read the full study, “Spatial Disorientation in Fatal General Aviation Accidents (2003 – 2021)” at FAA.gov.
