Phobias Trypophobia and the Fear of Holes Risk Factors for TrypophobiaByKendra CherryKendra CherryFacebookTwitterKendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.Learn about our editorial processUpdated on July 30, 2022Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MDMedically reviewed bySteven Gans, MDSteven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.Learn about our Medical Review BoardFact checked Verywell Mind content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Aaron JohnsonFact checked byAaron JohnsonAaron Johnson is a fact checker and expert on qualitative research design and methodology. Learn about our editorial processVerywell / Andrea Hickey Table of Contents View All Table of ContentsDefinitionTriggersSymptomsCauses of TrypophobiaRisk Factors for TrypophobiaTreatments for TrypophobiaCognitive Behavioral Therapy (CBT) Trypophobia is an aversion or fear of clusters of small holes, bumps, or patterns. When people see this type of cluster, they experience symptoms of disgust or fear. Examples of objects that might trigger a fear response include seed pods or a close-up image of someone's pores. There is some debate among researchers as to whether trypophobia is a genuine condition. Early reports of trypophobia were first described in an online forum in 2005, but it has not been recognized as a distinct diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.While not listed in the DSM-5, trypophobia would fall under the broad classification of specific phobias as long as the symptoms are persistent, excessive, and lead to significant impairment or distress. What Is Trypophobia? Trypophobia is often described as “the fear of holes,” but it is important to note that it may also apply to bumps or other patterns that are closely clustered together. When people see trigger objects, they experience symptoms such as severe fear, nausea, itching, sweating, shaking, and even panic attacks. Fear is one common symptom, but disgust is often described as the overwhelming emotion that people feel with this phobia. Trypophobia also tends to be highly visual. Seeing images online or in print is enough to trigger feelings of revulsion or anxiety. 1:30 Click Play to Learn More About the Phobia of HolesThis video has been medically reviewed by Steven Gans, MD. One case report illustrates how trypophobia often presents. The patient, a 12-year-old girl, experienced feelings of discomfort when she encountered surfaces and objects covered with holes or dots. When asked to draw a picture of her fear, she filled a paper with a repetitive pattern of clustered, round dots. How Common Is Trypophobia?While prevalence is unknown, some research indicates that trypophobia may be quite common. One 2013 study published in the journal Psychological Science found 16% of participants experienced feelings of disgust or discomfort when looking at an image of a lotus seed pod. Common Triggers of Trypophobia Research on trypophobia is still relatively rare, but some of the trigger objects that have been observed include:Bubble wrapBubblesCondensationCoralFruit seedsHoles in diseased or decaying fleshHoles or bumps on fleshHoneycombsInsect eyesLotus seed podsPomegranatesSpongesStrawberries Man-made patterns, as well as animals that have spotted or patterned coats, can also cause a phobic reaction. Symptoms of Trypophobia The symptoms of this condition are similar to those of other specific phobias. After seeing clusters of small holes or bumps, whether in person or in an image, people often experience:Emotional distressFear and anxietyFeelings of revulsionGoosebumpsItchingNauseaPanic attacksRapid breathingShakingSweatingVomiting Symptoms are persistent, leading to functional impairments in daily living. Trypophobia can lead to symptoms related to fear, disgust, or both, although research suggests that people report feeling greater disgust rather than fear. In addition to experiencing symptoms such as fear and disgust, people with trypophobia will often experience behavioral changes as well. Avoidance of trigger objects is common. For example, a person might avoid eating certain foods (such as strawberries or aerated chocolate) or avoid going to certain places (such as a room with dotted wallpaper). Causes of Trypophobia Research on trypophobia is still quite limited, but there are some theories about why it happens. Evolutionary Causes According to one of the most popular theories, trypophobia is an evolutionary response to things that are associated with disease or danger. Diseased skin, parasites, and other infectious conditions, for example, may be characterized by such holes or bumps. This theory suggests that this phobia has an evolutionary basis. It is also consistent with the tendency for those with trypophobia to experience greater disgust than fear when they see a trigger object. Associations With Dangerous Animals Another theory suggests that clustered holes share a similar appearance to skin and coat patterns on some venomous animals. People may fear these patterns out of unconscious associations. There is some research that supports this idea. A 2013 study looked at how people with trypophobia respond to certain stimuli in comparison to those without the condition. When viewing a honeycomb (a common trypophobic object), people who don't have trypophobia immediately think of things such as honey or bees. The researchers believe that those with trypophobia non-consciously associated the sight of a honeycomb with dangerous organisms that share the same basic visual characteristics, such as rattlesnakes. While they are not consciously aware of this association, it may be what causes them to feel feelings of disgust or fear. Associations With Infectious Pathogens A 2017 study found that participants tended to associate hole patterns with skin-transmitted pathogens. Study participants reported feelings of skin-itching and skin-crawling when viewing such patterns. Disgust or fear of potential threats is an adaptive evolutionary response. In many cases, these feelings help keep us safe from danger. In the case of trypophobia, researchers believe it may be an overgeneralized and exaggerated form of this normally adaptive response, A Response to Visual Characteristics Some research suggests that the discomfort people feel has more to do with the visual characteristics of the patterns themselves. One study published in Psychological Reports found that while people experience discomfort when viewing trypophobic patterns, these feelings were more related to the visual patterns themselves than to associations with dangerous animals. Such results call into question whether or not trypophobia is actually a phobia at all, or simply a natural response to certain types of visual stimuli. Risk Factors for Trypophobia Symptoms of trypophobia typically meet DSM-5 diagnostic criteria for specific phobias rather than other conditions such as obsessive-compulsive disorder (OCD). However, researchers have found that people with trypophobia were more likely to experience other conditions, too. These include: Depression Generalized Obsessive-compulsive disorder (OCD)Panic disorderBipolar disorder It's more common in women and in people with close relatives who also have trypophobia. Treatments for Trypophobia No specific treatment has been demonstrated particularly effective in the treatment of this condition. However, many of the treatments used for specific phobias and mood disorders are also likely to be helpful in reducing symptoms. Cognitive Behavioral Therapy (CBT) Cognitive behavioral therapy (CBT) involves working with a therapist to change the underlying thoughts and behaviors that might contribute to trypophobia. This might involve discussing unrealistic thoughts, replacing these with more realistic ones, and then making changes in behaviors. CBT might also involve gradual exposure to feared things or situations to decrease one's reactions to them. One of the reasons people experience phobia symptoms is because they often believe there is something inherently dangerous or threatening about the fear object. This leads to negative automatic thoughts as soon as they encounter the source of their fear. Exposure therapy, a type of CBT, involves progressively exposing a person to their fear object with the hope that fear symptoms will lessen over time. This process is usually done very gradually. A person may start by imagining what they fear, then looking at pictures of the fear object, and then finally being near or even touching the source of their anxiety. In the case of trypophobia, a person with symptoms may start by simply closing his eyes and imagining something such as a honeycomb or seed pod. They will continue working on this activity until symptoms start to recede. Once he is able to imagine the object without a response, he will move onto the next step, which often involves looking at an image of an object that normally triggers symptoms.Through CBT, people work to replace their often irrational beliefs and negative thoughts with more positive and realistic ones. With exposure therapy, patients may potentially encounter an object without feeling excessive disgust, fear, or anxiety. Relaxation Techniques Different relaxation strategies can also be useful for reducing feelings of disgust, fear, or anxiety. Visualization, deep breathing, and progressive muscle relaxation are a few strategies that might be helpful. Visualization involves picturing soothing images or situations. A person with trypophobia might try to envision a beautiful sunset or a field of flowers whenever they encounter something covered with tiny holes. A simple distraction can also be a useful coping technique. If you see something that triggers a trypophobic response, you might simply look away and find something else to think about or look at until your symptoms ease. Medications Anti-depressant or anti-anxiety drugs may sometimes be prescribed, particularly if the individual also experiences depression or anxiety. These may include selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or beta-blockers. These medications may be used alone, but they are often used in conjunction with another treatment approach such as CBT or other types of psychotherapy. Get Advice From The Verywell Mind PodcastHosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares how to face your fears in a healthy way.Follow Now: Apple Podcasts / Spotify / Google Podcasts A Word From Verywell While trypophobia has been discussed rather extensively online, psychologists are still split on whether it represents a genuine phobia. It is not currently recognized by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Further research is needed to determine the nature of the condition, its prevalence, and its treatment. Fortunately, most people who experience this condition can find relief through treatment options ranging from therapy to medication to self-help. 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Can W, Zhuoran Z, Zheng J. Is Trypophobia a phobia?Psychological Reports. 2017;120(2):206-218. doi:10.1177/0033294116687298Martínez-Aguayo JC, Lanfranco RC, Arancibia M, Sepúlveda E, Madrid E. Trypophobia: What do we know so far? A case report and comprehensive review of the literature. Front Psychiatry. 2018;9:15. doi:10.3389/fpsyt.2018.00015Cole GG, Wilkins AJ. Fear of holes. Psychological Science. 2013;24(10):1980-1985. doi:10.1177/0956797613484937Wabnegger A, Schwab D, Schienle A. The hole story: an event-related potential study with trypophobic stimuli. Motiv. Emot., 2019;43(6):985–992. doi:10.1007/s11031-019-09784-8American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). 5th edition. Washington, DC: American Psychiatric Association; 2013.Vlok-Barnard M, Stein DJ. Trypophobia: an investigation of clinical features. Revista Brasileira De Psiquiatria (Sao Paulo, Brazil: 1999). 2017;39(4):337-341. doi:10.1590/1516-4446-2016-2079Kupfer TR, Le ATD. Disgusting clusters: trypophobia as an overgeneralised disease avoidance response. Cognition & emotion. 2018;32(4):729-741. doi:10.1080/02699931.2017.1345721Can W, Zhuoran Z, Zheng J. Is Trypophobia a phobia?Psychological Reports. 2017;120(2):206-218. doi:10.1177/0033294116687298Akinci MA, Uzun N. Sertraline for trypophobia: Report of an adolescent case. Clinical Neuropharmacology. 2020;43(6):196-197. doi:10.1097/wnf.0000000000000414Anxiety & Depression Association of America. Types of therapy. Additional ReadingLe ATD, Cole GG, Wilkins AJ. Assessment of trypophobia and an analysis of its visual precipitation. Q J Exp Psychol. 2015;68(11):2304-2322. doi:10.1080/17470218.2015.1013970By Kendra Cherry Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. 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