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Trypophobia

What Is It, Causes, Treatment, and More

Author: Ali Syed, PharmD

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Abbey Richard

Copyeditor: Joy Mapes


What is trypophobia?

Trypophobia is a fear of holes, typically characterized by an aversion towards clusters of small holes. It is a specific phobia, a condition characterized by a persistent and excessive fear of an object or situation that poses no actual, or very little, danger. People with trypophobia may express disgust or fear when looking at images or objects containing irregular patterns, bumps, or clustered holes, such as in a lotus seed pod. 

What does trypophobia mean?

The term trypophobia is derived from the Greek words “trypta,” which means hole, and “phobos,” which means fear. Therefore, trypophobia literally translates to the fear of holes.

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What causes trypophobia?

The exact cause of trypophobia is unknown, as research in this area is limited. Various triggers of trypophobia have been identified, such as honeycombs, bubble wrap, or fruit seeds. Certain patterns, bumps, patterned animals, and imagery may also trigger trypophobic reactions. Researchers have postulated various theories to explain the origins of trypophobia, including evolutionary causes, associations of similar visual imagery with dangerous animals and diseases, a natural response to visual stimuli, and links to other disorders. 

Trypophobic reactions may be explained as unconscious reflex reactions that have evolved over time as survival mechanisms to avoid danger or disease. For example, images of poisonous animals, such as snakes or insects that have patterned skin or clustered body parts, may trigger trypophobic reactions. Images of diseased skin, characterized by clustered holes or bumps, may also induce trypophobic fear. Researchers have hypothesized that feeling disgust or fear towards such stimuli may be an adaptive evolutionary response meant to alert humans against dangerous organisms and infectious disease. On the other hand, contrary research suggests that trypophobic reactions may simply be a natural human response to certain types of visual stimuli, as opposed to an actual phobia.  

Lastly, some research proposes that people with trypophobia meet the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5) criteria for generalized anxiety, major depressive disorder, and obsessive-compulsive disorder. However, it is unclear whether any of these other conditions cause trypophobia.

How common is trypophobia?

It is estimated that up to 15% of adults may experience trypophobia to some degree, with trypophobia generally more common in females compared to males. However, the exact prevalence of trypophobia is unknown.

What are the signs and symptoms of trypophobia?

Signs of trypophobia may include avoidance of triggers -- images or objects associated with clustered holes -- like certain foods and animals. Symptoms of trypophobia typically present after encountering a trigger and are similar to those of other specific phobias: feelings of fear and disgust, which can result in panic attacks, sweating, and palpitations. Other symptoms of trypophobia may include feelings of discomfort, body shakes, goosebumps, itching, nausea, and vomiting.

How is trypophobia diagnosed?

Trypophobia is not currently listed in  the American Psychiatric Association’s DSM-5 as a mental disorder, so it is not a diagnosable condition. However, trypophobia may be acknowledged by some mental health professionals as a specific phobia if signs and symptoms are persistent and excessive, leading to emotional distress and functional impairment. 

Similar to other phobias, diagnosis of specific phobias by a mental health professional is generally based on an individual’s symptoms, along with a review of their medical, social, and family history. In some cases, physical examination, laboratory tests (e.g., blood tests or urine samples), and brain imaging may be conducted in order to rule out other conditions that may be impacting the individual’s mental health or that result in similar symptoms as trypophobia (e.g., psychiatric disorders, cancers affecting the brain, recent trauma). People with trypophobia may have other coexisting mental health conditions, such as depression, obsessive-compulsive disorder, or disordered substance use. In order to appropriately manage the associated conditions, a thorough evaluation from a mental health professional is very important.

How is trypophobia treated?

Although there are no specific treatments for trypophobia, many of the treatments used for other specific phobias are likely to mitigate symptoms of trypophobia as well. Treatment of specific phobias usually depends on the severity of symptoms and the medical history of the individual. Treatments may involve lifestyle changes, psychotherapy, and, sometimes, medications. 

Lifestyle modifications may include relaxation strategies, like visualizing soothing images, getting enough rest, and practicing mindfulness, meditation, or yoga. Reducing caffeine intake and increasing physical activity may help individuals reduce the severity of their fear reactions. General talk therapy with a mental health professional or support group can also be useful for those managing a phobia. These lifestyle changes are meant to help reduce trypophobia’s symptoms of fear and disgust by encouraging positive coping mechanisms and overall health and wellness. 

Psychotherapy options commonly feature exposure therapy (ET) or cognitive behavioral therapy (CBT) led by a certified mental health professional. In ET, treatment involves exposing individuals to situations that trigger their trypophobia, which gives their minds opportunities to adapt to the triggers, enabling better management of their fears. On the other hand, CBT focuses on changing individuals’ mental, emotional, and behavioral processing of situations that could stimulate their fear of holes, at times also involving exposure.

Depending on an individual’s situation and past treatments, a medical professional may prescribe certain medications to manage symptoms of trypophobia. Benzodiazepines (e.g., lorazepam or clonazepam) or other anti-anxiety medications may help prevent or reduce symptoms of anxiety or panic attacks. Beta-blockers, such as propranolol, may also be prescribed, as they can reduce fear-related symptoms, like increased heart rate, sweating, and dizziness. In some instances, sedatives may help relax and calm the body in triggering situations.

What are the most important facts to know about trypophobia?

Trypophobia is a specific type of phobia characterized by a fear of holes. People with trypophobia may express feelings of disgust or fear, as well as other nonspecific symptoms, when encountering stimuli containing irregular patterns or clustered holes. Trypophobia is not a diagnosable condition, and since the exact cause of trypophobia is unknown and symptoms alone may be nonspecific, identifying specific triggers may help optimize prevention and treatment strategies. Treatment options may include lifestyle modifications, talk therapy with a mental health professional or support group, exposure therapy (ET), cognitive behavioral therapy (CBT), and in some cases, medications. In general, overcoming trypophobia is not a simple process and requires patience, persistence, and dedication from the affected individual.

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Related links

Phobias
Panic disorder
Anticonvulsants and anxiolytics: Benzodiazepines
Anxiety disorders, phobias and stress-related disorders: Pathology Review

Resources for research and reference

Cherry, K. (2020, October 13). Trypophobia or the fear of holes. In Verywell Mind. Retrieved January 24, 2021, from https://www.verywellmind.com/trypophobia-4687678

Kupfer, T., & Fessler, D. (2018). Ectoparasite defence in humans: Relationships to pathogen avoidance and clinical implications. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 373(1751): 20170207. DOI: 10.1098/rstb.2017.0207

LaMottef, S. (2017). TV show triggers little-known phobia. In CNN: Health. Retrieved January 26, 2021, from https://www.cnn.com/2017/09/13/health/trypophobia-fear-of-holes-bumps-clusters 

Le, A., Cole, G., & Wilkins, A. (2015). Assessment of trypophobia and an analysis of its visual precipitation. Quarterly Journal of Experimental Psychology, 68(11): 2304–2322. DOI: 10.1080/17470218.2015.1013970

Martínez-Aguayo, J., Lanfranco, R., Arancibia, M., Sepúlveda, E., & Madrid, E. (2018). Trypophobia: What do we know so far? A case report and comprehensive review of the literature. Frontiers in Psychiatry, 9: 15. DOI: 10.3389/fpsyt.2018.00015

Milosevic, I., & McCabe, R. (Eds.). (2015). Phobias: The psychology of irrational fear. ABC-CLIO. 

Schacter, D., Gilbert, D., Wegner, D., & Hood, B. (2015). Psychology: Second European edition. Palgrave Macmillan. 

Yamada, Y., Sasaki, K. (2017). Involuntary protection against dermatosis: A preliminary observation on trypophobia. BMC Research Notes, 10(1): 658. DOI: 10.1186/s13104-017-2953-6