Trypophobia is derived from the Greek word ‘trypa.' The word trypa means a 'drilling' or a 'hole.' Phobia is described as a state of extreme and persistent fear that is generated unconsciously. The fear triggers anxiety upon facing a trigger or triggers (usually specific for an individual).

Trypophobia is a phobia or undue fear. The fear is usually expressed as disgust shown by a person. the trigger of trypophobia is arrangements of holes that are closely packed.

in some other instances, the trigger of trypophobia may be a cluster arrangement of other specific patterns.

What is common in all triggers of trypophobia is the close arrangement, which is a signature feature.  

Who does not loves to pop a bubble wrap? A fun thing to do, right. Yet, the mere sight of a bubble wrap may trigger a phobic attack in some people. 

Examples of some triggers that are often observed to initiate a Trypophobia attack include;

• head of a lotus seed pod
• strawberry with tightly packed tiny seeds on its exterior
• close-up image of someone's pores
• honeycombs
• sliced or seed-covered bread
• sliced block of cheese
• clothes with polka dots
• an animal print

Trypophobia has many controversies tagged with it.  Some call it a myth. On the other hand, individuals with Trypophobia present with real-time signs and symptoms of a fear attack.

The topic of Trypophobia is still under study. That is why it is difficult to number its prevalence. Yet, according to the research studies conducted, researchers observed it to be a pretty common condition.

According to a study, it was found that 16% of participants experienced and expressed their feelings of disgust (discomfort) while looking at a picture of a lotus seed pod (1).

What is Trypophobia?

Trypophobia is 'fear of holes.'

The earlieset description of Trypophobia was described in 2005. However, there has been no definitive or distinct diagnosis of Trypophobia in the fifth edition of the 'Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association' till date. 

Yet, a person with the condition show an intense fear towards

• Holes
• Repetitive patterns
• Protrusions
• Projections

The DSM-5 manual does not give any specific definition of Trypophobia. The condition is categorized under a general classification of phobias. The symptoms should be persistent, intense, and distressing enough to impair everyday life routine significantly.

It is observed that Trypophobia is not only fear but also includes a feeling of disgust when faced with the triggering stimuli.

The symptoms of Trypophobia are highly visual (2). Seeing a repetitive pattern directly or online can trigger a phobic response.

This was confirmed by an evaluation of a clinical case involving a 12-year old girl with symptoms of Trypophobia.

The child expressed feelings of discomfort upon encountering surfaces or objects covered with holes or dots. Her therapists asked the girl to draw what was scaring her. The drawing done by the girl showed a repetitive pattern of round dots that were clustered together (3).

What triggers Trypophobia?                                     

Some of the common triggers for Trypophobia are the following. They are concluded from available research and include (4);

• Bubble wrap
• Bubbles
• Condensation particles
• Coral
• Fruit seeds (strawberries)
• Pit holes in a decaying flesh made by fleas
• Bumps on flesh or skin pores
• Honeycombs
• Insect eyes
• Lotus seed pods
• Pomegranates
• Sponges
• Lotus seed pods
• Aluminum metal foam
• Cantaloupe
• An eye (enlarged picture of the eye of a housefly)
• Skin or fur of animals with spot arrangement (insects, amphibians, mammals, etc.)
• Artificial patterns

What are the symptoms of Trypophobia?

Fear and disgust are tagged with Trypophobia. The phobic attack of Trypophobia presents itself with the following signs and symptoms (5):

• Appearance of goosebumps
• A feeling of repulsion and disgust
• An intense feeling of distress and discomfort upon seeing trigger images
• Visual complaints as eyestrain, distortions, or illusions
• A sense of something crawling on the skin in the absence of any visible element
• Panic attacks
• Shaking body
• Sweating
• Nausea
• Emotional agony
• Fear and anxiety
• Itching on body
• Nausea and vomiting
• Rapid and shallow breathing
• Behavioral changes including avoidance of triggers (for example, not eating fruits like fresh strawberries, avoiding places adorned with dotted wallpaper)

What causes Trypophobia?

The research is still on to identify the underlying causes of Trypophobia. Researchers put forward theoretical explanations for the possible reasons for Trypophobia. Some of these include;

• Evolutionary Causes

According to some researchers, Trypophobia extends from the intrinsic natural fear of harmful stimuli. Moving away from harmful stimuli is a learned behavior of humans. These fears keep us safe from danger by acting as a trigger for flight or fight phenomena.

Trypophobia is an exaggerated and inflated form of this normal adaptive response, according to researchers.

Researchers describe Trypophobia as an acquired response to things related to disease and any other imminent danger. Skin diseases, harmful infections, and parasitic infestations often present as holes, lumps, and bumps.  

People who have Trypophobia are not afraid of the stimulus. instead, they are more disgusted with it. This signifies that the intrinsic learned behavior of moving away from damaging stimuli evolves into fear and disgust in people with trypophobia. 

• Associations with dangerous animals

The people affected by Trypophobia develop and associate harmless things (for example, lotus seed pods) with dangerous animals (like a blue-ringed octopus).

The theory suggests that clustered holes appear similar to some venomous animals' skin, coat, or fur appearance. People exhibit intrinsic fear of these animals by developing associations with these patterns without any conscious control.

Some pieces of research support this theory. A study involving two groups compared people with Trypophobia and the other without the condition (1).

The group with Trypophobia, upon seeing a honeycomb, stated that thought of things such as honey or bees came up.

The researchers postulated that the group with Trypophobia had developed an unconscious association between the sights of a honeycomb with a dangerous insect, the bees, thereby creating a feeling of disgust for the image.

In contrast, some other pieces of research disagree with the findings described above.

A recent study surveyed pre-school children to evaluate their response to seeing an image with holes (6). They also analyzed whether the fear was linked to visual traits of the graphic presentation or based on fear of dangerous animals.

The study results concluded that people who have Trypophobia are not afraid of poisonous and potentially harmful animals. Instead, the fear and disgust shown by people with Trypophobia were associated with how the physical looks of the creature.

• Associations with infectious agents

A study conducted found that people with Trypophobia reported a feeling of something crawling on their skin. They also exhibited signs of itchy skin when exposed to pictures of hole patterns caused by skin-transmitted pathogens (7).

This seconds the exaggerated evolutionary response theory.  

• A Response to Visual Characteristics

Some research suggests that the discomforting feeling experienced by people with Trypophobia has more to do with the visual features of the holes.  

One of the studies concluded that the triggers for Trypophobia resemble the basic graphic features of dangerous animals (7). The colors depicted in high contrast with the specific arrangement are responsible for triggering a phobic attack.

These features were defined as being low-level. That means the brain quickly works out the images.

That is why the triggers for Trypophobia instigate a rapid subconscious response in the brain. These are translated as the signature signs and symptoms of Trypophobia.

• Links to other disorders

This theory says Trypophobia is associated and often present as a parallel condition with other mental health disorders. It says that the state may be a sign of disease progression of some underlying mental health disorder (explained in the next section).

Are there any risk factors involved?

Research is ongoing to find all that is relevant to Trypophobia. Some researchers have linked Trypophobia with certain mental health disorders (8). These include;

• Major depressive disorder
• Generalized anxiety disorder
• Social anxiety (9)
• Obsessive-compulsive disorder

Diagnosis of trypophobia

Since trypophobia is not categorized as a definitive phobia, it is difficult for a therapist to diagnose the condition.

A doctor takes complete history from a patient regarding all signs and symptoms. These may be related to

• Medical issues
• Social behavior
• Psychiatric health

Treatment of Trypophobia

A mental health care expert treats and helps manage a patient the signs and symptoms of Trypophobia.

Fortunately, treatment modules for other phobias and mood disorders are observed to help manage Trypophobia (10).

The treatment for Trypophobia is a combination of many modules usually focusing on managing the symptoms.  The mental health expert helps the patient learn appropriate behavior and response when exposed to a triggering environment. This is done via:

• Exposure therapy

Exposure therapy is when a patient is exposed to a specific trigger that instigates disgust or fears multiple times. The therapist helps the patient to learn the appropriate response to that stimulus.

Exposure therapy is a subtype of CBT. It involves a progressive exposure of a person to the potential triggers. It gradually alleviates the symptoms of Trypophobia over time.

Exposure therapy makes people imagine their fears. Then the patient is made to see real-time or pictorial images of the specific triggers. The therapist may ask the patient to move closer to the triggering stimuli to ward off their fear or disgust. Sometimes the patient is asked to touch the stimulus.

For example, treating a person with Trypophobia may start by simply imagining a honeycomb or seed pod. This is continued over repeated sessions.

Repeated exposure causes the symptoms to start to recede. A patient can imagine a trigger without exhibiting a negative response, which calls for the next step. This involves looking at an image of the trigger object for some time and repeated sessions.

• Cognitive-behavioral therapy (CBT)

CBT is usually employed simulatneous intervention to exposure therapy for trypophobia. It helps the patient to gain control over their negative response, a move that keeps the anxiety under check.

A therapist trained in CBT employs the therapy to an individual. The therapist helps the patient to change the underlying thoughts and ideas contributing to Trypophobia via CBT.  

This usually involves talk therapy with the patient, targeting unrealistic thoughts and replacing them with accurate ones. This automatically changes the behavior of the patient with Trypophobia.  

Phobias are often generated because a patient believes that the trigger is inherently threatening. CBT tries to replace these negative thoughts associated with Trypophobia.

• Talk therapy

Talk therapy is another remedial solution for Trypophobia that parallels and syncs with CBT and ET. It involves a psychiatrist engaging in talk and conversation with a patient to help steer away from the thought process from negativity.

• Medicines

Drugs are suggested in patients who suffer from severe symptoms of trypophobia that disrupt sleep and result in socially unacceptable behavior. The medicines used for trypophobia include sedatives and anti-anxiety drugs.

Medication

 helps patients with trypophobia as it often co-exists with other mental health disorders, medication is beneficial.  Medicines like Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or beta-blockers are often prescribed to patients of Trypophobia because of the accompanying depression and anxiety.

Medications are not used as the sole treatment for trypophobia.

They are usually recommended as part of combination therapy alongside CBT or exposure therapy.

• Alternative remedies

Relaxation techniques like deep breathing, yoga, visualization, progressive muscle relaxation, and mindfulness are some essential measures that help manage the anxiety and fear of trypophobia.

Distraction is also a way of managing Trypophobia. A patient is asked to look away from a trigger. Replacing the image of a trigger with some pleasant picture or memory is also advised by a therapist.  

Lifestyle remedies for Trypophobia

Encouragement is of great significance while addressing fear and anxiety in patients with Trypophobia. This helps introduce a positive outlook on life which ultimately enables one to combat fear and disgust with things usually encountered in life.

• Consuming a healthy and balanced diet
• Maintaining hydration
• Avoiding sleep debt by following regular sleep habits and taking ample rest
• Avoiding dietary ingredients (like caffeine) that contribute to anxiety and restlessness
• Quitting smoking
• Maintaining a healthy social circle
• Reaching out to friends and family when seeking help
• Connecting with support groups to learn coping mechanisms for Trypophobia

Take home message

Though not an officially recognized phobia, patients with intense fear and disgust for holes or specific arrangements show symptoms in real-time; finding the root cause is vital to treat Trypophobia, a subject that requires extensive research. Cognitive-behavioral and exposure therapy, medication, and self-care, when combined, help to manage the symptoms and give lasting relief from symptoms of Trypophobia.