Is Trypophobia Really a Fear of Holes or Something Else Entirely?

Though the internet has its flaws, it’s excellent at bringing together like-minded people, whether they’re stanning one true pairing, trading cat GIFs, or planning protests. One group of individuals who have found community online are those who identify as having trypophobia, a term used to describe a fear of or aversion to clusters of holes. (Or even things that might look like clusters of holes.)

Not sure if this applies to you? Ask yourself if looking at something dotted with holes, like a honeycomb, makes you shudder involuntarily. If you’re really brave, you can try googling “lotus flower seed head” and seeing how the images make you feel. We’ll wait, but don’t say we didn’t warn you: This plant is a loathed and notorious trypophobia trigger.

If you have trypophobia, looking at objects covered in holes can stir up waves of discomfort. You might start to shake; feel like crying (or actually cry); suddenly become itchy or nauseated; feel short of breath, panicky, or sweaty; or experience a racing heart. To some mental health experts, this reaction clearly designates trypophobia as a “true” phobia that can be severe enough to qualify as a mental disorder. Others aren’t so sure. Here, we’re diving deep into what experts think trypophobia really is and is not.

The origins of a debated term

Your first question might be: Why is it called trypophobia if experts haven’t agreed it actually qualifies as one? Well, because experts don’t seem to have been the ones to come up with the name.
It’s impossible to know for sure who first coined this term for an irrational fear of holes. Trypophobia lore, however, holds that the moniker sprang from a GeoCities page, of all things.

In 2005 a blogger going by the name Louise wrote that she’d consulted Oxford English Dictionary spokesperson Margot Charlton about the correct way to combine the Ancient Greek prefix trypa, meaning “holes,” with phobia, meaning “fear.” As Louise wrote on GeoCities, Charlton reportedly explained that “trypophobia” would be the grammatically correct phrasing, resulting in the creation of a term that gets over 1 million results when you type it into Google. The naming process was apparently as scrappy as you’d expect for a condition that is mostly self-diagnosed, since no official diagnostic criteria for it exist.

Unlike anxiety disorders such as social phobia (also known as social anxiety) and agoraphobia (a fear of situations that it would be hard to escape), trypophobia isn’t explicitly listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. The DSM-5 is published by the American Psychiatric Association (APA) and considered the definitive professional resource for diagnosing and treating psychological conditions in the United States. To some experts, that—along with other factors we’ll get into later—means trypophobia’s existence as a “real” phobia is up in the air.

The DSM-5 does have an entry for specific phobias, though, describing them as almost always provoking immediate “marked fear or anxiety about a specific object or situation.” Other identifying characteristics include:

• the fear or anxiety being out of proportion to the actual danger at hand;
• the person with the phobia avoiding the object or situation they fear (or enduring it with intense anxiety);
• the person experiencing “clinically significant” distress or impairment in areas like work or personal relationships;
• the fear, anxiety, and avoidance lasting for a long time, typically six months or more;
• the reaction not being explained by other mental health conditions.

The DSM-5 groups specific phobias into the following categories: animal type, natural environment type (like a fear of heights), blood-injection-injury type (like a fear of needles), situational type (like a fear of flying), and “other type.” Since trypophobia wouldn’t fall into any of those first four categories, that last one is particularly interesting. The DSM-5 explains that someone can have a phobia if they experience the above symptoms in response to a trigger. For some people that trigger appears to be holes—trypophobia’s lack of mention in the DSM-5 be damned.

According to the APA, the DSM-5 is an evolving handbook based on research breakthroughs and new clinical knowledge. As many who research and experience trypophobia will have you know, just because the DSM-5 doesn’t outright discuss trypophobia doesn’t automatically mean it isn’t a very real phenomenon that can cause discomfort or even debilitating distress.

“Once triggered, I feel nauseous [and] dizzy,” Estelle, 27, who experiences trypophobia, tells SELF. “I usually have to pause whatever I’m doing and step away. It’s not something I can power through or ignore—it feels like all of my other senses are really overwhelmed with how freaked out I am, and I shut down until the stimuli is removed.”

There has been limited research into trypophobia, so it’s hard to say how many people relate to Estelle’s experience. A 2013 study in Psychological Science that described trypophobia as “hitherto unreported in the scientific literature” did look into prevalence. The researchers found that 16% of the 286 participants thought photos of the infamous lotus flower seed head were “uncomfortable or even repulsive to view.” Obviously this is a pretty tiny number of people to survey research-wise, so it’s not clear exactly how this figure applies to the general population. However, some researchers have pointed out that many people online appear to share these feelings about clustered holes, suggesting that trypophobia could be more common than previously thought.

What is it about these images?

That Psychological Science study explored the shared visual properties of objects that trigger trypophobia. According to the researchers, these items (or pictures of them) tend to have relatively high-contrast energy at midrange spatial frequency. Kudos to you if you’re nodding sagely like, “Ah, yes, of course.” If you need that translated into non-scientist speak, though, this basically means that these images tend to have small, closely grouped, repetitive patterns with a stark contrast: The light parts are very light and the dark parts are very dark.

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“The greater the contrast, the greater the [trypophobic] reaction,” study co-author Arnold Wilkins, D.Phil., professor emeritus of psychology at the Department of Psychology at the University of Essex in the United Kingdom, tells SELF. “Holes have high contrast because of the shadows from directional lighting.”

Because of the core visual properties that seem to underlie these images, trypophobia triggers can be more varied than its etymology would suggest. “The shapes don’t have to be holes,” Tom Kupfer, Ph.D., a research associate in the Department of Social and Organizational Psychology at Vrije Universiteit Amsterdam who has published work on trypophobia, tells SELF. Any pattern made of small repeating shapes with high contrast can do it. In a 2018 Frontiers in Psychiatry case study, a girl with trypophobia reported being triggered by seeds on bread, polka dot or animal prints, holey cheese, and honeycomb. People in a trypophobia support group on Facebook that has more than 13,600 members have discussed how everything from the ends of hollow stacked pipes to bumpy frogs’ backs can trigger their symptoms.

Why do these relatively high-contrast energy at midrange spatial frequency images trip the trypophobia alarm for some people? You probably won’t be shocked to hear that there appear to be some fairly intricate brain processes happening here.

Your brain on trypophobia

There are two prevailing theories about why looking at clusters of holes (or similar patterns) can stoke negative feelings, R. Nathan Pipitone, Ph.D., assistant professor of psychology at Florida Gulf Coast University, tells SELF (his research looks at how biology and evolution impact human behavior (including trypophobia).

The first draws on Wilkins’s research suggesting that trypophobic images mimic patterns on poisonous or dangerous animals: think leopard spots or the markings on the highly venomous blue-ringed octopus. The other theory—which Pipitone says is currently most researchers’ favorite—says that clusters of holes are visually similar to rashes or lesions caused by parasitic or infectious diseases.

Either way, experts believe trypophobia stems from natural selection. Historically, people with an aversion to these animal markings or signs of disease would typically have been more likely to avoid anything bearing these patterns. This could mean they weren’t eaten, poisoned, or infected and were thus around to pass on their genes compared with those who didn’t know to stay away.

With this in mind, researchers believe that many people experience some degree of discomfort when looking at trypophobia-inciting images. “As with any adaptive reaction [such as a fear of snakes], most people experience the reaction at normal levels, whereas others may experience it in excess, leading to a phobia,” Stella F. Lourenco, Ph.D., associate professor of psychology at Emory University Department of Psychology, tells SELF.

Like other phobias, some people’s fear of holes seems to have started as a result of a bad experience lodged in their memory. “Some sufferers remember and can describe a certain traumatic event in their childhood when the trypophobia began,” Wilkins says. One example appears to be skin diseases: A 2017 report in the journal BMC found that across two studies with a combined total of 1,546 participants, people with a history of skin conditions were more likely to experience trypophobia.

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However, because these things are rarely clear-cut, not everyone remembers exactly when their trypophobia started. Some people say they’ve always been repulsed by the sight of clustered holes. According to researchers, even without an inciting event, certain personality traits might make people more susceptible to this fear. As a 2016 SpringerPlus study on trypophobia proneness explained, a phenomenon known as core disgust may be a big one.

That brings us to a persistent question at the center of trypophobia research: Are people really even experiencing a fear of holes at all? Or is it something different entirely?

The emotional root of trypophobia—and if it even really matters

Some trypophobia researchers posit that people with a strong aversion to holes might not be experiencing fear so much as disgust. For some, this throws a wrench into the idea that trypophobia is a phobia at all.

In a 2018 PeerJ study, 44 participants were shown pictures of threatening animals, items covered in holes, and “neutral” objects like a cup or a butterfly. The researchers measured the size of participants’ pupils throughout to gauge their subconscious reactions to these images. They found that when people looked at the “scary” animal photos, their pupils dilated relative to their baseline, and when they looked at hole-filled images, their pupils constricted relative to their baseline. According to the researchers, this lends credence to the thought that trypophobia may really be rooted in disgust, not fear.

All this eye talk might sound weird and unrelated to trypophobia, but pupil changes are involved in how you react to both disgust and fear. It all comes down to your autonomic nervous system (ANS).

Your ANS works pretty damn hard for you by controlling involuntary processes like your heartbeat and digestion. To do its job, your ANS is divided into two parts: your sympathetic nervous system (SNS) and your parasympathetic nervous system (PNS). Although it’s far more complex than this, for our purposes, you can think of the SNS as the accelerator of your ANS and your PNS as the brake. When something scares you, your SNS kick-starts your fight-or-flight response. You get a surge of adrenaline, your heart rate speeds up, your stomach winds up into a knot—and, less noticeably to you, your pupils dilate to allow you to see better. In contrast, disgust appears to mainly trigger the PNS, causing a cascade of physiological changes including pupil constriction. When it comes to disgust, this reaction is thought to be your PNS trying to get you to withdraw from the perceived threat and get it away from your body.

This nit-picking over exactly which emotion trypophobia triggers might seem petty. If bunches of holes make you want to run away screaming, does it really matter why? According to some experts, yes, it does. Since different parts of the brain are involved to different degrees in generating fear and disgust (notably the amygdala and the anterior insula, respectively), parsing this out may help mental health professionals tailor trypophobia treatment accordingly, says Lourenco, who co-authored the study on pupil size. “There are also commonalities between fear and disgust, which should be considered when considering treatment options,” she adds.

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To Lourenco’s point, fear and disgust are really similar. So much so that it makes perfect sense that they would play off each other. Fear, anxiety, and disgust have the same broad purpose of trying to get us away from things our bodies think could hurt us, whether that’s a tarantula or someone’s weeping skin rash.

The really fascinating part here is that even if disgust were the underlying cause of trypophobia, that wouldn’t necessarily preclude it from being designated an actual phobia in future editions of the DSM. Remember that blood-injury-injection phobia in the DSM-5 that we mentioned earlier? (It’s also referred to as BII phobia for a bit less of a mouthful.) As its name suggests, this phobia involves an irrational aversion to anything related to blood or injury, injections, and other medical procedures. But some research has found that when people with BII phobia are shown an image intended to stimulate their fear, their bodies respond in ways that can be indicative of disgust.

While digging into the roots of trypophobia is fascinating, it doesn’t matter as much as the day-to-day impact it can have on some people’s lives. This is what makes many experts—and people living with trypophobia—categorize it as a valid phobia.

“The most important factor in my and many others’ view is how much disruption the condition causes,” trypophobia researcher Kupfer tells SELF. “There is evidence showing that trypophobia can cause considerable discomfort and suffering, and it can disrupt normal daily functioning at work and home. Several sufferers told us, for example, that the images in their [minds] prevent them from sleeping. Another said she had to quit her job as a nurse to avoid seeing anything with clusters.”

Ultimately, even if the fundamental cause is disputed, people with trypophobia have to learn to live in a world full of potential triggers.

Coping with trypophobia

Exposure therapy is one of the most commonly suggested treatments for issues like trypophobia, Wilkins says. It involves gradually facing your trigger until your brain no longer perceives it as a threat or you’re able to calm your fears with strategies you learn as part of the therapy. While exposure therapy can be effective, it can be really difficult for the patient to tolerate, Wilkins explains, so researchers are working on new ways to tackle trypophobia, including covering one eye—a treatment that has been shown to help in types of epilepsy where seizures are triggered by specific types of images.

Since research on trypophobia and possible treatment for it is still evolving, those with this aversion often come up with their own ways to cope.

After stumbling upon a triggering image, Estelle tries to find soft, smooth visual stimuli instead, explaining that it feels “safe.” She also takes lots of deep breaths or even goes out for a run if possible so she can channel that fight-or-flight energy elsewhere. Everyone has their methods for managing while science tries to catch up.

“I know that enough other people feel this way that there’s a name for it,” Estelle says. As for the people who don’t think trypophobia is “real”? “It doesn’t really matter. It is my experience, and I know that that’s real.”