Trypophobia

Why trypophobia does not fit the phobia category

No diagnostic manual carries trypophobia. It has no entry in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and a clinician meeting a case that involves persistent, excessive fear with real distress or impairment files it under specific phobia, a general category taking a particular complaint on loan.

The trouble is that the complaint may not be fear. A reaction assembled mostly or wholly out of disgust sits badly inside a category defined around fear. Wikipedia describes a study in which most participants with trypophobia satisfied the DSM-5 definition of a specific phobia while reporting disgust and no fear at all, then failed the same definition at the other end by not reaching the threshold for distress or impairment. The study is not named where the finding is given.

Obsessive-compulsive disorder is the other neighbour. Wikipedia reports that a minority of people with trypophobia, described only as significant, reach the DSM-5 threshold for obsessive-compulsive disorder, and gives no proportion and no study. Martínez-Aguayo and colleagues list major depressive disorder and generalised anxiety disorder as common comorbidities, while Le and colleagues concluded that general anxiety does not produce the reaction.

Where the word trypophobia came from

Greek supplies both halves: trŷpa, a hole, and phóbos, fear. Read literally it means fear of holes, which is how most list sites gloss it, and the gloss is wrong twice over. The reaction is usually not fear, and one hole does nothing. Repetition is the condition.

The coinage is credited to a participant in an online forum in 2005. The forum is not identified, the participant is not identified, no post is quoted and no month is given, and Wikipedia hedges the attribution itself as something believed rather than established. A term with a research literature, a symptom questionnaire and a settled place in ordinary internet vocabulary has no traceable first use.

What sets trypophobia off

Triggers fall into two piles with nothing in common but their geometry:

• harmless: bubbles, fruit, the seed head of a lotus
• not harmless: holes bored by insects, wounds, and diseased tissue, the example given being the damage mango flies do to animals, dogs especially

The response is autonomic before it is anything else, and its mildest form is a cringe. Reported reactions include:

• shuddering, shaking and the sensation of the skin crawling
• sweating, palpitations, nausea and itching
• goose bumps and panic attacks
• eyestrain, distortion and illusion, which are visual rather than bodily
• nosebleeds

That last one is what a symptom list built from self-report looks like.

Why trypophobia might be about venom or about disease

Geoff Cole and Arnold Wilkins hold that the reaction is an "unconscious reflex reaction" resting on biological revulsion rather than on anything learned. Their supporting observation is that several venomous animals, certain snakes and insects and spiders among them, carry markings with the visual properties of the trigger images, and the frog Pipa pipa is named as a trigger on the same footing. Fear of snakes and fear of spiders attach to an animal. This attaches to an arrangement, and follows it onto a seed head, a wall or a phone. Can and colleagues consider the evolutionary link weak and argue that where it exists at all it appears later in life rather than in childhood.

The second account points at disease. Yamada and Sasaki argued that the images resemble diseased skin closely enough to borrow the aversion diseased skin attracts. Kupfer and Le tested a version of that idea and found a split: participants with and without trypophobia were both averse to cluster images carrying a disease meaning, and only the trypophobic participants were also averse to clusters with no disease relevance whatever. Martínez-Aguayo and colleagues read the result as support for an aversion to clustered stimuli overgeneralised from a parasitic and infectious threat, since neither sensitivity nor neuroticism accounted for the difference.

Both accounts rest on a claim about the pictures rather than about the people. Cole and Wilkins describe the trigger images as carrying unusual contrast energy concentrated at midrange spatial frequencies, and Martínez-Aguayo and colleagues describe the property as spread across the low and midrange bands together. An Trong Dinh Le, Cole and Wilkins built a symptom questionnaire on that basis, and it is the only instrument the term has.

How common trypophobia is

How many people have trypophobia is not known, and the encyclopedia says so plainly. The single figure on record is that 16 per cent of the 286 people in a 2013 study called a photograph of a lotus seed pod uncomfortable or repulsive. That is a rating of one image by one sample rather than a rate in a population, the authors are not named in the sentence that reports it, and it is the number every popular article about trypophobia repeats.

The same study found that participants without trypophobia also rated the trigger images as more uncomfortable than neutral ones, which points at a continuum rather than at two kinds of people. That finding is the more interesting of the two and it travels far less.

On who is affected, the encyclopedia offers one sentence: trypophobia appears to be more prevalent in women. No figure is attached to it and no survey is named.

Treatment has the same shape. Nothing has been trialled. Wikipedia states that no treatment is known and then predicts that exposure therapy is likely to work because it works for phobias, which is a reasonable expectation and not a result.

Kathleen McAuliffe has proposed a reason for the thinness of the record: disgust has drawn less research attention than other emotions, and the images repel the researchers who would have to look at them. As of 2021, by the encyclopedia's own account, scientific understanding of the term was poor.

What trypophobia pictures do once they circulate

Self-identified trypophobics found each other on Facebook and Instagram, in groups formed to trade the images that set the reaction off. Many people with the reaction have no name for it and assume they are alone in it until they come across such a group, which describes how the word spread and makes an odd foundation for a clinical entity.

Circulation changed the pictures. The most effective are composites: clusters, the lotus seed head above all, edited onto human skin. Cole and Wilkins found that disgust rises when the holes are on skin, a result the people making the composites had reached by trial. Some of the sharing is hostile, aimed at provoking the reaction in someone known to have it.

Writing in Popular Science, Jennifer Abbasi argued that emotional contagion inside these groups may account for some of the reactions reported within them. The suggestion is awkward for the field, since it makes the 2005 forum post part of the cause rather than part of the history.

Two collisions with consumer products gave the word its widest audience:

1. American Horror Story wrote a trypophobic character into its 2017 season and ran advertising built to provoke the response, drawing complaints that the programme was careless with the people who have it
2. in September 2019 Apple released the iPhone 11 Pro with three closely spaced camera lenses, and some owners said the back of the phone set the reaction off