Have You Heard of Trypophobia?
If you've ever experienced strong aversion, fear or disgust while looking at objects or photos of objects with lots of little holes, you might have a condition called trypophobia. This strange word describes a type of phobia in which people have a fear of, and therefore avoid, patterns or clusters of small holes or bumps, says Ashwini Nadkarni, M.D., a Boston-based associate psychiatrist and instructor at Harvard Medical School.
While the medical community does have some uncertainty about the official classification of trypophobia and what causes it, there's no doubt that it manifests in very real ways for individuals who experience it.
So, What Is Trypophobia?
There's little known about this condition and its causes. A simple Google search of the term will bring up loads of potentially triggering trypophobia pictures, and there are even online support groups for trypophobics to warn each other of things like movies and websites to avoid. Yet, psychologists remain skeptical of what, exactly, trypophobia is and why some people have such adverse reactions to specific images.
"In my 40-plus years in the field of anxiety disorders, no one has ever come in for treatment of such a problem," says Dianne Chambless, Ph.D., a psychology professor at the University of Pennsylvania in Philadelphia.
While, Martin Antony, Ph.D., a professor of psychology at Ryerson University in Toronto and author of The Anti-Anxiety Workbook, says he did get an email once from someone who was struggling with trypophobia, he has never personally seen anyone for the condition.
Dr. Nadkarni, on the other hand, says she treats a fair number of patients in her practice who present with trypophobia. Although it's not named in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), an official manual compiled by the American Psychiatric Association used as a means for practitioners to assess and diagnose mental disorders, it is recognized under the umbrella of specific phobias, says Dr. Nadkarni.
Why Trypophobia Isn't Officially Considered a Phobia
There are three official diagnoses for phobias: agoraphobia, social phobia (also referred to as social anxiety) and specific phobia, says Stephanie Woodrow, a Maryland-based licensed clinical professional counselor and nationally certified counselor specializing in the treatment of adults with anxiety, obsessive-compulsive disorder, and related conditions. Each of these is in the DSM-5. Basically, the specific phobias category is the catch-all for every phobia from animals from needles to heights, says Woodrow.
It's important to note that phobias are about fear or anxiety, and not disgust, says Woodrow; however, obsessive-compulsive disorder, which is a close friend to anxiety disorder, can include disgust.
Trypophobia, on the other hand, is a bit more convoluted. There is a question of whether it might be better classified as a generalized fear or disgust toward dangerous things, or whether it can be considered an extension of other disorders such as a generalized anxiety disorder, says Dr. Nadkarni.
She adds that existing studies on trypophobia indicate that it does involve some sort of visual discomfort, particularly toward imagery with a certain spatial frequency.
If trypophobia conclusively fell under the classification of a phobia, then the diagnostic criteria would include an excessive and persistent fear of the trigger; a fear response out of proportion to the actual danger; avoidance or extreme distress related to the trigger; a significant impact on the person's personal, social or occupational life; and at least six months of duration in symptoms, she adds.
Triggers are often biological clusters, such as lotus-seed pods or wasps' nests that occur naturally, though they can be other types of non-organic items. For example, the Washington Post reported the three camera holes on Apple's new iPhone were triggering for some, and the new Mac Pro computer processor tower (dubbed the "cheese grater" among the tech community) sparked conversation around trypophobia triggers on some Reddit communities.
A few studies have linked the emotional response of trypophobia to the triggering visual stimuli as part of an aversion response rather than a fear response, says Dr. Nadkarni. "If disgust or aversion is the primary physiological response, this may suggest the disorder is less of a phobia since phobias trigger the fear response, or 'fight or flight'," she says.
What It's Like to Live with Trypophobia
Regardless of where science stands, for people like Krista Wignall, trypophobia is a very real thing. It only takes a glimpse of a honeycomb—in real life or on a screen—to send her into a tailspin. The 36-year-old Minnesota-based publicist is a self-diagnosed trypophobic with a fear of multiple, small holes. She says her symptoms began in her 20s when she noticed a strong aversion to items (or photos of items) with holes. But more physical symptoms began to manifest as she entered her 30s, she explains.
"I would see certain things, and it felt like my skin was crawling," she recalls. "I would get nervous ticks, like my shoulders would shrug or my head would turn—that body-convulsion type of feeling." (Related: Why You Should Stop Saying You Have Anxiety If You Really Don't)
Wignall dealt with her symptoms the best she could with little understanding of what was causing them. Then, one day, she read an article that mentioned trypophobia, and although she had never heard the word before, she says she immediately knew this is what she had been experiencing.
It's a little hard for her to even talk about the incidents, as sometimes just describing things that have triggered her can make the convulsions come back. The reaction is nearly instantaneous, she says.
While Wignall says she wouldn't call her trypophobia "debilitating", there's no doubt it's impacted her life. For example, her phobia forced her to get out of the water two different times when she spotted a brain coral while snorkeling on vacation. She also admits to feeling alone in her phobia because everyone she opens up to about brushes it off, saying they've never heard of it before. However, there now seem to be more people speaking out about their experience with trypophobia and connecting with others who have it via social media.
Another trypophobia sufferer, 35-year-old Mink Anthea Perez from Boulder Creek, California says she was first triggered while dining at a Mexican restaurant with a friend. "When we sat down to eat, I noticed her burrito had been cut down the side," she explains. "I noticed her whole beans were in a cluster with perfect little holes between them. I was so grossed out and horrified, I started itching my scalp really hard and just freaked out."
Perez says she's had other frightening occurrences, too. The sight of three holes in a wall at a hotel pool sent her into a cold sweat, and she froze on the spot. Another time, a triggering image on Facebook led her to break her phone, throwing it across the room when she couldn't stand to look at the image. Even Perez's husband didn't understand the seriousness of her trypophobia until he witnessed an episode, she says. A doctor prescribed Xanax to help ease her symptoms—she can sometimes scratch herself to the point she brakes the skin.
Antony says exposure-based treatments used to treat other phobias that are done in a controlled way, where the sufferer is in charge and not forced into anything, may help people learn to overcome their symptoms. For example, gradual exposure to spiders can help ease fear for arachnophobes.
Dr. Nadkarni echoes the sentiment that cognitive-behavioral therapy, involving consistent exposure to the feared stimuli, is an essential component of treatment to phobias because it desensitizes people to their feared stimuli. So in the case of trypophobia, treatment would involve exposure to small holes or clusters of these holes, she says. Yet, since the blurred line between fear and disgust is present in people with trypophobia, this treatment plan is just a cautious suggestion.
For some trypophobia sufferers, getting over a trigger may just require looking away from the offending image, or focusing their attention on other things. For others like Perez, who are more deeply affected by trypophobia, treatment with anxiety medication may be needed to better control symptoms.
If you know someone who's trypophobic, it's key to not judge how they react or how triggering images make them feel. Often, it's beyond their control. "I'm not afraid [of holes]; I know what they are," says Wignall. "It's just a mental reaction that goes into a body reaction."