Trypophobia

The holes in lotus seedheads trigger feelings of discomfort or repulsion in some people.

Trypophobia is an aversion to irregular patterns or clusters of small holes, or bumps. Juan Carlos Martínez-Aguayo et al. describe it as triggered by "high-contrast energy at midrange spatial frequencies". The condition is not officially recognized as a mental disorder, and is rarely referenced in scientific literature, but may fall under the broad category of specific phobia if fear is involved and the fear is excessive and distressing. People may express express only disgust, or both fear and disgust to trypophobic imagery.

Although few studies have been done on trypophobia, researchers hypothesize that it is the result of a biological revulsion that associates trypophobic shapes with danger or disease, and may therefore have an evolutionary basis.

The term trypophobia is believed to have been coined by a participant in an online forum in 2005. Since then, the concept of trypophobia has become popular on social media.

Classification

Trypophobia is not recognized by name as a mental disorder, and so is not a specific diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5). Jennifer Abbasi of Popular Science said that it is rarely referenced in scientific literature, but also that "professionals who study and treat phobias tend not to use all the Latin and Greek names that get tossed around on message boards and in the press." If the fear is excessive, persistent, and associated with significant distress or impairment, trypophobia may fall under the broad category of specific phobia.

Author Kathleen McAuliffe suggested that trypophobia is yet to be extensively studied because researchers have not given as much attention to topics of disgust as they have to other areas of research, and because of the revulsion viewing the images could incite in researchers. Psychiatrist Carol Mathews said, "There might really be people out there with phobias to holes, because people can really have a phobia to anything, but just reading what's on the Internet, that doesn't seem to be what people actually have." Mathews felt that most people writing online are likely disgusted by these types of images without meeting criteria for a real phobia. Tom Kupfer stated the condition may be "a disorder based on disgust and disease avoidance".

Whether trypophobia can be accurately described as a specific phobia might depend on whether the person mainly responds with fear or with disgust. Because phobias involve fear, a response to trypophobic imagery that is based mostly or solely on disgust renders its status as a specific phobia questionable. In one study, most of the participants with trypophobia met the DSM-5 criteria for specific phobia, even though they experienced disgust instead of fear when shown imagery of clusters of holes; however, they did not meet the distress or impairment criterion.

Signs and symptoms

Trypophobia often presents with an autonomic nervous system (neurovegetative) response. Shapes that elicit a trypophobic reaction include clustered holes in innocuous contexts, such as fruit and bubbles, and in contexts associated with danger, such as holes made by insects and holes in wounds and diseased tissue such as those caused by mango worms in animals, especially dogs. Upon seeing these shapes, some people said they shuddered, felt their skin crawl, experienced panic attacks, sweated, palpitated, or felt nauseated or itchy. Some said the holes seemed disgusting and gross or that something might be living inside the holes. Other reported symptoms include goose bumps, body shakes, feeling uncomfortable, and visual discomfort such as eyestrain, distortions, or illusions.

Trypophobia may manifest as a reaction of fear, disgust, or both. Disgust is usually the stronger emotion in those with trypophobia.

Causes

The understanding of trypophobia is limited. Geoff Cole and Arnold Wilkins of the University of Essex's Centre for Brain Science were the first scientists to extensively publish on the phenomenon. They believe the reaction is based on a biological revulsion, rather than a learned cultural fear. In a 2013 article in Psychological Science, Cole and Wilkins write that the reaction is based on "the primitive portion of the brain" that associates the shapes with danger, and that it is an "unconscious reflex reaction". Imagery of various venomous animals (for example, certain types of snakes, insects, and spiders) have the same visual characteristics. Because of this, Cole and Wilkins hypothesized that trypophobia has an evolutionary basis meant to alert humans of dangerous organisms. They believed this to be an evolutionary advantage, although it also causes people to fear harmless objects.

Cole and Wilkins analyzed videos and images containing clusters of holes, with the images presented in an arrangement that was considered to rank the likelihood they will induce fear. Early images in the series included fruits such as oranges and pomegranates. Then clusters of holes with a possible association with danger were presented, such as honeycombs, frogs, and insects and arachnids. Finally, images featured wounds and diseases. Using this data, Cole and Wilkins analyzed example images and believe that the images had "unique characteristics". In another research article, An Trong Dinh Le, Cole and Wilkins developed a symptom questionnaire that they say can be used to identify trypophobia.

Cole and Wilkins also stated that "given the large number of images associated with trypophobia, some of which do not contain clusters of holes but clusters of other objects, these results suggest that holes alone are unlikely to be the only cause for this condition" and they "consider that the fear of holes does not accurately reflect the condition." A 2018 review of the literature by Martínez-Aguayo et al. described trypophobia as usually involving "an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general, images that present high-contrast energy at low and midrange spatial frequencies."

Researches have also speculated that the images could be perceived as cues to infectious disease (similar to reactions to images of leprosy, smallpox and measles, which manifest as small bumps and clusters on the skin) or parasites, which could be alerts that give one a survival advantage. That the images invoke thoughts of decay, which is why mold on bread or vegetables have certain visual cues and characteristics similar to trypophobic stimuli, has also been theorized. Conversely, psychiatrist Carol Mathews believes that trypophobic responses are more likely from priming and conditioning.

Wilkins and Le also considered that the discomfort from trypophobic images is due to the geometry of the holes making excessive demands on the brain; they stated that these excessive demands may cause visual discomfort, eyestrain or headache, adding that these images have mathematical properties that cannot be processed efficiently by the brain and therefore require more brain oxygenation. Wilkins and researcher Paul Hibbard proposed that the discomfort occurs when people avoid looking at the images because they require excessive brain oxygenation, adding that the brain uses about 20 per cent of the body's energy, and its energy usage needs to be kept to a minimum. They stated that mold and skin diseases can provoke disgust in most people, regardless of whether or not the people have trypophobia, and that they are investigating why some people and not others experience an emotional response in these cases.

Whether trypophobia is associated with obsessive-compulsive disorder (OCD) has also been studied, but a significant minority of those with trypophobia meet the DSM-5 criteria for obsessive–compulsive disorder. Martínez-Aguayo et al. stated that other research has indicated that trypophobia is "chronic and persistent" and has "common co-morbid psychiatric diagnosis, such as major depressive disorder (MDD)" and generalized anxiety disorder (GAD).

Treatment

There are no documented treatments for trypophobia, but exposure therapy, which has been used to treat phobias, is likely to be effective for treating trypophobia.

Epidemiology

The number of peer-reviewed articles on trypophobia is low, as of 2018. To what extent trypophobia exists is unknown, but the available data suggests that having an aversion to trypophobic imagery is relatively common. 16% of a sample of 286 participants in Cole and Wilkins's study reported discomfort or repulsion when presented with an image of a lotus seed pod. They found that non-trypophobic individuals also reported higher discomfort ratings when viewing images with visual characteristics associated with trypophobic patterns than when viewing neutral images.

Research indicates that trypophobia is more prevalent in women.

Society and culture

The term trypophobia is believed to have been coined by a participant in an online forum in 2005. The word is from the Greek: τρύπα, trýpa, meaning "hole" and φόβος, phóbos, meaning "fear". Groups on social media sites such as Facebook and Instagram exist for self-identified trypophobics to share and discuss images that they say trigger the reaction.

Because trypophobia is not well known to the general public, many people with the condition do not know the name for it and believe that they are alone in their trypophobic reactions and thoughts until they find an online community to share them with. This has led to an increase in trypophobic images on social media; in some cases, people seek to intentionally trigger those with trypophobia by showing them trypophobic images, with the most triggering images being holes and clusters (especially the lotus seedhead) photoshopped onto human skin. Cole and Wilkins also stated that the level of disgust with trypophobia increases if the holes are on human skin. Writing in Popular Science, Jennifer Abbasi argues that emotional contagion within such social media groups may be responsible for some of the aversive reactions to such images.

In 2017, trypophobia received significant media attention when American Horror Story featured a trypophobic character and trypophobia-inducing advertisements promoting the storyline; some people were disturbed by the imagery, and criticized the show for "insensitivity towards sufferers of trypophobia." Although there was sentiment that the increased media attention could lead to people trying to trigger those with trypophobia, there were also opinions that it might help people understand trypophobia and encourage more research on the matter.

See also

• List of phobias