Trypophobia: Symptoms, Types, Causes and Treatment

Trypophobia—sometimes called the “fear of holes”—is a relatively newly recognized phenomenon that has garnered attention from both the scientific community and the general public. Characterized by intense discomfort or even disgust when viewing clustered patterns (often of holes or bumps), trypophobia is more than just a fleeting unease. For some, it leads to significant psychological distress and impairment. In this article, we’ll break down the symptoms, types, causes, and treatment approaches for trypophobia, weaving together the latest research to give you a comprehensive understanding of this intriguing condition.

Symptoms of Trypophobia

When people think of phobias, fear is usually the first emotion that comes to mind. However, trypophobia is unique: the response is often one of disgust as much as (or more than) fear. The symptoms can range from mild discomfort to severe physical and psychological reactions.

Symptom	Description	Impact	Sources
Disgust	Strong aversion, revulsion, or nausea	Emotional distress	2 3 5 6
Anxiety	Unease, tension, or apprehension	Mild to moderate distress	3 5
Skin Sensations	Itching, crawling, or tingling	Physical discomfort	2 3 5
Physiological	Nausea, rapid heartbeat, sweating, increased HRV	Bodily symptoms	9 10
Avoidance	Avoiding images or objects with clustered holes	Functional impairment	3 10

Table 1: Key Symptoms

Emotional Responses: Disgust vs. Fear

Unlike classic phobias, trypophobia is more closely associated with disgust than with fear. Many sufferers describe an overwhelming feeling of revulsion, often accompanied by nausea, rather than panic or terror. Scientific studies using physiological measures (like heart rate and pupillometry) confirm that the disgust response is primary, though some anxiety can also occur 2 3 5 6 8 9.

Physical and Psychological Symptoms

Common physical reactions include:

• Skin crawling, itching, or tingling sensations—sometimes described as “skin-crawling” or the urge to scratch 2 3 5.
• Nausea and even vomiting in severe cases 3 9 10.
• Rapid heartbeat, sweating, and increased heart rate variability (HRV), especially in individuals with high trypophobia proneness 9 10.
• General feelings of discomfort or distress when exposed to trypophobic images.

On the psychological side, symptoms can include:

• Persistent intrusive thoughts about trypophobic stimuli.
• Strong avoidance behaviors—covering images, turning away, or asking others to stop showing or describing triggering patterns 10.
• Impairment in daily functioning, especially if exposure to triggers is frequent 3 10.

Chronicity and Comorbidity

Research shows that trypophobia symptoms are often chronic and persistent, not just fleeting reactions. Many individuals with trypophobia also experience comorbid conditions, most notably major depressive disorder and generalized anxiety disorder 3. The severity and duration of symptoms are closely linked to the degree of distress and impairment experienced.

Types of Trypophobia

Not all trypophobic reactions are the same. While the classic trigger is clusters of holes, the condition encompasses a range of visual patterns and can manifest differently across individuals.

Type	Triggering Pattern	Common Examples	Sources
Holes	Concave clusters	Lotus seed pods, honeycombs	1 3 5
Bumps	Convex clusters	Bubbles, coral, sponges	1 5
Organic	Biological surfaces	Skin lesions, animal markings	2 7 10
Artificial	Man-made objects	Aerated chocolate, drilled holes	1 5 7

Table 2: Types of Trypophobic Triggers

Holes vs. Bumps: The Shape Debate

Although trypophobia was originally dubbed the “fear of holes,” research shows that clusters of bumps or protrusions can be just as aversive as holes. The key trigger appears to be the arrangement and visual properties of the clusters, rather than whether they are holes or raised objects 1 5.

Organic and Artificial Stimuli

Triggers can be:

• Organic: found in nature, such as lotus seed pods, honeycombs, coral, or even diseased skin (lesions, rashes) 2 7 10.
• Artificial: man-made items like aerated chocolate, drilled holes, or patterned designs 1 5 7.

For many individuals, organic surfaces—especially those resembling skin diseases or parasite infestations—are particularly potent triggers, likely due to evolutionary factors linked to disease avoidance 2 7.

Individual Variation

Not everyone responds to the same triggers. Some people are only disturbed by natural patterns, while others react to almost any clustered object. Severity also varies, from mild aversion to debilitating avoidance.

Causes of Trypophobia

Why do so many people recoil at clustered patterns? The answer lies in a blend of evolutionary psychology, visual perception, and individual differences.

Cause	Description	Evidence Type	Sources
Evolutionary	Overgeneralized disease avoidance	Theoretical, survey	2 5 6 7
Visual Profile	Midrange spatial frequency “energy”	Image analysis	1 5 7
Disgust Sens.	Higher baseline disgust sensitivity	Psychometric	2 4 6
Comorbidity	Links with anxiety, depression	Clinical study	3 4
Gender/Traits	No gender difference; role of empathy	Survey, scale data	4 6

Table 3: Major Causes and Correlates

Evolutionary Roots: Disease Avoidance

A leading theory suggests that trypophobia is an exaggerated form of an adaptive response: avoiding visual cues that historically signaled parasites or infectious disease. Many trypophobic images bear a striking resemblance to the patterns found on diseased skin or the nests of parasitic insects. The disgust response may have evolved to help humans steer clear of sources of infection, but in trypophobia, this response is overgeneralized to harmless stimuli 2 5 7.

Visual Mechanisms: Spatial Frequency and Discomfort

Scientific studies reveal that trypophobic images share specific visual properties: namely, high-contrast “energy” at midrange spatial frequencies. This spectral profile is not unique to holes but is found in both clusters of holes and bumps—and even in some dangerous animals’ markings. These visual features can induce discomfort at a neurological level, triggering aversion in sensitive individuals 1 5 7.

Disgust Sensitivity and Psychological Traits

People high in disgust sensitivity are more likely to experience trypophobia. This trait may explain why some individuals are deeply affected while others are unfazed. Empathic traits (such as a tendency toward self-oriented distress) and a general proneness to visual discomfort also predict trypophobia proneness 2 4 6.

Comorbidity and Personality

Trypophobia often co-occurs with anxiety disorders and depression, but it is not simply a manifestation of these conditions. Instead, it shares similarities with specific phobias and even obsessive-compulsive disorder, though most research supports its classification as a specific phobia 3 4.

Demographics and Individual Differences

Unlike some other phobias, trypophobia does not show a consistent gender bias—men and women appear equally likely to experience symptoms 4. Individual differences in personality traits, such as neuroticism, conscientiousness, and behavioral inhibition, also play a role.

Treatment of Trypophobia

Although research on treatment is still emerging, several strategies have shown promise in alleviating trypophobia’s distressing symptoms. Approaches range from behavioral therapies to medications.

Approach	Description	Evidence/Outcome	Sources
Psychoeducation	Teaching about triggers & responses	Foundational step	10
Behavioral Therapy	Systematic desensitization, exposure	Reduced symptoms	10
CBT	Cognitive restructuring, coping skills	Potentially effective	10 11
Medication	SSRIs (e.g., sertraline)	Case study success	11
Coping Strategies	Avoidance reduction, relaxation	Improved functioning	10

Table 4: Treatment Approaches

Psychoeducation and Assessment

A thorough initial assessment—including interviews and self-monitoring—helps identify the specific triggers and the severity of the condition. Psychoeducation provides sufferers with scientific explanations for their symptoms, which can reduce shame and anxiety and set the stage for further intervention 10.

Behavioral and Cognitive-Behavioral Therapy

Behavioral approaches, particularly systematic desensitization and graduated exposure to trypophobic images, are foundational. These methods involve:

• Creating a hierarchy of triggers, from least to most distressing.
• Gradual and controlled exposure to these triggers while practicing relaxation techniques.
• Cognitive restructuring to address irrational beliefs or catastrophic thinking associated with the triggers 10 11.

CBT may also be helpful, especially in addressing comorbid anxiety or depressive symptoms.

Pharmacological Treatments

Although not a first-line treatment, some case reports suggest that selective serotonin reuptake inhibitors (SSRIs) such as sertraline may be effective for individuals with severe or persistent trypophobia, particularly when comorbid with anxiety or depression 11.

Coping Strategies

Other strategies include:

• Practicing controlled breathing and relaxation to manage physiological arousal.
• Developing alternative behaviors to replace avoidance.
• Enlisting social support when confronting triggers 10.

Limitations and Future Directions

Research on trypophobia treatment is still limited. Most evidence comes from case studies and adapted protocols from treatments for other phobias. Further clinical trials are needed to establish standardized, evidence-based interventions.

Conclusion

Trypophobia is a fascinating and often misunderstood condition that blends visual perception, evolutionary psychology, and emotional processing. While research is ongoing, the current evidence paints a compelling picture:

• Symptoms: Primarily disgust, with physical (nausea, skin sensations) and psychological (avoidance, distress) components.
• Types: Triggered by both holes and bumps, in organic and artificial patterns; not limited to “holes” alone.
• Causes: Likely rooted in evolutionary disease-avoidance mechanisms, with a key role for visual processing and individual disgust sensitivity.
• Treatment: Behavioral and cognitive-behavioral interventions, psychoeducation, and—occasionally—medication show promise, but more research is needed.

Understanding trypophobia can not only help those who suffer from it but also shed light on the complex ways our brains process danger, disgust, and pattern recognition.