Is Trypophobia a Phobia?

Trypophobia, skin disease, and the visual discomfort of natural textures

In the last decade, the behavioral sciences have described the phenomenon of trypophobia, which is the discomfort felt by some individuals when viewing images containing clusters of bumps or holes. One evolutionary hypothesis for this phenomenon is that this visual discomfort represents an adaptation which helps organisms avoid skin disease and/or ectoparasites. Even though trypophobic imagery and disease imagery are both examples of visual textures, to date there has been no comparison of the visual discomfort elicited by these two specific kinds of textures within the larger context of the visual comfort elicited by natural texture imagery more generally. In the present study, we administered the Trypophobia Questionnaire (TQ) and recorded the visual comfort ratings elicited by a large set of standard natural texture images, including several trypophobic and skin disease images. In two independent samples, we found that while all observers find skin diseases uncomfortable to view, only those scoring high on the TQ rated trypophobic imagery equally uncomfortable. Comparable effects were observed using both standard ANOVA procedures as well as linear mixed effects modeling. Comparing the ratings of both high-TQ and low-TQ participants to the standard textures, we find remarkably consistent rank-order preferences, with the most unpleasant textures (as rated by both groups) exhibiting qualitative similarities to trypophobic imagery. However, we also find that low-level image statistics which have been previously shown to affect visual comfort are poor predictors of the visual comfort elicited by natural textures, including trypophobic and disease imagery. Our results suggest that a full understanding of the visual comfort elicited by natural textures, including those arising from skin disease, will ultimately depend upon a better understanding of cortical areas specialized for the perception of surface and material properties, and how these visual regions interact with emotional brain areas to evoke appropriate behavioral responses, like disgust.

The social learning account of trypophobia

Trypophobia is the condition in which individuals report a range of negative emotions when viewing clusters of small holes. Since the phenomenon was first described in the peer-reviewed literature a decade ago, 49 papers have appeared together with hundreds of news articles. There has also been much discussion on various Internet forums, including medical and health-related websites. In the present article, we examine the degree to which the phenomenon is caused by a form of social learning, specifically, its ubiquitous social media presence. We also examined its prevalence among the broad population. In Experiment 1 (n = 2,558), we assessed whether younger people and females (i.e., greater social media users) are more sensitive to trypophobic stimuli, as predicted by the social media hypothesis. In Experiment 2 (n = 283), we examined whether sensitivity to trypophobic stimuli and rates of trypophobia is greater in people who are aware of the condition's existence, as opposed to those who have never heard of the phenomenon. In line with the social media theory, results showed that younger people and females are indeed more susceptible to trypophobia. However, 24% of trypophobic individuals have never heard of the condition. Overall, these data suggest that both social learning and non-social learning contribute to trypophobia. We also find that the prevalence of trypophobia is approximately 10%.

Is trypophobia real?

Approximately 10-18% of the adult population experience some form of anxiety when viewing clusters of small holes. 'Trypophobia' has been the subject of much discussion within the peer-reviewed literature, news outlets, health-related websites and social media. However, there is some scepticism surrounding the phenomenon. It is often stated that the condition is not recognised by the American Psychiatric Association, and not listed as a phobia in the DSM-5. It has also been claimed that trypophobia is no more than a particularly successful internet meme. In this editorial, I argue that such criticisms are misplaced. There is, for instance, no list of phobias in the DSM-5; only criteria that determine phobia classification. Using these criteria, as well as personal testimonials, trypophobia is clearly a phobia. Furthermore, the meme hypothesis cannot account for the fact that the phenomenon existed long before the internet.

Excessive fear of clusters of holes, its interaction with stressful life events and the association with anxiety and depressive symptoms: large epidemiological study of young people in Hong Kong

BACKGROUND

Excessive and persistent fear of clusters of holes, also known as trypophobia, has been suggested to reflect cortical hyperexcitability and may be associated with mental health risks. No study, however, has yet examined these associations in representative epidemiological samples.

AIMS

To examine the prevalence of trypophobia in a population-representative youth sample, its association with mental health and functioning, and its interaction with external stress.

METHOD

A total of 2065 young people were consecutively recruited from a household-based epidemiological youth mental health study in Hong Kong. Trypophobia, symptoms of anxiety, depression and stress, and exposure to personal stressors were assessed. Logistic regression was used to assess the relationships between trypophobia and mental health. Potential additive and interaction effects of trypophobia and high stress exposure on mental health were also tested.

RESULTS

The prevalence of trypophobia was 17.6%. Trypophobia was significantly associated with severe symptoms of anxiety (odds ratio (OR) = 1.83, 95% CI = 1.32-2.53), depression (OR = 1.78, 95% CI = 1.24-2.56) and stress (OR = 1.68, 95% CI = 1.11-2.53), even when accounting for sociodemographic factors, personal and family psychiatric history, resilience and stress exposure. Dose-response relationships were observed, and trypophobia significantly potentiated the effects of stress exposure on symptom outcomes, particularly for depressive symptoms. Those with trypophobia also showed significantly poorer functioning across domains and poorer health-related quality of life.

CONCLUSIONS

Screening for trypophobia in young people may facilitate early risk detection and intervention, particularly among those with recent stress exposure. Nevertheless, the generally small effect sizes suggest that other factors have more prominent roles in determining recent mental health outcomes in population-based samples; these should be explored in future work.

Preschool children aged 4 to 5 years show discomfort with trypophobic images

The fear or disgust of clustered patterns, such as honeycomb or lotus seed pods, is known as trypophobia. A previous developmental study reported that 4-year-old children prefer neutral images over clustered images. However, whether those results indicated higher rating scores for trypophobic images has been controversial. In this study, we examined discomfort with trypophobic images in adults and children aged 4-9 years using an identical experimental procedure. A modified rating scale applicable for children was used that was based on the established Trypophobia Scale for adults. The participants were required to rate five trypophobic and five neutral images on four rating items (disgusting, fear, feel itchiness, and like) on a 4-point scale ranging from 1 (not at all) to 4 (very much). The participants in all age groups indicated higher rate scores for trypophobic images than for neutral images in terms of 'disgust', 'fear', and 'feeling itchiness', whereas they indicated higher scores for neutral images than for trypophobic images in terms of 'like'. These results suggest that children aged 4-5 years have responses comparable to the responses of adults with respect to trypophobic and neutral images; thus, trypophobia appears to emerge at least by the age of 4-5 years.

A social media network analysis of trypophobia communication

Trypophobia has attracted scientific attention in recent years. Few related studies have recruited participants using online methods, and even less is known about health communication in an environment where trypophobia was first widely discussed (i.e., the Internet). This study describes communication patterns in a Facebook group for trypophobia by detecting frequent topics, top contributors, and their discourses. We identified key commenters and performed word frequency analysis, word co-occurrence analysis, topic modeling, and content analysis. Impactful users posted and replied more often when discussing peer-reviewed science. Triggering content was actively removed by the group administrators. A wide variety of triggers not discussed in trypophobia-related literature were frequently mentioned. However, there was a lack of discussion on peer-reviewed treatments. The combination of a few expert and many supportive amateur gatekeepers willing to understand trypophobia, along with active monitoring by administrators, might contribute to in-group trust and the sharing of peer-reviewed science by top users of the trypophobia Facebook group.

Evaluating the 'skin disease-avoidance' and 'dangerous animal' frameworks for understanding trypophobia

ABSTRACTTrypophobia refers to the extreme negative reaction when viewing clusters of circular objects. Two major evolutionary frameworks have been proposed to account for trypophobic visual discomfort. The skin disease-avoidance (SD) framework proposes that trypophobia is an over-generalised response to stimuli resembling pathogen-related skin diseases. The dangerous animal (DA) framework posits that some dangerous organisms and trypophobic stimuli share similar visual characteristics. Here, we performed the first experimental manipulations which directly compare these two frameworks by superimposing trypophobic imagery onto multiple image categories to evaluate changes in comfort. Participants from two countries (United States and Croatia) were evaluated on several measures, including general trypophobia levels, perceived vulnerability to disease, and generalised anxiety. Several analyses showed stronger changes in comfort in the human skin condition (hand, feet, and chest images) compared to the dangerous animal condition (snake and spider images). Furthermore, participants with higher levels of trypophobia showed significantly stronger changes in comfort in the skin condition than the dangerous animal condition, with comparable effects obtained across nationalities. Several variables entered as covariates failed to significantly account for this effect. The present work is the first to experimentally test both evolutionary frameworks of trypophobia, with results supporting the skin disease-avoidance framework.

An exploration of the nomological network of trypophobia

BACKGROUND

Trypophobia is characterised by an aversion to or even revulsion for patterns of holes or visual stimuli featuring such patterns. Past research has shown that trypophobic stimuli trigger emotional and physiological reactions, but relatively little is known about the antecedents, prodromes, or simply covariates of trypophobia.

AIM

The goals of this study were (a) to draw the contours of the nomological network of trypophobia by assessing the associations of symptoms of trypophobia with several constructs that were deemed relevant from past research on anxiety disorders and specific phobias, (b) to compare such associations with those found for symptoms of spider phobia and blood and injection phobia (alternative dependent variables), and (c) to investigate the main effect of gender on symptoms of trypophobia and replicate the association of gender with symptoms of spider phobia and blood and injection phobia (higher scores for women).

METHODS

Participants (N = 1,134, 53% men) in this cross-sectional study completed an online questionnaire assessing the constructs of interest.

RESULTS

Most assessed constructs typically associated with anxiety disorders (neuroticism, conscientiousness, anxiety sensitivity, trait anxiety, disgust sensitivity, and disgust propensity) were also associated with trypophobia in the predicted direction. All of these constructs were also associated with spider phobia and blood and injection phobia. Behavioral inhibition was negatively associated with trypophobia and spider phobia-contrary to what was expected, but positively with blood and injection phobia. We found no gender difference in trypophobia, whereas women scored higher on spider phobia and blood and injection phobia.

DISCUSSION

Although some differences were observed, the nomological network of trypophobia was largely similar to that of spider phobia and blood and injection phobia. Further studies are needed to clarify similarities and dissimilarities between trypophobia and specific phobia.

Priming with skin-problems increases fear of clusters

Trypophobia is induced by viewing multiple clustered objects. To date, several studies have investigated why certain people experience discomfort when looking at clustered patterns. Recently, “involuntary protection against dermatosis” (IPAD) hypothesis was proposed to explain the causes of trypophobia. The IPAD hypothesis suggests that involuntary aversive responses to skin diseases cause discomfort in response to image clusters. However, this idea has not been fully investigated empirically. Therefore, the present study used a modified version of the priming procedure and tested whether the activation of the concept of skin-related diseases affected the evaluation of trypophobic images. In Experiment 1, participants engaged in a lexical decision task in which words related to skin problems, negative events, or neutral events were presented. Then, they evaluated the discomfort of trypophobic, negative, and neutral images. The results indicated that participants evaluated trypophobic images as more discomforting after they were exposed to skin-problem-related words, whereas the exposure to words related to skin-problems did not enhance the discomfort of negative images. These findings demonstrate that the association with skin-related problems increases the discomfort of trypophobic images. In Experiment 2, we further tested the reproducibility of the priming effect observed in Experiment 1 and investigated the effect of priming with words related to COVID-19 in the context of a spreading infection. Contrary to predictions, no priming effect was produced by either skin-related words or COVID-19-related words. Future studies should further explore the causal relationship of the association between skin disease and trypophobia.

Sertraline for Trypophobia: Report of an Adolescent Case

Trypophobia is a clinical entity that is characterized by unpleasant feelings related to or an aversion to irregular patterns of small holes or bumps. There are insufficient data about the etiological factors underlying trypophobia. It has been associated with anxiety disorders because it shows comorbidity and symptom similarity with anxiety disorders. Literature on the treatment strategies of trypophobia is somewhat limited. In this case report, we present an adolescent girl with trypophobia that is successfully treated with sertraline.

Object Clusters or Spectral Energy? Assessing the Relative Contributions of Image Phase and Amplitude Spectra to Trypophobia

Trypophobia refers to the visual discomfort experienced by some people when viewing clustered patterns (e.g., clusters of holes). Trypophobic images deviate from the 1/f amplitude spectra typically characterizing natural images by containing excess energy at mid-range spatial frequencies. While recent work provides partial support for the idea of excess mid-range spatial frequency energy causing visual discomfort when viewing trypophobic images, a full factorial manipulation of image phase and amplitude spectra has yet to be conducted in order to determine whether the phase spectrum (sinusoidal waveform patterns that comprise image details like edge and texture elements) also plays a role in trypophobic discomfort. Here, we independently manipulated the phase and amplitude spectra of 31 Trypophobic images using a standard Fast Fourier Transform (FFT). Participants rated the four different versions of each image for levels of visual comfort, and completed the Trypophobia Questionnaire (TQ). Images having the original phase spectra intact (with either original or 1/f amplitude) explained the most variance in comfort ratings and were rated lowest in comfort. However, images with the original amplitude spectra but scrambled phase spectra were rated higher in comfort, with a smaller amount of variance in comfort attributed to the amplitude spectrum. Participant TQ scores correlated with comfort ratings only for images having the original phase spectra intact. There was no correlation between TQ scores and comfort levels when participants viewed the original amplitude / phase-scrambled images. Taken together, the present findings show that the phase spectrum of trypophobic images, which determines the pattern of small clusters of objects, plays a much larger role than the amplitude spectrum in determining visual discomfort.

Trypophobic images gain preferential access to early visual processes

Trypophobia is a common but unusual phobia that is induced by viewing many clustered objects. Previous studies suggested that this trypophobia is caused by the specific power spectrum of the images; this idea has not been fully investigated empirically. In the present study, we used breaking continuous flash suppression (b-CFS) to clarify whether the trypophobic images affect access to visual awareness, and what features of trypophobic images contribute to rapid access of awareness. In the b-CFS paradigms, a dynamic masking pattern presented to one eye suppresses the target images shown to the other eye. The participants' task was to indicate where the target image appeared in a dichoptic display through a mirror stereoscope. The target images consisted of trypophobic, fear-related, clusters or neutral images. The trypophobic images emerged into awareness faster than the other types of images. However, the phase-scrambled versions of the trypophobic images did not show any differences across the image types, suggesting that the trypophobic power spectra themselves did not affect access to awareness. Moreover, the phase-scrambled trypophobic images without CFS tended to be detected earlier than the phase-scrambled fearful and neutral images. These findings indicate that trypophobic power spectra might affect post-perceptual processing, such as response production.

Enhanced early visual processing in response to snake and trypophobic stimuli

Background

Trypophobia refers to aversion to clusters of holes. We investigated whether trypophobic stimuli evoke augmented early posterior negativity (EPN).

Methods

Twenty-four participants filled out a trypophobia questionnaire and watched the random rapid serial presentation of 450 trypophobic pictures, 450 pictures of poisonous animals, 450 pictures of snakes, and 450 pictures of small birds (1800 pictures in total, at a rate of 3 pictures/s). The EPN was scored as the mean activity at occipital electrodes (PO3, O1, Oz, PO4, O2) in the 225–300 ms time window after picture onset.

Results

The EPN was significantly larger for snake pictures than for the other categories, and significantly larger for trypophobic pictures and poisonous animal pictures than for bird pictures. Remarkably, the scores on the trypophobia questionnaire were correlated with the EPN amplitudes for trypophobic pictures at the occipital cluster (r = −.46, p = .025).

Conclusions

The outcome for the EPN indicates that snakes, and to a somewhat lesser extent trypophobic stimuli and poisonous animals, trigger early automatic visual attention. This supports the notion that the aversion that is induced by trypophobic stimuli reflects ancestral threat and has survival value. The possible influence of the spectral composition of snake and trypophobic stimuli on the EPN is discussed.

Pupillometry reveals the physiological underpinnings of the aversion to holes

An unusual, but common, aversion to images with clusters of holes is known as trypophobia. Recent research suggests that trypophobic reactions are caused by visual spectral properties also present in aversive images of evolutionary threatening animals (e.g., snakes and spiders). However, despite similar spectral properties, it remains unknown whether there is a shared emotional response to holes and threatening animals. Whereas snakes and spiders are known to elicit a fear reaction, associated with the sympathetic nervous system, anecdotal reports from self-described trypophobes suggest reactions more consistent with disgust, which is associated with activation of the parasympathetic nervous system. Here we used pupillometry in a novel attempt to uncover the distinct emotional response associated with a trypophobic response to holes. Across two experiments, images of holes elicited greater constriction compared to images of threatening animals and neutral images. Moreover, this effect held when controlling for level of arousal and accounting for the pupil grating response. This pattern of pupillary response is consistent with involvement of the parasympathetic nervous system and suggests a disgust, not a fear, response to images of holes. Although general aversion may be rooted in shared visual-spectral properties, we propose that the specific emotion is determined by cognitive appraisal of the distinct image content.

Trypophobia: What Do We Know So Far? A Case Report and Comprehensive Review of the Literature

In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns, known as trypophobia. This condition has not yet been recognised by diagnostic taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. Trypophobia usually involves 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. It is commonly accompanied by neurovegetative symptoms. In the case we present here, the patient also suffered from generalised anxiety disorder and was treated with sertraline. After she was diagnosed, she showed symptoms of both fear and disgust towards trypophobic images. After some time following treatment, she only showed disgust towards said images. We finish this case report presenting a comprehensive literature review of the peer reviewed articles we retrieved after an exhaustive search about trypophobia, we discuss how this case report contributes to the understanding of this anxiety disorder, and what questions future studies should address in order to achieve a better understanding of trypophobia.