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Understanding Trypophobia: the Fear of Holes MJP Online Early 02-09-16 BRIEF COMMUNICATION Understanding Trypophobia: The Fear of Holes Aminuddin I & Lotfi HA Department of Psychological Medicine, University of Malaya, Malaysia Abstract The sight of clustered holes can bring about uneasiness in people, and the disgust response towards it is called trypophobia. Reactions in humans vary from nausea to severe depression. We explore the possible causes of this unique phenomenon, such as evolutionary adaptation and spectral features. We also uncover the clinical features and its relationship to other psychological conditions for example, obsessive-compulsive disorder. Keywords: Trypophobia, Fear of Holes, Phobia Introduction as a fatality of “the war of nature” [7],” said Charles Darwin. Human beings are built Trypophobia is a repulsion of clusters of with an innate and perceptive small holes or objects that are reminiscent of neurobiological system that promotes clusters of holes [2]. It is different from adaptation to change and provides efficient other types of phobia in the sense that its aversion mechanisms towards danger [6]. discovery was birthed from the rapid advancement of technology. The term was Physical signs like scars, sores and spots, as first coined in 2005 in an online forum, well as spots found on dangerous animals stemming from the Greek words trýpa and like the blue-ringed octopus, the king cobra phóbos, meaning “hole” and "fear" and also holes found on a hornets’ nest [2] respectively [3]. Ever since then, its may induce trypophobia. documentation on the Internet has been widely reported compared to other types of ii. Unique spectral features phobia [2] with various Internet-based Images that act as a stimulus towards support groups, where people provide trypophobia, such as a cluster of holes, show testimonials regarding their struggles with a feature of high contrast energy at midrange trypophobia. spatial frequencies [2]. This feature does not reach humans’ conscious awareness, thus Proposed etiology can lead to fear in adults [8]. i. Evolutionary adaptation towards Any images with the same spectral feature danger will act as a trigger and induce this feeling “Organisms that fail to adapt to their of disgust as a survival adaptation [2], even environment and pass on their gene will fall though the stimuli are harmless such as the MJP Online Early 02-09-16 head of a lotus seed, a pink coral reef and [9]. However the core disgust sensitivity is soap bubbles. higher in female [4]. This explains the reason individuals with trypophobia are A study done showed that preschoolers predominantly, female [13]. showed discomfort towards trypophobic image due to the unique spectral feature Why is it unique? rather than its danger. In this study, the children showed discomfort towards the Despite being a topic that has had quite a image of a starfish with spots covering its following online, it is under-reported in body. However, after showing another scientific literature. In fact, trypophobia is picture of a starfish, only this time the spots not recognized as a disorder, neither does it were removed, the children do not exhibit have its own formal definition in DSM-5 any signs of discomfort [8]. [9,16]. In addition to that, those with trypophobia are self-reported or self- iii. Learned behavior diagnosed [17]. Another theory is that this phobia is learned rather than an innate response mechanism With trypophobia, the stimuli might be towards danger. The primitive discomfort harmless, such as soap bubbles, honeycomb towards holes is heightened through various or the seed head of lotus flowers - making experiences such as bitten by a snake or a the phenomenon difficult to explain in terms hornet and this lead to adults reporting of of learning theory [2]. being a trypophobe [8]. Interestingly, most of the respondents did not have an upsetting Clinical features experience involving holes itself that predisposed them to trypophobia [13]. Symptoms can be divided into 3 categories: cognitive-related (eg; feelings of uneasiness iv. Overgeneralized emotional response and aversion), skin-related (eg; skin It is found that increased emotional crawling and itching) and physiological functioning that facilitates avoidant behavior symptoms (eg; nausea, difficulty breathing) with respect to potential threats, results in [17]. trypophobia [4]. In this study, The Trypophobia Questionnaire (TQ) was used. The symptoms are chronic, persistent, and TQ consists of predictors of trypophobic affect mostly women. One can also proneness, such as core disgust sensitivity, experience symptoms when not in direct Personal Distress (PD) and proneness to contact with the clusters of holes. Severity visual discomfort. PD is the proneness to varies between individuals; from no anxiety have self-oriented feelings of anxiety and at all to having 25 panic attacks per month. unease [11,12]. Comorbid psychiatric diagnoses include major depressive disorder and generalized Trypophobia is thought to not only be an anxiety disorder [13]. extension of the feeling of disgust towards holes, trypophobic images may also act as a Despite the distress and impairment in daily self-oriented negative stimuli towards function, a majority of them have never individuals who are already has a high sought treatment [13]. proneness to trypophobia [4]. There are no gender differences in trypophobia proneness MJP Online Early 02-09-16 Resemblance to obsessive-compulsive References disorder. [1] George Grall, N. (2017). If These A 2017 study suggested that rather than fear, Photos Disgust You, You May Have trypophobia is more accurately described as Trypophobia. [online] a disgust-based aversion [15]. The News.nationalgeographic.com. association to disgust links trypophobia to Available at: obsessive-compulsive disorder (OCD), http://news.nationalgeographic.com/ however it is worth noting that has also been 2017/07/trypophobia-fear-of-holes- described in specific phobia [14]. The study-spd/. clinical features of trypophobia versus OCD have been assessed, and it was concluded [2] Cole, G. and Wilkins, A. (2013). that individuals were more likely to meet the Fear of Holes. Psychological diagnostic criteria for specific phobia than Science, 24(10), pp.1980-1985. OCD. There are also cases whereby an individual experiences both OCD and [3] Abbasi, J. (2011, July 25). Is trypophobia [13]. trypophobia a real phobia? Popular Science. Retrieved from What is the recommended approach in the http://www.popsci.com/trypophobia management of trypophobia? [4] Imaizumi, S., Furuno, M., Hibino, There is no specific treatment for H. and Koyama, S. (2016). trypophobia except by removing the stimuli Trypophobia is predicted by disgust by progressive spatial filtering of the sensitivity, empathic traits, and offensive images [2]. However, trypophobia visual discomfort. SpringerPlus, is associated mostly with common 5(1). psychiatric diagnoses such as major depressive disorder and generalized anxiety [5] Skaggs W (2014) Fear of holes. disorder. Hence, treatment should be Scientific American. Mind 25:12. designed accordingly. Individuals reported doi:10.1038/ significant psychological distress and scientificamericanmind0314-12b. impairment and among these individuals who seek treatment specifically for [6] Mobbs, D., Hagan, C., Dalgeish, T., trypophobia, only 50% of the patients found Silston, B., and Prévost, C. (2015). it to be helpful, mostly through online The ecology of human fear: survival support groups [13]. optimization and the nervous system. Front Neurosci. 9: 55. Conclusion/Suggestion doi: 10.3389/fnins.2015.00055. Steps need to be taken to first come up with [7] Darwin, C. (1871). The Descent of a diagnostic classification. In view of the Man and Selection in Relation to psychological distress that an individual Sex. London: John Murrey. with trypophobia faces, as well as the low numbers of them seeking professional help, [8] Can, W., Zhuoran, Z. and Zheng, J. awareness on the topic and effective (2017). Is Trypophobia a Phobia?. treatment is called for. Psychological Reports, [online] MJP Online Early 02-09-16 120(2), pp.206-218. Available at: investigation of clinical features. http://journals.sagepub.com/doi/abs/ Revista Brasileira de Psiquiatria, 10.1177/0033294116687298 [online] (0). Available at: [Accessed 31 Jul. 2017]. http://www.scielo.br/scielo.php?pid =S1516- [9] Imaizumi S, Furuno M, Hibino H, 44462017005009102&script=sci_art Koyama S (2016) Development of text [Accessed 31 Jul. 2017]. the Japanese version of Trypophobia Questionnaire. Jpn J Pers 25. [14] Sawchuk, C., Meunier, S., Lohr, J. and Westendorf, D. (2002). Fear, [10] Olatunji BO, Haidt J, Mckay D, disgust, and information processing David B (2008) Core, animal in specific phobia:. Journal of reminder, and Anxiety Disorders, 16(5), pp.495- contamination disgust: three kinds 510. of disgust with distinct personality, behavioral, physiological, and [15] Kupfer, T. and Le, A. (2017). clinical correlates. J Res Pers Disgusting clusters: trypophobia as 42:1243–1259. an overgeneralised disease doi:10.1016/j.jrp.2008.03.009. avoidance response. Cognition and Emotion, pp.1-13. [11] Davis MH (1980) A multidimensional approach to [16] American Psychiatric Association. individual differences in Diagnostic and Statistical Manual of empathy. JSAS Cat Sel Doc Psychol Mental Disorders, Fifth Edition 10:85. (DSM-5). Arlington: American Psychiatric Publishing; 2013. [12] Davis MH (1983) Measuring individual-differences in empathy: [17] Le, A., Cole, G. and Wilkins, A. evidence (2015). Assessment of trypophobia for a multidimensional approach. J and an analysis of its visual Pers Soc Psychol 44:113–126. precipitation. The Quarterly Journal doi:10.1037//0022-3514.44.1.113. of Experimental Psychology, 68(11), pp.2304-2322. [13] Vlok-Barnard, M. and Stein, D. (2017). Trypophobia: an Corresponding Author Irdina Amin Faculty of Medicine, University of Malaya Lembah Pantai, 50603 Kuala Lumpur Malaysia Email: [email protected] .
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