The Very Common Fear That You Didn’t Realize You Had

If you have a specific phobia, in which you have an extreme and disabling fear of a certain type of item or experience, you’re part of the group of individuals suffering from the most prevalent form of anxiety disorder. Specific phobias affect 12.5 percent of the population in the U.S. at some point in life, making this group of disorders the third most prevalent of all common psychological disorders. If you don’t have a specific phobia, you may have one or two symptoms involving fear of such common stimuli as spiders, germs, enclosed spaces, or heights.

If you’ve never heard of the irrational fear of holes, or trypophobia, you may find it difficult to believe that such a condition actually exists. The holes that are the source of trypophobia aren’t huge gaping holes in the middle of the road that could literally swallow you up, but instead those very small holes that you might see in a lotus flower head, a honeycomb, or the electron microscopic photo of a cell. Do you have the creeps just thinking about these stimuli? If so, read on.

According to University of Essex psychologists An Le, Geoff Cole, and Arnold Wilkins (2015), the aversion to holes is a particularly interesting phobia. The triggers don’t even have to be real objects but instead might simply be drawings or photos. Indeed, according to the authors, the images of small holes “are generally innocuous images that pose no threat, making the phenomenon hard to explain in terms of learning theory." In an earlier study, Cole and Wilkins asked a sample of slightly over 200 participants to indicate whether they found one instance of such a photo (that of a lotus flower seed head) to be uncomfortable or repulsive to view. A surprisingly high 15 percent of participants said that they did.

Le et al. set about to determine whether they could quantify this phenomenon and then find out how the fear of holes correlated to anxiety-related measures, including scales that assessed other, unrelated phobias. The purpose of their work was to set the stage for future studies that would allow researchers to determine whether this irrational fear might someday be considered a phobia in its own right.

Clarifying further, in case this is a phenomenon that comes close to home for you, trypophobia isn’t limited to fear of individual holes but also can include clusters of small pinpoints, patterns, and bumps as well as groups of spots on the skin, such as rashes or lesions. As a starting point in their study, the British group analyzed testimonials from members of an online support group and then subjected these responses to additional refinement and validation.

Le et al. coded the self-reported symptoms of the online group into 3 categories: (1) cognitive symptoms, referring to aversion or uneasiness; (2) skin-related symptoms, including itchiness or skin-crawling; and (3) physiological responses, including nausea and difficulty breathing. These are the final 17 items of the Trypophobia Questionnaire (TQ). Rate yourself using a scale of 1 (not at all) to 5 (extremely), based on your reaction if you saw photos of objects such as a lotus seed head or a honeycomb:

1. Feel skin crawl
2. Feel aversion, disgust or repulsion
3. Be uncomfortable or uneasy
4. Shiver
5. Freak out
6. Feel itchiness
7. Get chills
8. Have goosebumps
9. Be nervous (e.g., heart pounding, butterflies in stomach, sweating, stomach ache, etc.)
10. Feel anxious, full of dread, or fearful
11. Feel sick or nauseous
12. Feel as if you are going crazy
13. Feel like panicking or screaming
14. Have an urge to destroy the holes
15. Have trouble breathing
16. Feel like crying
17. Vomit

The Le et al. sample on which the TQ was tested actually came from two sources—one an online support group in which people self-identified as having trypophobia, and the other a set of college student participants. Comparisons of the supposedly nonsymptomatic college students with the online support group revealed that a score of 31 or above was enough to distinguish between the symptomatic and nonsymptomatic participants. This means that you would have to endorse 14 of the 17 items as slightly or more like you in order to qualify as potentially having this phobia.

In a second study, the British psychologists compared individuals with scores above the criterion with those having a nonsymptomatic score in their reactions to images that were considered trypophobic, another set that had holes but were neutral with regard to the phobia (e.g. a trumpet), and a third set of unpleasant images such as mold, sewage, cockroaches, dry skin, and varicose veins. Participants also rated their levels of anxiety. As expected, people with high TQ scores rated as most unpleasant the trypophobic images, giving these small-hole pictures higher unpleasantness ratings than even those of sewage or cockroaches.

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To control for the fact that the online sample was self-identified and therefore were not randomly chosen individuals, Le et al. then replicated the image-comparison study on a university sample alone. The trypophobia questionnaire scores correlated only, as expected, with the ratings of the trypophobic images but not with the other images, nor was TQ correlated with general anxiety.

In subsequent studies reported in the paper, the University of Essex researchers examined the specific qualities of small holes that correlated most strongly with the TQ scores. They were interested in determining whether “low-level” visual characteristics could precipitate the phobic reactions in people who are prone to this type of phobia. One set of findings showed that the fainter the images of the holes, the weaker the phobic reaction. In other words, the greater the contrast, the more disturbing the image was to those who are prone to this condition. Comparing the contribution of “holes” to “bumps” in trypophobia, Le et al. then went on to test the reaction of people with high TQ scales on images that were similar in size and distribution but differed in whether the shadowing made them appear to be curved inward or outward.

As the findings indicated, trypophobia can be regarded as involving fear of both bumps and holes, but the aversion to these stimuli occurs only when the holes or bumps are closely clustered. Because at this point in the series of studies the stimuli didn’t look like natural objects but were computer-generated, the authors maintain that the fear of closely-clustered holes and bumps is a reaction determined by your senses. It is not, in other words, a function of learned fears or unconscious conflicts. The fear that people with this condition experience stems from an “exaggerated sensitivity” (p. 2320) to particular visual stimuli. If you’re one of those with trypophobia, it may be reassuring to know that your fears stem not from issues in your early childhood years but from a true physiological reaction that develops on its own accord.

To sum up, part of living a fulfilling life is the ability to approach potentially fear-inducing stimuli without experiencing the type of discomfort identified in the TQ. Even though this particular variety of specific phobia hasn’t made it to the DSM-5, if it is disabling enough, there are treatments that work, allowing you to find that fulfillment.