Trypophobia: why clusters of small holes make us shudder

A sponge by the sink. The bubbles rising on a pancake in the pan. A dried lotus pod in a bouquet. And suddenly, a shiver down your back, your skin starts to itch, and you want to look away right now. If this sounds familiar, you may already have seen its name on social media: trypophobia, the fear of holes.

I am a sophrologist, hypnotherapist and wellbeing coach in Bordeaux. When people mention it to me, they often laugh a little awkwardly, as if it were silly to be bothered by holes. It is not silly. The discomfort is real, it happens in the body, and research is starting to explain it quite well.

Here you will find what trypophobia is, what we know about its causes, how to get a sense of where you stand without a dubious online test, an exercise to calm the reaction, and the situations where it is better to see a doctor.

What is trypophobia?

The word comes from the Greek trypa, a hole. It describes an intense discomfort at clusters of small holes or small round shapes packed tightly together. The usual triggers are dried lotus seed pods, honeycomb, sponges, coral, strawberry seeds and some animal skins.

The first scientific description came from a University of Essex study. The researchers analysed the images that set off the reaction and found something they share: a high-contrast arrangement of shapes, the same one found in images known to tire the eyes, and on several dangerous animals.

Here is the surprising part: the holes are not necessarily what matters. Another Essex team, which developed the questionnaire researchers use, found that clusters of small bumps bother people just as much as clusters of holes. It is the pattern that disturbs.

What it feels like in the body

People who have it rarely describe fear in the usual sense. They talk instead about:

• shivers, goosebumps, skin crawling;
• itching, an urge to scratch;
• nausea, retching;
• an urgent need to close the picture or leave the room.

In a University of Kent study, many of the free-text answers mentioned exactly these skin sensations. That detail matters for what comes next.

Is it a real phobia?

Everyone asks this, and the answer has some nuance. You often read that trypophobia "is not recognised". In an editorial in BJPsych Open, the researcher who first described it points out that the American psychiatric manual contains no list of phobias, only criteria. According to him, roughly 10 to 18% of adults feel some form of anxiety when they see clusters of small holes, and the experience existed long before the internet. So it is not just a meme.

The MSD Manual sums up those criteria: a fear out of proportion to the real danger, avoidance, lasting at least six months, and real difficulties in social or working life. Shuddering at a photo of a lotus pod is not enough. Rearranging your life so you never see one again is.

When it becomes a burden

A University of Cape Town survey of 195 people with trypophobia describes long-lasting symptoms, real distress and everyday difficulties. Most felt disgust rather than fear, yet their experience looked more like a specific phobia than like obsessions. It is not my place to say where you stand: that is a doctor's job.

How to know if you have trypophobia

Online "trypophobia tests" show you one picture of holey skin after another, often edited, to see whether you can cope. I would steer clear of them. They measure nothing serious and can leave you uneasy for the whole evening. The NHS also advises care when searching online if you have a phobia, because you can quickly land on images you are not ready to see.

The Essex researchers' Trypophobia Questionnaire exists and is validated, but it is a research tool. To get a sense of where you stand, these questions tell you more:

• Do I avoid certain foods (strawberries, crumpets, cheese with holes), objects or places?
• Do I close apps or videos in case I come across an image?
• Does the reaction last long after the image: unease, nausea, thoughts that keep coming back?
• Has this gone on for several months, and does it cost me in daily life?

If you answer no to all of them, you are probably one of the many people these images bother, and that is all. If you answer yes to several, it is worth talking to your doctor.

Where does the fear of holes come from?

Several explanations have been put forward. A recent University of Essex review of about sixty studies sets out four: the visual structure of the images, a resemblance to dangerous animals, disease avoidance, and learning from others. The authors find disease avoidance the most convincing.

A protective reflex that overreacts

The idea is simple. Clusters of spots, pustules or bites on the skin can signal an infection or parasites. We may have kept a useful disgust reflex towards these signs. In people with trypophobia, the reflex would spread to perfectly harmless objects. That is what the University of Kent work shows: everyone finds diseased skin repulsive, but only people with trypophobia also react to a sponge or to bubbles.

A French CNRS team, in Dijon and Clermont-Ferrand, points the same way: faced with these images, disgust outweighs fear. The authors add that fear is still there. That is worth knowing, because we do not work with disgust in quite the same way as with fear.

Early in life, and with stress

The reaction appears early. A Japanese study showed that children aged 4 to 5 already react to these images the way adults do. The NHS also notes that phobias usually begin in childhood or adolescence and can be learned by watching a loved one react.

Stress seems to play a part. Among 2,065 young people surveyed by the University of Hong Kong, 17.6% had trypophobia, more often linked with marked anxiety or low mood, especially after a hard time. The authors stress that the effect is modest and that other factors weigh far more.

An exercise to calm the reaction

When the image pops up, the body reacts before the mind does: a shiver, tension, a caught breath. This exercise helps you take back that moment. I often suggest it in sessions because you can do it anywhere, discreetly. The NHS lists breathing exercises among the things you can do yourself for a phobia.

1. Look away without running

Look somewhere neutral: a wall, the sky, your hands. You do not have to stare at the image, nor rush out of the room. Simply tell yourself: "This is my disgust reflex. There is no danger."

2. Lengthen the out-breath

Breathe in through your nose for a count of four, out through your mouth for a count of six. Keep going for two or three minutes. A longer out-breath helps the body slow down. If you like very structured exercises, heart coherence breathing works on the same principle.

3. Settle the skin

Place your hands flat on your forearms and slide them slowly, with firm pressure, from wrists to elbows. Three or four times. The shiver and the itch often settle better with firm touch than with scratching.

4. Come back to something pleasant

Think of a texture you love: a soft fabric, warm sand, a cat's fur. Imagine it under your fingers for a few breaths. You are not trying to erase the image, you are giving your body different information.

This exercise will not make trypophobia disappear. It helps you get through the wave faster. For more ideas when emotions overflow, you can read my article on managing stress and emotions.

What helps, and when to see a doctor

For phobias in general, the most studied approach is gradual exposure, a form of CBT (cognitive behavioural therapy). The MSD Manual explains the principle: you draw up a list of situations, from the least uncomfortable to the hardest, and face them step by step instead of avoiding them. It adds that a single session can already bring some benefit.

For trypophobia, research is only just beginning. A team at Macquarie University in Sydney tested one intensive session of this kind, adding work on disgust: pairing the images with pleasant experiences. Symptoms stayed stable during the waiting period, then dropped clearly after the session, and the drop still held a month later. Both fear and disgust went down. The authors call the results preliminary, obtained with a single-case design, so with few people. I read it as a promising lead, not a certainty.

Signs that call for medical advice

See your doctor if:

• you avoid more and more foods, objects or outings;
• the reaction stops you working, studying or using your phone normally;
• you have felt anxious, worn out or low for several weeks;
• your child is very upset by these images, or others show them to your child to laugh at the reaction;
• you have real marks on your skin that worry you: they deserve to be examined.

The NHS advises seeing a doctor as soon as a phobia affects your life. Your doctor can refer you to a psychiatrist or a health professional trained in CBT. Sophrology and hypnosis do not replace medical advice. They come alongside it.

What sophrology and hypnosis can bring

I would rather be clear: there is no study on sophrology for trypophobia. What I offer draws on what helps with phobias in general. The MSD Manual mentions relaxation techniques, breathing and hypnosis as support during exposure, to help people calm down and see what frightens them differently.

In sophrology, you learn to notice the shiver as it rises, to release your shoulders and jaw, and to breathe before the wave takes up all the space. The people I work with for a phobia often describe the moment when the reaction arrives faster than the thought. That is where we work: finding a little space between the image and the body's response.

Hypnosis, to approach the image gently

Hypnosis, as I practise it, lets you approach the images you dread in your imagination, in a relaxed state, before looking at them for real. Since disgust plays a big part, we can also pair these images with pleasant sensations, which echoes the idea tested in Sydney. If another specific fear affects you, my article on emetophobia describes a similar approach.

How I work

At my practice, we start from your own list: what you avoid, what costs you the most. We move forward in small steps, and I never put an image in front of you by surprise. Hypnosis takes place only at my practice on rue Ducau. Sophrology is also available by video call.

If you would like to start, try the long out-breath today, at a calm moment, so it already feels familiar the day an image catches you off guard. For support, you can book a hypnosis session for adults, a sophrology session, or a hypnosis session for children from the age of 8. I see clients as a hypnotherapist in Bordeaux, and you can read about my background on the about page.