Is Trypophobia Skin Real?

Symptoms of trypophobia usually occur in response to an encounter with a trigger such as objects or images that have clusters of holes, and may include: 

• Avoidance of triggers 
• Feelings of fear 
• Disgust
• Anxiety 
• Panic attacks
• Sweating
• Palpitations
• Feelings of discomfort
• Body trembling
• Goosebumps
• Itching
• Nausea
• Vomiting
• Feeling that something is crawling on the skin

The cause of trypophobia is unknown because it has not been extensively researched. 

• One theory is that there are evolutionary causes for trypophobia because certain dangerous animals and diseases may have similar visual imagery. It may have arisen as a survival mechanism to avoid danger or disease. 
• Other research suggests trypophobic reactions may be a natural human response to certain types of visual stimuli, and not an actual phobia.  
• Some people who have trypophobic reactions may instead have another mental health disorder such as generalized anxiety, major depressive disorder, and/or obsessive-compulsive disorder (OCD).

Triggers of trypophobia symptoms may include objects or photographs that present clustered holes, bumps, or nodules, such as:

• Honeycombs
• Bubble wrap
• Fruit seeds
• Strawberries 
• Certain patterns
• Bumps
• Patterned animals such as snakes or insects
• Patterned imagery 
• Diseased skin characterized by clustered holes or bumps
• Coral 
• Condensation 
• Lotus seed pods 
• Pomegranates 
• Sea sponges

Trypophobia is not currently listed in the American Psychiatric Association’s DSM-5 as a mental disorder, so it is not technically a diagnosable condition. Some mental health professionals may acknowledge the condition in patients with significant symptoms that cause them emotional distress and functional impairment. 

Specific phobias are diagnosed with an evaluation by a mental health professional who will ask questions to determine the phobia and avoidance behaviors it provokes, and also determine whether there are co-existing conditions such as other anxiety disorders, mood disorders, and alcohol dependence. 

The DSM-5 criteria for specific phobia include: 

• Marked fear or anxiety about a specific object or situation 
• The phobic object or situation almost always provokes immediate fear or anxiety.
• The phobic object or situation is actively avoided or endured with intense fear or anxiety.
• The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
• The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Sometimes tests are done to rule out other conditions that may affect a person’s mental health, such as: 

• Blood tests
• Urine samples
• Brain imaging

It is common for people with trypophobia to have other mental health conditions, such as depression, obsessive-compulsive disorder (OCD), or substance use disorders that need to be diagnosed and managed. 

There is no specific treatment for trypophobia, but many of the treatments used for other specific phobias can often help reduce symptoms of trypophobia. 

Treatment for specific phobias usually involves lifestyle modifications, therapy, and sometimes medication. 

• Lifestyle modifications 
  • Relaxation strategies such as visualization 
  • Getting adequate rest
  • Practicing mindfulness
  • Meditation
  • Yoga
  • Reducing caffeine intake 
  • Increasing physical activity 
• Cognitive-behavioral therapy (CBT) for specific phobia consists of strategies designed to alter poor coping strategies that continue to sustain emotional distress
  • The main component of CBT for specific phobia is exposure therapy, which involves repeated, methodical confrontation of the feared stimulus to reduce fear through extinction and inhibitory learning 
  • In the beginning, patients are exposed to the fear-producing stimuli in a safe and controlled environment to gradually help a patient face and reduce fearful responses
  • Other components of CBT include anxiety management and reduction of safety behaviors
• Medication
  • Not a first-line treatment, but may be used in patients who do not have access to CBT with exposure or those who prefer medication over CBT 
  • Usually benzodiazepines such as lorazepam (Ativan) or clonazepam (Klonopin) are used
  • Beta-blockers such as propranolol (Inderal LA, Hemangeol, InnoPran XL) may be prescribed to help reduce fear-related symptoms such as increased heart rate, sweating, and dizziness
  • Other sedatives may be prescribed to help relax and calm the patient in triggering situations