There is all manner of things in the world to be afraid of – death, darkness, clowns, heights, spiders, small spaces, dentists, balloons, and even flutes (yes, it is a real phobia and it is called aulophobia).

If that small selection was not enough, thousands of people in the last decade claim to be disturbed or frightened by something that can pop up anywhere…a cluster of irregular holes, bumps or patterns.

This is called trypophobia, an intense, irrational fear or disgust of closely packed holes and clusters of circles and bumps, such as those found in pods of lotus flowers, milk foam bubbles on a latte, or the spots on a frog’s back.

People who suffer from trypophobia usually feel queasy when looking at common triggers such as:

• Lotus seed pods
• Honeycombs
• Strawberries
• Coral
• Aluminum metal foam
• Pomegranates
• Bubbles
• Condensation
• Cantaloupe
• A cluster of eyes

Symptoms can also be triggered by animals (including insects, amphibians, and mammals) and other creatures that have spotted skin or fur.

Some of these symptoms include goosebumps, repulsion, feeling uncomfortable, visual discomfort (eyestrain, distortions, or illusions), distress, ‘crawling’ skin, panic attacks, sweating, nausea, and body shakes.

Trypophobia first came to light in an online forum in 2005 and soon developed a following. Despite the claims of thousands of people, however, the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders” does not consider it to be a recognized phobia, stating that a phobia must interfere “significantly with the person’s normal routine.” More research is required to fully understand the scope of trypophobia and the causes of the condition.

Published in 2013, one of the first studies on trypophobia suggested that it may be an extension of a biological fear of harmful things. Researchers found that symptoms were triggered by high-contrast colors in a particular graphic arrangement. They argued that people affected by the phobia were subconsciously associating harmless items – like lotus seed pods – with dangerous animals, such as the blue-ringed octopus.

Another study published in April 2017, disputes these findings. Researchers surveyed preschoolers to confirm the fear upon seeing an image with small holes is based on a fear of dangerous animals or a response to visual traits. Their results suggest that people who experience trypophobia do not possess a nonconscious fear of venomous creatures. The fear is triggered by the creature’s appearance.

Little is known about the risk factors linked to trypophobia. Another 2017 study found a possible link between the phobia and major depressive disorder and generalized anxiety disorder (GAD). According to the study, people with trypophobia were more likely to also experience major depressive disorder or GAD. A 2016 study noted a link between trypophobia and social anxiety.

To diagnose the phobia, a doctor will ask a series of questions about the symptoms. The doctor will also take note of medical, psychiatric, and social history and may also refer to the “Diagnostic and Statistical Manual of Mental Disorders” to help their diagnosis.

There are different ways trypophobia can be treated. The most effective method is exposure therapy. Exposure therapy is a type of psychotherapy that focuses on changing your response to the object or situation causing your fear. Another common treatment is cognitive behavioral therapy. This combines exposure therapy with other techniques to help manage the anxiety and keep the sufferer’s thoughts from becoming overwhelming.

Other treatment options that can help you manage trypophobia include:

• General talk therapy with a counselor or psychiatrist
• Medications such as beta-blockers and sedatives to help reduce anxiety and panic symptoms
• Relaxation techniques, such as deep breathing and yoga
• Physical activity and exercise to manage anxiety
• Mindful breathing, observation, listening, and other mindful strategies to help cope with stress

It may also be helpful to get enough rest, eat a healthy, balanced diet, avoid caffeine and other substances that can make anxiety worse, reach out to friends, family, or a support group to connect with other people managing the same issues, and face fearful situations head on as often as possible. While medications have been tested with other types of anxiety disorders, little is known about their efficacy in trypophobia.

In September 2017, trypophobia garnered a lot of media attention when “American Horror Story: Cult” featured a trypophobic character (Ally Mayfair Richards, played by Sarah Paulson). In the season-opening episode, holes in a soufflé and a coral ornament in her therapist’s office – that she claims is staring at her – overwhelm Richards.

Heavily criticized by sufferers of trypophobia, the promotional material for “American Horror Story” featured plenty of holes and bumps. Many people claimed the show displayed “insensitivity towards sufferers of trypophobia.”

Although this may be of no comfort to those who suffer from trypophobia, it is simply one of an enormous number of fears that people experience, some more distinctive than others. The online Phobia List, contains the names of hundreds of fears, from the well-known (fear of heights: acrophobia) to the fringe (fear of beautiful women: caligynephobia). Trypophobia has not made the list yet.