In a study by Kupfer and Le, trypophobic and non-trypophobic participants showed significant aversion to disease-relevant cluster images, but only trypophobic participants displayed a significant aversion to disease-irrelevant cluster images. Researchers have also speculated that trypophobic reactions could be perceived as cues to infectious disease, which could be alerts that give one a survival advantage. Based on the imagery's visual cues, An Trong Dinh Le, Cole, and Wilkins developed a symptom questionnaire that they believe can be used to identify trypophobia. Whether together or separate, it appears that low and midrange spatial frequencies are necessary for inducing trypophobic reactions. described trypophobia as usually involving "an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general, images that present high-contrast energy at low and midrange spatial frequencies." Cole and Wilkins also stated the imagery has high spatial frequency with greater energy at midrange. Can et al., however, believe the connection between trypophobia and evolution as a result of a threat from deadly creatures to be weak and that, if a connection does exist, it manifests later in life rather than in childhood. Because of this, it is hypothesized that trypophobia has an evolutionary basis meant to alert humans of dangerous organisms. Furthermore, other animals such as the frog Pipa pipa have been known to be a trypophobia trigger. Imagery of various venomous animals (for example, certain types of snakes, insects, and spiders) have visual characteristics similar to trypophobic imagery. Geoff Cole and Arnold Wilkins believe the reaction is an "unconscious reflex reaction" based on a biological revulsion, rather than a learned cultural fear. Several possible causes have been proposed. The understanding of trypophobia is limited. Disgust is usually the stronger emotion in those with trypophobia. Trypophobia may manifest as a reaction of fear, disgust, or both. Other reported symptoms include goose bumps, body shakes, nosebleeds, feeling uncomfortable, and visual discomfort such as eyestrain, distortions, or illusions. Upon seeing these shapes, some people said they shuddered, felt their skin crawl, experienced panic attacks, sweated, palpitated, or felt nauseated or itchy. Shapes that elicit a trypophobic reaction include clustered holes in innocuous contexts, such as fruit and bubbles, and in contexts associated with danger, such as holes made by insects and holes in wounds and diseased tissue such as those caused by mango flies in animals, especially dogs. Trypophobia often presents with an autonomic nervous system response. In one study, most of the participants with trypophobia met the DSM-5 criteria for a specific phobia, even though they experienced disgust instead of fear when shown imagery of clusters of holes however, they did not meet the distress or impairment criterion. Because phobias involve fear, a response to trypophobic imagery that is based mostly or solely on disgust renders its status as a specific phobia questionable. Whether trypophobia can be accurately described as a specific phobia might depend on whether the person mainly responds with fear or with disgust. However, it may fall under the broad category of specific phobia if it involves fear that is excessive, persistent, and associated with significant distress or impairment. Trypophobia is not recognized by name as a mental disorder, and so is not a specific diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5). It has since become a popular topic on social media. The term trypophobia was coined by a participant in an online forum in 2005. Exposure therapy is a possible treatment. Although few studies have been done on trypophobia, researchers hypothesize that it is the result of a biological revulsion that associates trypophobic shapes with danger or disease, and may therefore have an evolutionary basis. The scientific understanding of trypophobia is limited. A minority of people experience the same level of fear and disgust, and a few express only disgust or fear. Most affected people experience mainly disgust when they see trypophobic imagery. It is not officially recognized as a mental disorder, but may be diagnosed as a specific phobia if excessive fear and distress occur. Trypophobia is an aversion to the sight of repetitive patterns or clusters of small holes or bumps. The holes in lotus seed heads elicit feelings of discomfort or repulsion in some people.
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