Abstract

Background: Trypophobia describes aversive responses to clustered visual patterns, but its epidemiology and cross-cultural measurement remain insufficiently studied. This study evaluated the psychometric properties of the Turkish Trypophobia Questionnaire (TQ) and examined factors associated with symptom severity.

Methods: This cross-sectional study included 261 community participants aged ≥15 years. Reliability and construct validity were assessed using internal consistency measures, exploratory and confirmatory factor analyses, and parallel analysis. Independent associations with TQ scores were examined using multivariable linear regression with HC3 robust standard errors.

Results: The TQ showed high internal consistency (Cronbach’s α=0.968; McDonald’s ω=0.970), but 61.7% of participants had the minimum score. Parallel analysis favored one factor, whereas one-factor CFA showed poor fit (CFI=0.768, TLI=0.726, RMSEA=0.230). Higher scores were independently associated with female sex and psychiatric disorders, while age and educational level showed inverse associations.

Conclusions: The Turkish TQ showed strong internal consistency, but its structural validity remains uncertain because of the marked floor effect and poor CFA fit. Further validation using independent samples and methods appropriate for ordinal data is needed.

Keywords: trypophobia, psychometric validation, reliability, construct validity, Türkiye

License

Copyright (c) 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to Cite

1.
Gül SS, Aygün H. Psychometric validation of the Turkish Trypophobia Questionnaire and determinants of trypophobia symptoms in a community-based sample. J Trends Med Invest. 2026;2(2):82-91. https://doi.org/10.64512/JTMI.2026.31

References

  1. Cole GG, Wilkins AJ. Fear of holes. Psychol Sci. 2013;24(10):1980-5. https://doi.org/10.1177/0956797613484937
  2. Can W, Zhuoran Z, Zheng J. Is trypophobia a phobia? Psychol Rep. 2017;120(2):206-218. https://doi.org/10.1177/0033294116687298
  3. Cole GG. Is trypophobia real? BJPsych Open. 2024;10(2):e48. https://doi.org/10.1192/bjo.2023.621
  4. Mayor E, Meyer A, Miani A, Lieb R. An exploration of the nomological network of trypophobia. PLoS One. 2021;16(9):e0257409. https://doi.org/10.1371/journal.pone.0257409
  5. Thiebaut G, Méot A, Prokop P, Bonin P. Is trypophobia more related to disgust than to fear? Assessing the disease avoidance and ancestral fear hypotheses. Q J Exp Psychol (Hove). 2025;78(12):2681-2687. https://doi.org/10.1177/17470218251323236
  6. Alkhalifa F, Wilkins A, Almurbati N, Pinelo J. Examining the visual effect of trypophobic repetitive pattern in contemporary urban environments: Bahrain as a case for middle east countries. Journal of Architecture and Urbanism. 2020;44(1):44-51. https://doi.org/10.3846/jau.2020.11142
  7. Wong SMY, Tang EYH, Hui CLM, et al. Excessive fear of clusters of holes, its interaction with stressful life events and the association with anxiety and depressive symptoms: large epidemiological study of young people in Hong Kong. BJPsych Open. 2023;9(5):e151. https://doi.org/10.1192/bjo.2023.540
  8. Cole GG, Millett AC, Juanchich M. The social learning account of trypophobia. Q J Exp Psychol (Hove). 2024;77(10):2076-2083. https://doi.org/10.1177/17470218241232665
  9. Schaller M, Park JH. The behavioral immune system (and why it matters). Current Directions in Psychological Science. 2011;20(2):99-103. https://doi.org/10.1177/0963721411402596
  10. Curtis V, de Barra M. The structure and function of pathogen disgust. Philos Trans R Soc Lond B Biol Sci. 2018;373(1751):20170208. https://doi.org/10.1098/rstb.2017.0208
  11. Kupfer TR, Le ATD. Disgusting clusters: trypophobia as an overgeneralised disease avoidance response. Cogn Emot. 2018;32(4):729-741. https://doi.org/10.1080/02699931.2017.1345721
  12. DiMattina C, Pipitone RN, Renteria MR, Ryan KJ. Trypophobia, skin disease, and the visual discomfort of natural textures. Sci Rep. 2024;14(1):5050. https://doi.org/10.1038/s41598-024-55149-8
  13. Yu P, Yu L, Li Y, et al. Emotional and visual responses to trypophobic images with object, animal, or human body backgrounds: an eye-tracking study. Front Psychol. 2024;15:1467608. https://doi.org/10.3389/fpsyg.2024.1467608
  14. Ayzenberg V, Hickey MR, Lourenco SF. Pupillometry reveals the physiological underpinnings of the aversion to holes. PeerJ. 2018;6:e4185. https://doi.org/10.7717/peerj.4185
  15. Le A, Cole GG, Wilkins A. Trypophobia: heart rate, heart rate variability and cortical haemodynamic response. J Affect Disord. 2020;274:1147-1151. https://doi.org/10.1016/j.jad.2020.06.002
  16. Olatunji BO, Armstrong T, Elwood L. Is disgust proneness associated with anxiety and related disorders? A qualitative review and meta-analysis of group comparison and correlational studies. Perspect Psychol Sci. 2017;12(4):613-648. https://doi.org/10.1177/1745691616688879
  17. Le ATD, Cole GG, Wilkins AJ. Assessment of trypophobia and an analysis of its visual precipitation. Q J Exp Psychol (Hove). 2015;68(11):2304-22. https://doi.org/10.1080/17470218.2015.1013970
  18. Imaizumi S, Furuno M, Hibino H, Koyama S. Development of the Japanese version of Trypophobia Questionnaire. The Japanese Journal of Personality. 2016;25(2):171-173. https://doi.org/10.2132/personality.25.171
  19. Imaizumi S, Tanno Y. Rasch analysis of the Trypophobia Questionnaire. BMC Res Notes. 2018;11(1):128. https://doi.org/10.1186/s13104-018-3245-5
  20. Prinsen CAC, Mokkink LB, Bouter LM, et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27(5):1147-1157. https://doi.org/10.1007/s11136-018-1798-3
  21. Marsh HW, Morin AJS, Parker PD, Kaur G. Exploratory structural equation modeling: an integration of the best features of exploratory and confirmatory factor analysis. Annu Rev Clin Psychol. 2014;10:85-110. https://doi.org/10.1146/annurev-clinpsy-032813-153700
  22. Rhemtulla M, Brosseau-Liard PÉ, Savalei V. When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychol Methods. 2012;17(3):354-73. https://doi.org/10.1037/a0029315
  23. Liu J, Bao Y, DiStefano C, Jiang W. Collapsing sparse responses in likert-type scale data: advantages and disadvantages for model fit in CFA. Educ Psychol Meas. 2026;86(4):649-673. https://doi.org/10.1177/00131644251401097