Cacophobia (An Overview)

In this blog we will discuss Cacophobia (symptoms, causes and treatment). 

What is Cacophobia? 

Someone suffering from Cacophobia will have a fear of ugliness. This fear is experienced or interpreted in different ways by different people.

Unlike other specific phobias, this type is more subjective.

Every individual defines ugliness in various ways and has a diverse set of criteria to label something/someone as ugly. 

This specific phobia can be experienced in two ways; either it is a fear of being/looking ugly or it is the fear of seeing ugly things. 

A person with Cacophobia will suffer extreme anxiety if they assume that they look ugly.

Another possibility is that a sufferer will get anxious if they assume an object to be gross.

People’s interpretations may differ, for example, a dirty plate might seem to be the reason for one’s anxiety but to someone else with the same phobia type, the dirty plate will hold no significance.   

In severe cases, the anxiety can cause panic attacks or the person might need hospitalization.

Sufferers will be overly critical not just about other people or things but for themselves too.

This self-criticism can cause the person to suffer from depression or Obsessive-compulsive Disorder (OCD) in the long run.

An individual, who is critical of himself will be extremely conscious about their looks and appearance.

This can or will affect their social and occupational functioning, causes hindrances in their personal relations or social life.

For example, someone who fears that they’re looking ugly will spend hours on trying to fix themselves.

These people will impulsively spend lots of money to undergo either surgeries or other beauty treatments in an attempt to look beautiful. 

According to the DSM-5, for the diagnosis of Cacophobia, one needs to have anxiety lasting for at-least 6-months.

This anxiety alongside with other physiological symptoms should affect the individual’s social and occupational functioning.  

Cacophobia is an irrational fear of ugliness.

An individual suffering from this type of specific phobia will feel extreme anxiety upon an encounter with something ugly or gross. 

Symptoms of Cacophobia

All the specific phobias including Cacophobia have anxiety as their main symptom.

Anxiety helps to differentiate a normal, judgmental or critical person with a sufferer of Cacophobia.

Apart from anxiety, someone suffering from this phobia will feel sickened/disgusted upon encountering something which they perceive to be ugly. 

The sufferers might be able to rationalize their fear and acknowledge the subjectivity of it but, they’re still unable to control it. 

Someone with the phobia might be suffering from low self-esteem due to which they either criticize their own appearances or are highly judgmental about how other people or objects look like.

People with Cacophobia also have low confidence, this is why they feel anxious. 

The symptoms of Cacophobia are as follows:

  • Extreme anxiety when seeing something as ‘ugly’ 
  • Extreme anxiety when thinking about something that is ‘ugly’
  • Inability to control emotions or feelings 
  • Being overly self-critical or judgmental.  
  • Panic attacks 
  • Shortness of breath 
  • Increase in heartbeat 
  • Excessive sweating 
  • Drying of mouth 
  • Trembling 
  • Nausea 
  • Feeling dizzy 
  • Muscle tension 

Out of all these symptoms, at least 3-5 should be present in a person to be diagnosed with Cacophobia.

Anxiety being the main symptom.

Causes  of Cacophobia

All phobias either have a genetic cause or a past traumatic event that led to the emergence of a specific phobia.

There is no one real cause for them, instead one has specific phobias due to a combination of these two explanations. 

Cacophobia, like all other phobias, has a genetic as well as an environmental or personal explanation. 

According to the genetic explanation of specific phobias, there is always a genetic predisposition.

Either there is a chemical imbalance in the brain or a distortion in the genes structure that causes Cacophobia.

Because all specific phobias or anxiety disorders are hereditary, they can be passed on from one generation to the next. 

For example, if a person’s parent(s) had an anxiety related disorder or any type of specific phobia, then he/she is more likely to have Cacophobia (when triggered by a fearful stimuli), as compared to someone who doesn’t have a family history. 

However, according to the environmental explanation, phobias are caused by a trigger event.

Any traumatic past experience through which one goes through might be the reason why they develop a specific phobia, either years after the incident or immediately afterwards. 

For example, if a person sees someone or something as ugly, this might be because of their internal feelings.

If an individual is gloomy then they will perceive all the things happening around them as unpleasant or anxiety causing.

This is why they label the things or people they dislike as ugly. 

Also, someone who is very self-conscious and overly critical of themselves will find themselves ugly and be anxious of the way they look.

Some people lack confidence in themselves because of the way they see the world.

They might have inferiority complexes or were raised in an environment where they were used to be seeing people look or behave a specific way. 

This pre-conditioning affects their perception of other people because, either they see themselves as ‘ugly’ or a misfit or they start criticizing others for the way they look or behave.

Children for example develop Cacophobia because maybe they were bullied when young, based on their looks. 

They may also develop a fear of objects such as trash cans etc., by which they were bullied.

Therefore, they displace their fear of the incident with the object they are afraid of and see it as disturbing or triggering anxiety. 

Because this phobia is highly subjective and specific to the experiences of each individual suffering from it, there can be a number of possible examples because of which one develops Cacophobia. 

One of the many possible examples can be, as a child someone might have been abused physically or sexually by a person.

The victim will develop a fear of the person and or any object they might have in memory that was present at the time of the incident.

As the child grew, he developed a dislike for either the object that was in his memory and became fearful of it, feeling extremely anxious when they come across anything like it. 

Or the child can develop hate for themselves and will see their own self as ugly.

The person might also find other people, sharing a few characteristics of the convict as ugly or terrifying. 

All these examples show that Cacophobia is caused by a number of environmental factors, including a genetic link.

The biology of one’s mind or body, along with their personal experiences can give rise to this irrational fear of ugliness. 

Treatment  of Cacophobia

Like all the other specific phobias, Cacophobia is treated by a number of different therapies including Cognitive-behavioral Therapy (CBT) and or medications that lower downs the anxiety or other physical symptoms. 

. • Cognitive-Behavioral Therapy (CBT) 

It is one of the most frequently used treatments for patients with almost all kinds of mental disorders. 

Cacophobia is defined as the irrational fear of ugliness.

Thus, the therapist helps the patient in replacing these irrational thoughts with more rational ones.

The patients are helped out in analyzing and justifying the way they feel about being exposed to something they label as ugly.

The therapists assist them in uncovering the reasons behind their fear and later they provide them with alternate, pleasant thoughts. 

The patient is told to maintain a thought diary (with ABCD column) which provides them a replacement for every irrational thought they have, when thinking about a particular situation.

The ABCD stands for: 

        i. A (antecedents) a situation or triggering event. 

        ii. B (belief) the thought that comes to one’s mind when in that triggering situation

       iii. C (consequences) the symptoms/feelings caused by that event/thought 

       iv. D (dispute) alternate, rational thoughts provided by the therapist in an attempt to dispute/challenge those irrational beliefs.

This last section of the thought diary is what really plays a role in helping the person feel good/less anxious.  

• Dialectical Behavior Therapy (DBT) 

This is another effective therapy used to treat Cacophobia.

It is more commonly used with people suffering from personality disorders, but is also useful with patients of Cacophobia.

Coping skills are taught in the DBT group which lasts for about 6months and can have a number of people (depending on how many join the group). 

         i. Half-smiling is the first module of DBT. It is a technique that is used with patients who are distressed because of their irrational thoughts.

The technique is known as ‘Half-smiling’ because the person is first advised to think about the stimuli that fears or upsets them, and while doing so they are told to lift the corners of their mouths by subtly smiling.

Smiling is not that will help one get rid of these unpleasant thoughts, it is the person’s ability to constrain itself from thinking about those thoughts while half smiling.

         ii. Mindfulness, the second module, is another technique used in DBT groups which helps the individual in getting rid of those negative thoughts.

Individuals are told to focus on the present and be attentive to what is going on around them at the moment.

This helps in breaking the link between their mind and any negative thought that might come to them then. 

For example, a person is told to focus on his breath or on the sound of the wind, making use of their auditory sense. 

        iii. The third technique or module of the DBT is distress tolerance skills.

This module teaches people to calm themselves down in healthy ways when they are distressed or emotionally overwhelmed.

Individuals are allowed to make wise, rational decisions and take immediate action, rather than being captured by emotionally destructive thoughts that might make the situation worse.

Reality acceptance skills are also learnt under this model so that people fully accept reality and later make plans on how to address the problem/fearful aspects to it. 

• Mindfulness-Based Stress Reduction (MBSR) 

MBSR is a meditation therapy, used to manage stress or anxiety. It is an 8-week program which includes group sessions.

Mindfulness meditation and Hatha yoga are practiced in these sessions, lectures and group discussions are also done to talk about mental health and increase interactivity.

In mindfulness meditation the person is told to, for example, to focus on the sensations felt while breathing or the rhythm of the chest rising and falling during the process.

This distracts the person’s attention from something stressful to something which is neutral and soothing. 

For quick and effective treatment, patients are also given a set of home works, for example 45 minutes’ yoga and meditation 6 days a week and to record their results/feelings in a book or diary for 15minutes a day. 

• Yoga/Meditation 

They are not just one of the many treatment therapies used for Cacophobia, instead they are one of the most common ways of relaxation used by many people.

Yoga tends to stimulate the meditative state of one’s mind while a person is in a particular yoga pose/position.

Through yoga/meditation the mind is diverted towards something more productive and calmer, allowing the person to escape the negative, distress causing thoughts.

 Out of a number of yoga types, one can benefit from any yoga type/pose they like.

Hatha yoga is one of the different types of yoga.

The breathing techniques or the imagery, one creates while in a yoga posture are the real factors that makes the person feel less anxious and diverts their mind, away from the thoughts about ugliness or something gross. 

• Drug Therapy 

Drugs are used to reduce the physical symptoms caused by Cacophobia.

Drugs are very quick in effectiveness, as they start showing progress in the patients’ health at least 2 weeks after the medicine is taken.

This type of biological treatment is usually more effective if the cause of the phobia is only genetic.

 However, these drugs/medicines are not to be taken without a doctor’s prescription or consultation.

Two types of drugs are used in the treatment of this phobia:

          i. Anti-anxiety Drugs

These include medicines called Diazepam.

They are most commonly used with patients who experience panic attacks and also lowers the anxiety by binding to receptor cells of the brain that cause these unpleasant symptoms. 

         ii. Antidepressant Drugs

These drugs as the name suggest don’t only treat depression but are also very effective in treating phobias.

Medicines like Zoloft reduce the anxious feelings of a person and makes him feel calm.

They need to be taken on a daily basis but not without a doctor’s advice. 

Whether the cause of Cacophobia, or any other type of specific phobia is genetics, environmental or both, the best and the most effective way of treating them is by using a combination of both biological treatments (drugs) with cognitive treatment (for example CBT/exposure therapy).

Titles to read

by Edmund J. Bourne PhD and Matthew McKay PhD

by Martin M. Antony, Michelle G. Craske, et al

by Sabrina Strings, Allyson Johnson, et al

by Assen Alladin

Frequently Asked Questions

Q1) Are Body Dysmorphic Disorder (BDD) and Cacophobia the same?

No. BDD is a separate disorder in the DSM-5, however Cacophobia is a specific phobia which comes under the category of Anxiety Disorders.

Q2) How do I know if I have Cacophobia?

The symptoms of Cacophobia include excessive anxiety accompanied by panic attacks.

A person’s heartbeat will increase and someone might even feel unconscious. 

Q3) Does Cacophobia require hospitalization?

No. It does not require hospitalization, only until the symptoms worsen and the patient needs immediate medical help.

Q4) Will I develop Cacophobia if either of my parents have it?

Though Cacophobia has a genetic link with the occurrence of this disorder, it is not necessary for a child to have it if the parents are suffering.

Any other environmental trigger, like personal experiences ca also lead to one having Cacophobia.

Also someone who has a family history of Anxiety Disorders is not destined to have it too, only their chances of having it are higher than others.