American Horror Story: Cult: Why is Ally afraid of small holes? 

centers on Ally (Sarah Paulson), a troubled Michigan woman who is overcome with anxiety after the 2016 presidential election doesn’t turn out quite

the way she was hoping. She soon begins hallucinating clowns everywhere — example: screwing in the grocery store’s produce section — and panicking when she sees objects with small holes.

Many people are afraid of clowns at least a little bit — thanks, 

. But less common is her phobia of holes: In one scene, Ally explains to her therapist (Cheyenne Jackson) that the coral in his office is triggering her, “staring” at her, because of its holes. In another, the holes in her soufflé cause her to see blood pouring out of the dish, which then results in more clown hallucinations.

Ally lives with trypophobia, the disgust (and in her case fear) of small, closely connected holes. NYU Langone psychologist David Austern explained to EW that the types of objects commonly avoided by people with trypophobia either feature several holes or even bubbles clumped together — for example, barnacles, certain types of flowers, the underside of a tongue, or honeycombs, which the show uses in its teaser posters and videos.

“For most people who suffer from this, it has to do with the visual characteristics of the image,” Austern explains. “But when people see things like that, it triggers a strong emotional reaction. So they don’t find that it happens as much if they imagine it, so the object has to be present visually for them.”

Austern cites one 2013 study that suggested around 16 percent of people have some level of trypophobia, or at least experienced disgust when looking at hole-filled images. According to him, when people have one phobia, it is common for them to have multiple phobias, much like Ally, who fears clowns (coulrophobia) and confined spaces (claustrophobia), too.

Austern, however, denies that a phobia would make someone hallucinate as Ally does when she sees blood pouring out of a soufflé. “Panic attacks don’t usually tend to result in hallucinations,” he says, adding that trypophobia more closely concerns a disgust reaction as opposed to a fear or anxiety reaction. “If someone is imagining things that are not really there, and if they are really losing touch with reality, that would definitely be more in the psychosis realm.”

Most phobias can be effectively treated with cognitive behavioral therapy (CBT), and Austern says those with trypophobia are also likely to have success using that method. With exposure therapy, a patient works with a therapist, figures out together the things they are afraid of, and what they are avoiding because they are afraid. Then the therapist will help the patient gradually start to approach the things they have been avoiding. “This is what’s been proven to work the best for specific phobias and it works really well,” Austern says.

Of course, Sarah Paulson going to a bee farm and looking at some honeycombs doesn’t make for great TV — so 

‘s first episode has her running around a grocery store throwing bottles of rosé at scary clowns.

“I tend to think for most people it’s usually more subtle than what would be depicted on TV,” Austern says. “I think if people are encountered with the thing they are afraid of, I can definitely imagine them feeling very panicky and wanting to remove themselves from that as quickly as possible. So, it might look just like avoidance. It might not be some kind of dramatic outburst.”

In the show, Ally’s phobias worsen because of her post-election anxiety, which according to Austern, is certainly realistic. “People with any kind of mental health issue, whenever there’s stress, they are more likely to be symptomatic,” he explains.

We’ll have to see if Paulson’s character is truly losing touch with reality and hallucinating the clowns and blood. Or perhaps the clowns are real and they are preying on Ally’s phobias in an attempt to destroy her family? Either way, she should probably avoid soufflé for a while.

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