Tailor-Made Terror: The Mystery of Koumpounophobia, the Fear of Buttons

Paul is an IT consultant who lives in Georgia. Some years ago, he agreed to meet a woman that a friend of his thought would be perfect for him. They went on a date. She was nice, but Paul told his friend it wasn’t going to work out because she had been wearing a shirt with buttons. Lots of buttons.

Since childhood, Paul has had an aversion to buttons. When his parents took him to church and he was forced to wear a dress shirt, he insisted on covering the line of buttons with a necktie so he wouldn’t have to see them. As an adult, he leaves his work attire buttoned almost to the top, leaving just one undone so he can pull it over his head. That way, he won’t have to touch the rest of them. “The ones I hate most are the four-hole, iridescent buttons,” Paul tells Mental Floss, describing one of the most common types of plastic clothing buttons. “But they are all degrees of disgusting.”

Paul suffers from , or a fear of buttons—a phobia so rare that only one clinical case has ever been documented in psychiatric literature. Unlike more common ailments like a fear of snakes or heights, those afflicted with koumpounophobia find it difficult to practice avoidance. Buttons are everywhere. On clothes. In stores. Stuffed in closets. Lurking in laundry hampers. If sufferers can somehow avoid wearing them, they’re still distressed by the sight of them on others. A hug from a button-wearer can provoke as much anxiety as the feeling of a spider crawling up an arachnophobe’s leg.

Despite his apprehensions, Paul agreed to see his date again. But before their relationship could continue, he had to sit her down and explain his affliction. “This is weird,” he told her, “but if we keep seeing each other, you need to make an effort not to wear buttons.”

Koumpounophobia had its moment in the spotlight in 2007, when The Wall Street Journal intimated that Apple co-founder Steve Jobs hated buttons. The evidence, according to the paper, included Apple’s debut iPhone, a touchscreen-based device that would revolutionize telecommunications, as well as Jobs’s wardrobe, which consisted mostly of black turtlenecks. While not a disclosed phobia, the button-free preferences of Jobs (who died in 2011) has led some observers to speculate his aversion might have led to radical tech innovations that changed the course of history.

For most koumpounophobes—which may number just one in 75,000 people, a fraction of the 9 percent of Americans who suffer from specific phobias—their disgust for buttons simply changes the course of their day. They avoid looking at, touching, wearing, or thinking about buttons, an aversion that idles at the intersection between terror and repulsion, according to Wendy Silverman, Ph.D., the director of the Yale Child Study Center Program for Anxiety Disorders.

"There is linkage between phobia, fear, and disgust," Silverman tells Mental Floss. What people think of as fear may instead be a strong loathing. Either way, it results in avoidance behavior. In 2002, Silverman co-authored and published the only clinical paper [PDF] chronicling a case study of an adolescent presenting with a button avoidance.

At the time, Silverman was in clinical practice at Miami's Florida International University and agreed to see a mother and her 9-year-old son. The mother said that her son had struggled with his school uniform, which included a button-up shirt. He refused to touch the buttons or look at them. He didn’t like the smell of them.

“He had the feeling they were just gross,” Silverman says. “Because of the uniform, he was forced into enduring them. They caused extreme distress.”

Silverman learned of a telling incident that happened when the child was 5 years old: During a kindergarten art lesson, the boy had run out of buttons to glue to his poster board. Walking up to a giant bowl of them on the teacher’s desk, he slipped. The bowl tipped over, scattering buttons everywhere.

It’s easy to imagine the embarrassment of the boy, eyed by his classmates after sending the stockpile of buttons flying. But Silverman says that such inciting incidents are hard to come by. For most phobics, they can’t always remember that pivotal moment when an innocuous object became a threat. Memory is unreliable, and therapists don't typically find that learning the origin of a fear aids in helping to treat it. “Typically, it’s not common for kids presenting with a phobia to have experienced a direct event like this. Many times, it’s just them observing someone else or hearing about it.”

According to Silverman, the child had a hierarchy of distaste. Small plastic buttons provoked the strongest reaction; large, jean-style brass buttons were only minimally troubling. The Jobs theory aside, electronic-style buttons—like the kind used on computer keyboards—don’t seem to be a trigger. “It’s a gradient common in phobias,” she says. “If you have a fear of dogs and see a poodle, that’s different from seeing a big dog that’s not on a leash.”

Silverman ruled out obsessive-compulsive disorder in the child’s case, as he didn’t claim any repetitive or persistent thoughts about buttons, and decided to initiate exposure therapy by slowly introducing him to physical interactions with buttons, a common approach for phobias. When he handled them, he received positive enforcement from his mother. Yet his anxiety increased: All he wanted to do was prevent anyone from assailing him with buttons. For years, that was his coping mechanism.

“Avoidance behavior, over time, just makes it worse,” Silverman says. “The mother was buying special clothes and he was allowed to avoid them.” Left untreated, koumpounophobes can come to find that buttons will begin to exact increasing influence over their lives.

In order to get Ronald, almost 4, to wear buttons, his mother Viv tries to make a game out of it, buttoning her own shirt as he buttons his. Sometimes this works; other times, he becomes so distressed that she gives up. What concerns her most is that Ronald spends his time in preschool being extremely wary of children wearing buttons.

“The way we see it happening is that he just avoids any child with buttons and has a tendency to play by himself at school,” Viv tells Mental Floss. “The teachers probably just don't see the pattern because who would think to tie whether he likes a kid or not to what the kid is wearing? They probably think of him as a bit antisocial.”

To hate buttons is to avoid people wearing buttons, something that can have significant social implications for both children and adults. Paul is, in a sense, one possible future for Ronald. His phobia dictates his moods, his relationships, and his stress levels. Forced to wear buttons, he likens it to someone with anxiety over flying. “You sit on the plane but you don’t like it,” Paul says. “It’s not comfortable. You’re aware of it the whole time.”

He has little influence over how others wield buttons. If a person wearing buttons comes in for a hug, he’ll perform only the bare minimum in return. “A side hug, maybe,” he says. His wife—the same woman to whom he admitted his phobia 10 years ago—will sometimes put a button in her mouth to annoy him. People find his discomfort over fasteners funny.

“I’ve had people at work leave buttons on my desk," Paul says. "I don’t like it. A box of random buttons is gross. It’s not there for any reason.” Gratuitous shots of buttons in movies or on television annoy him. “It’s like, why are you showing this in close-up?” If he's forced to touch a button, he’ll wash his hands. “It’s like, ‘I gotta get this button off of me.’”

Contamination might be one possible explanation for why button phobics react the way they do. Paul remembers chewing on his collar as a child. Maybe, he says, a foul-tasting button made him regard all buttons as something off-putting and dirty. It’s enough to provoke unease, but not quite on the level of phobias that can cripple a person’s activities.

“Most people with a button phobia don’t meet diagnostic criteria in terms of distress and disability,” Graham Davey, a professor of psychology at the University of Sussex, tells Mental Floss. "So in this sense, button phobia will usually be only a mild phobia and can usually be addressed by simply cutting off all the buttons from clothing before wearing those clothes … But I have known people whose discomfort with buttons is generally down to feeling constricted by them, so it may represent a very unusual form of claustrophobia.”

Cognitive behavioral therapy (CBT), which suggests modulating thought processes away from the unhelpful behavior, is one way to address an avoidance of buttons. Exposure therapy, a common technique used in CBT, subjects patients to an escalating series of encounters with the thing that causes them distress. If someone has a fear of flying, they might start with looking at a picture of an airplane before sitting in a grounded aircraft and then, ultimately, taking off. In the case of the 9-year-old boy in Miami who was brought in hating buttons, exposure wasn't enough.

"He was still having distress reactions," Silverman says. So she switched to focusing on the disgust portion of his aversion. She instructed him to imagine buttons falling on him and to consider how they felt, looked, and smelled, forcing him to analyze his own feelings and regard them as disproportionate to the objective harmlessness of the objects. His distress, measured verbally by the boy on a one-to-nine scale, began to decrease.

At follow-up at six and 12 months, the boy reported only minimal discomfort when exposed to buttons. The clear plastic kind, once the most troubling, were worn without incident on a daily basis.

While Viv has not pursued professional help for her son, she has shown Ronald videos on button-making that didn’t seem to produce much anxiety. They also made buttons out of Play-Doh. “Maybe we’ll try again,” she says, “after we get through potty training.”

A sense of embarrassment can often stifle such attempts to cope. Paul has seen a therapist for general issues relating to looming middle age but has avoided the button topic, fearing it will sound ridiculous. Sufferers find it easier to practice avoidance, customizing tasks in an effort to reduce exposure. While cognitive therapy and exposure may work, the sufferer has to want it to work.

Paul has learned to iron shirts that are already buttoned up so he doesn’t have to touch them. More distressing than that is the fact his young daughter is beginning to exhibit signs of koumpounophobia. “She’s started to have the same aversion to buttons which has caused a bit of concern for me,” he says. “I’m trying to introduce buttons into her world so she doesn’t have to deal with the constraint.” But Paul also admits he’s most comfortable when his family’s closets are button-free, or close to it. “I can’t remember a time when I didn’t hate buttons wholeheartedly,” he says.