Misophonia

Misophonia

Rear view photo of person working at office desk wearing headphonesMisophonia, meaning “hatred or dislike of sound,” is characterized by mild to extreme negative emotional reactions to noises and audial triggers. While still unrecognized by the American Psychological Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM), misophonia is a real condition researchers have identified as separate from anger issues, anxiety, or any other mental health diagnosis.

Because misophonia is relatively unknown and can remain unidentified even in those who experience it, there are not yet reliable statistics regarding how prevalent it is worldwide or even in the United States alone. Some studies have shown misophonia is more likely to affect white women under the age of 30, but this finding may be slightly skewed due to the mode of study (for example, this demographic is also more likely to use and respond to surveys publicized on social media). The more research presented on the topic, the more evidence overwhelmingly supports recognizing misophonia as its own psychiatric condition.

Understanding Misophonia

For individuals with misophonia, some sounds trigger the flight-or-flight response in the brain. This means seemingly harmless or simply annoying noises can affect someone with misophonia to a point where they experience terror and rage, rather than mild exasperation or aversion. The individual usually feels an urgent need to leave the area or put an end to the offending noise. Some people with the condition find it difficult to keep a job because of trigger-related panic attacks and find family time unbearable due to the accompanying noises.

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Misophonia is commonly miscategorized with anger issues, irritability, autism, obsessions and compulsions (OCD), and other mental health concerns, but it is an independent condition that may or may not co-occur with any of the above issues and more. Brain scans reveal similar reactions to audial triggers in those with misophonia as in those with Tourette syndrome, autism, tinnitus, and OCD. But whereas the latter conditions are more likely to involve sound sensitivity related to volume or a cacophony of noise, misophonia is a reaction to the sounds themselves. The overlap in brain imaging may help researchers identify neuropathological similarities that ultimately point to a longer-term cure or relief for people with misophonia.

Common Misophonia Triggers

Sounds that tend to be triggering for individuals with misophonia vary greatly. Though many sounds might be unpleasant, each person can likely name a few specific noises that set them off more than others. Some reactions are so strong a person with misophonia may even be triggered by a picture or mention of the sound. Some triggers might include:

  • Food packaging noises (chip bags rustling, jars popping open)
  • Eating noises (chewing, slurping, lip smacking)
  • Bodily functions (burping, sniffling, persistent coughing, throat clearing)
  • Environmental factors (dripping faucets, barking dogs, household appliance noises)
  • Repetitive behaviors (pen clicking, whistling, knuckle cracking, breathing noises)

Misophonia Symptoms and Signs

Misophonia is most likely to develop in early adolescence, and many people describe first becoming aware of triggering sounds from parents or primary caregivers growing up. The condition may become more pervasive over time, producing more triggers or a stronger reaction, but the severity may also remain relatively unchanged. Some might notice they are more tolerant of triggers when they’re displayed by someone they love, but the reaction is generally present regardless of the person or people present. 

As more people continue to discuss misophonia, the more the field of psychotherapy and individual therapists are likely to acknowledge and respect the process of helping people achieve more peace with the condition and live more fully. 

Some trigger responses may include:

  • Crying related to agitation
  • Panic attacks
  • Leaving the area
  • Inability to speak or move
  • Moderate to severe agitation
  • Violent thoughts or impulsivity
  • Intense anxiety
  • Increased heart rate
  • Sweating

The overwhelm of emotions and intense physiological reactions to triggers can cause some people with misophonia to seek alcohol or drugs to help cope with the situation. Though some have said the mind-altering effects can diminish the effects of a trigger at the moment it arises, cumulative substance use can have the opposite effect, heightening someone’s overall sensitivity to triggers. For this reason, people with misophonia are generally discouraged from alcohol and drug use.

Therapy and Treatment for Misophonia

People who live with misophonia can help make the experience easier in some cases by wearing headphones or earplugs, counteracting triggering noises with sounds they find calming, and discussing the issue with people they often spend time around. These actions likely will not address the underlying triggers of misophonia, but they can help someone live more comfortably. 

Therapy might focus on helping an individual manage the fight-or-flight response initiated by a trigger; control anger that arises; and develop positive ways of talking to family, friends, and coworkers about being aware of any triggering sounds they make. A therapist may encourage people with misophonia to experiment with calming imagery, soothing noises, and meditation–especially when confronted with a triggering sound.

Because research on misophonia is lacking and the condition is not yet included in the DSM, public reaction isn’t always accepting of the condition or those who live with it. But as more people continue to discuss misophonia, the more the field of psychotherapy and individual therapists are likely to acknowledge and respect the process of helping people achieve more peace with the condition and live more fully. 

Case Examples

  • Misophonia since adolescence: Sufi, 32, has experienced feelings of rage related to certain audio triggers since her early teenage years. At first her reactions were isolated to her father, who tended to slurp his coffee and whistle while doing chores. Her family convinced her these issues were typical signs of a teenage temper, but as she grew up the triggers didn’t go away. If anything, they got worse. It takes a couple of tries to find a therapist who acknowledges the condition as misophonia rather than a byproduct of anxiety, but finally Sufi finds relief through talk therapy, guided meditation, self-care, and some anger management workbooks her therapist recommends to her. 
  • Co-occurring misophonia and obsessive-compulsive issues: Robin, 44, has noticed the OCD he’s lived with since it was first diagnosed in his 20s has gotten worse since his divorce. He’s been meaning to return to therapy to address the new obsessions and compulsions, but over the last two years a more pressing issue has presented itself: persistent anxiety and agitation related to sounds around him. His coworkers’ gum chewing and pen clicking are the worst of several triggers, and he can neither find relief in his office nor understand why these issues have been so grating lately. Robin finally revisits therapy with a counselor who is aware and understanding of misophonia. The counselor is able to help him identify triggers and coping mechanisms for them while they work together to address the OCD symptoms Robin experiences.

References:

  1. Cavanna, A. E., & Seri, S. (2015). Misophonia: Current perspectives. Neuropsychiatric Disease and Treatment, 11, 2117. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547634
  2. Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: Physiological investigations and case descriptions. Frontiers in Human Neuroscience, 7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691507
  3. Gallagher, J. (2017). Misophonia: Scientists crack why eating sounds can make people angry. BBC. Retrieved from http://www.bbc.com/news/health-38842561 
  4. Krauthamer, Judith T. (2014). Descriptive statistics of misophonia. Retrieved from https://www.academia.edu/7074008/Descriptive_Statistics_of_Misophonia 
  5. Lewin, A., Storch, E. A., & Murphy, T. K. (n.d.) Like nails on a chalkboard: A misophonia overview. International OCD Foundation. Retrieved from https://iocdf.org/expert-opinions/misophonia
  6. Newcastle University. (2017, February 3). Wired for sound: Enraging noises caused by brain connection overdrive. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2017/02/170203085144.htm 
  7. Schröder, A., Vulink, N., & Denys, D. (2013). Misophonia: Diagnostic criteria for a new psychiatric disorder. PLoS One, 8(1), e54706. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054706 

 

Last updated: 09-19-2017

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