Misophonia refers to having excess sensitivity to particular sounds. When triggered, someone with misophonia experiences intense reactions, such as anxiety, panic, resentment, and even rage. It can even cause them to feel acute distress that lasts for several hours after the event. While misophonia can be challenging, it is highly treatable, and therapeutic relief can come quickly and in many forms.
What Is Misophonia?
Misophonia is assumed to be a neurological condition characterized by an increased autonomic nervous system arousal coupled with negative emotions.1 People with misophonia tend to have superb hearing, but experience physiological distress when hearing specific sounds. Misophonia is sometimes referred to as noise anxiety, fear of sound, chewing phobia, or selective sound sensitivity syndrome.
According to M. Zachary Rosenthal, PhD, Associate Professor at Duke University and Director of the Center for Misophonia & Emotion Regulation:
“Each person may have their own unique trigger sounds, and for most people with misophonia this includes oral or nasal sounds, like the sounds of people chewing, smacking their lips, or sniffling.”
Each person’s misophonia reactions are unique, and triggers can vary, including tapping, typing, swallowing, specific voices, shallow breathing, or repetitive movements. Some people with misophonia also experience phonophobia, which refers to having a fear of a particular sound.2 However, not everyone with misophonia identifies fear as a symptom.
Symptoms of Misophonia
Unfortunately, many people that assume the symptoms of misophonia are an overreaction. They might overlook mild discomfort altogether. The stigma surrounding misophonia often prevents people from understanding their condition and reaching out for the appropriate support.
Common symptoms of misophonia include:
- Feeling intense reactions to certain sounds (anger, disgust, rage, frustration)
- Becoming verbally or physically aggressive in response to the sound
- Increased blood pressure
- Rapid heart rate
- Dilated pupils
- Hypervigilance around others
- Tightened chest and muscles
- Having the urge to flee or escape
- Prickling skin sensations
- Severe avoidance (of people or places where the sound may manifest)
These symptoms can cause impairment in critical areas of functioning. For instance, they may affect a child’s ability to focus in school, or impede how an employee completes their work. Exacerbated physiological reactions may contribute to various physical and emotional issues, too.3
Triggers of Misophonia
Specific, unpleasant noises are the primary triggers of misophonia. Chewing noises tend to be the most common trigger, but sounds like slurping, clicking, sniffling, tapping, cracking knuckles, clipping nails, and crunching can all be triggers as well. Some people experience misophonia in response to sounds made by inanimate object like motors whirring, clocks ticking, or machines running.4
Other triggers of misophonia include:
- Feeling trapped with a particular sound
- Believing someone is making that sound on purpose
- Experiencing stress in other areas of life
Causes of Misophonia
Researchers have not determined an exact cause of misophonia. However, they have noted a strong relationship between misophonia and other conditions.
Here are five potential causes of misophonia:
- Tinnitus
- Anxiety disorders
- Obsessive compulsive disorder (OCD)
- Tourette syndrome
- History of trauma
The first onset of symptoms tends to happen before puberty, between ages 9-12; however, like with any mental health condition, the onset of symptoms can arise at any time. Some studies note a trend where patients reported feeling disgusted by hearing a family member eating during their childhood. Over time, this sound trigger may expand into other triggers.5
Misophonia Treatment
People with misophonia tend to respond best to a multidisciplinary approach to treatment. A multidisciplinary team may consist of audiologists, primary care physicians (PCPs), and therapists. The overarching goal of treatment is for people to become more neutralized to triggering sounds. Over time, this neutralization reduces the activation of negative emotions.
Rosenthal notes the need for a multidisciplinary approach: “Start with evaluations and treatment recommendations from a psychologist or audiologist with training in evidence-based interventions. Then seek evaluations and additional treatment recommendations from other providers. Include your primary care physician or pediatrician, so that all treatment providers are aligned on a coherent plan.
For misophonia specifically, interventions that are known to work for lots of different problems can be used in a personalized way. For example, there are cognitive behavioral interventions that can help with attentional hypervigilance, regulation of physiological arousal, managing distressing thoughts, learning new ways of responding to unpleasant triggers, and improving relationship functioning using communication skills. A well-trained therapist in cognitive behavioral therapies can do all of these interventions.
Sometimes patients ask about exposure therapy, and we generally don’t recommend using traditional habituation-based exposure therapy with misophonia unless a patient asks for it. On the other hand, we do sometimes use interventions that help people learn new patterns of thinking and responding to triggering situations and cues.”
Cognitive-Behavioral Therapy (CBT)
CBT can help people learn appropriate relaxation skills, which may reduce the adverse effects of triggering sounds. These relaxation skills include deep breathing, progressive muscle relaxation, and guided imagery. It can also help people challenge the negative thoughts associated with their triggers. For instance, instead of automatically thinking, “I hate this sound. It must stop,” people can reframe their thoughts into, “This sound may be unpleasant, but it will pass. I am going to take a few deep breaths.”
CBT can also be a useful treatment for people struggling with co-occurring mental health conditions, including:
Misophonia Retraining Therapy (Sound Therapy)
Audiologists trained in misophonia retraining therapy use positive sound protocols combined with counseling to change negative responses into more manageable ones.6 In this therapy, the patient may start the session by listening to their favorite music while eating dinner (if triggered by chewing noises). Eventually, they learn to develop a more positive association with dinnertime and the sounds associated with it. Over time, they can become more comfortable without listening to the desired noise.
In other cases, audiologists will use tools like white sound machines, music recordings, or relaxing scripts to aid a patient during their treatment. The goal is to replace negative sound associations with more positive ones.
Holistic Approaches
Some providers may recommend other supplementary approaches for misophonia. These approaches can be beneficial as additional suggestions for traditional therapies.
These management techniques can include:
- Hypnotherapy
- Meditation and mindfulness
- Healthy diet
- Neurofeedback
- Positive association exercises
While there are no specific medications for treating misophonia, patients with other mental health conditions may benefit from an evaluation. Taking antidepressants or anti-anxiety medication might reduce symptoms that exaggerate misophonia reactions.
How to Get Help For Misophonia
Getting help with misophonia starts with awareness. In many cases, people can self-diagnose themselves. If you recognize that you are struggling, that insight is the first step towards proactive change. From there, meeting with a therapist can provide you with initial relief and support. Together, you will collaborate on a reasonable treatment plan and work together to accomplish the specific goals.
Finding a therapist specializing exclusively in misophonia may be challenging, but you can start by looking for a provider specializing in CBT or other phobias. Begin your search using a trustworthy directory of qualified professionals.
How Can I Help a Loved One Dealing With Misophonia?
According to Rosenthal, there are a lot of things you can do:
- First, become educated from places like the International Misophonia Research Network about what is and is not known about misophonia.
- Second, be validating and compassionate. Living with misophonia can feel like there is a grizzly bear that suddenly appears next to you. The body can go into a rapid state of flight or fight, and it can feel overwhelming and uncontrollable.
- Third, when a loved one is worried about being triggered or is triggered, encourage communication so that you can understand what is happening and how to be kind and helpful.
- Fourth, when someone you care about is triggered, help them regulate their intense emotions with whatever skillful and effective coping skills they have for those moments. When the situation passes, then you can talk to them more rationally and reassure them about how to continue to make changes in the future.
Final Thoughts On Misophonia
Misophonia can result in frustrating consequences for you or your loved ones. Fortunately, you don’t have to suffer in silence. Treatment is available. What you’re experiencing right now can be challenging, but it’s highly treatable. Therapy and specialized support can help make a meaningful difference in your life.
