Misophonia: Definition, Symptoms, & Treatments

What Is Misophonia?

Misophonia is a type of noise sensitivity anxiety 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.

How Common Is Misophonia?

While the exact prevalence is uncertain, it is estimated that misophonia affects nearly 15% of adults. In fact, in 2014 the University of South Florida published a study showing that, out of 500 college students surveyed, 20% had clinically significant misophonia.³ It seems to be more common, or more severe, in women than in men, and many people suffer in silence, presenting as irritable or easily overwhelmed when exposed to certain sounds.

Common Misophonia Triggers

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.⁴ However, not everyone with misophonia identifies fear as a symptom.

Common triggers of misophonia include:⁵

• Noisily chewing food
• Ticking clock
• Heavy breathing
• Tapping fingers or feet
• Water dripping
• Rustling paper
• Smacking lips
• Crunching sounds
• Slurping or gulping
• Snoring
• Sniffling or nose blowing
• Loud typing
• Clicking a pen
• Throat clearing
• Coughing
• Toilet running
• Bell or telephone ringing
• Animal sounds (like dogs barking)

Misophonia Symptoms

The first onset of misophonia 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.⁶

Unfortunately, many people 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.⁷

What Causes Misophonia?

Researchers have not determined an exact cause of misophonia. However, they have noted a strong relationship between misophonia and other conditions, as well as structural brain differences and a potential connection with genetics.

Brain Structure Differences

People with misophonia may have differences in brain structure and activity. It is thought that misophonia could be the result of having increased connections and brain activity in regions of the brain responsible for processing sounds and managing emotions. This could lead to a fight-or-flight response to otherwise harmless sounds.⁵

Overlap With Other Conditions

Misophonia is more likely to occur in people with neurodivergence, including ADHD, autism, or tourette syndrome. There may also be a connection between mental health conditions, like major depressive disorder (MDD), post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), and obsessive compulsive disorder (OCD) and misophonia. Finally, hearing-related challenges, like hearing loss, tinnitus, and hyperacusis, a condition in which everyday sounds seem unbearably loud or even painful, are also sometimes associated with misophonia.⁵

Family History & Genetics

Early research suggests that misophonia does run in families, and may be genetic. One study suggests that it could be attributed to a genetic marker near the TENM2 gene, which is involved in brain development.⁸ If someone in your family has been diagnosed with misophonia, then you are more likely to suffer from the condition yourself. It is important to know your family history, and seek help from a physician if you notice symptoms.

How Is Misophonia Diagnosed?

There is currently no agreed-upon criteria for diagnosing misophonia. While some consider misophonia to be a condition of its own, others view it as a symptom of other underlying mental health conditions. Misophonia is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but physicians have reportedly discussed including it under Obsessive and Compulsive Disorders in future revisions.⁹ Talking to a doctor about your symptoms will help them to determine if misophonia is an appropriate diagnosis.

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, like OCD, anxiety, and depression.

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.¹⁰
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

Is There Medication for Misophonia?

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. One recent study showed that beta blockers were markedly effective at treating the physical and emotional symptoms of a patient with misophonia.¹¹

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. Begin your search using an online therapist directory of qualified professionals or by asking your primary care provider for a referral.

Is There a Cure for Misophonia?

There is currently no known cure for misophonia. However, there are ways to manage symptoms effectively to improve your quality of life. Tinnitus retraining therapy, counterconditioning, and cognitive-behavioral therapy could all provide supportive intervention in coping with misophonia.

Misophonia Self-Care Options

Living with misophonia can be challenging, but strategies for self-care can help you to cope more effectively, feel empowered, and improve your quality of life.

Here are some self-care tips for when you’re trying to figure out how to deal with misophonia:

• Utilize good earplugs: Noise canceling headphones or earplugs can help to significantly reduce the volume of triggering noises, potentially blocking them out altogether.
• Have music playing: Playing favorite songs in the background throughout your day or when experiencing potential triggers can create positive associations to sounds, and keep you feeling relaxed.
• Use white noise: White noise machines can offer a hypnotic, relaxing sound that might also drown out any triggering noises.
• Learn relaxation techniques: Practicing deep breathing, muscle relaxation, and positive affirmations can help you to be prepared for overwhelming moments with misophonia, potentially lessening its impact.
• Practice assertive communication: Learning how to assert yourself respectfully can be invaluable when it comes time to ask a child, co-worker, spouse, or parent to please stop clicking their pen, tapping their foot, or clearing their throat!

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.
• 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.
• 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.
• 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.