What Is Phonophobia? Definition, Symptoms, & Treatments

What Is Phonophobia?

Phonophobia, also known as sonophobia, ligyrophobia, and acousticophobia, is a specific phobia consisting of the persistent fear of loud noises.¹ People with phonophobia do not have a hearing disorder but are afraid of loud noises, which are especially frightening when they occur unexpectedly.

Phonophobia is a common trait in highly sensitive people and highly sensitive children, with one study showing that around 10% of school-aged children have phonophobia.² It is also common in folks with autism and attention-deficit/hyperactivity disorder (ADHD).

Phonophobia is also found to occur in 80% of people who experience migraine headaches.⁹ These individuals were found to be sensitive to even lower-intensity sounds.³

Here are some types of noises that individuals with phonophobia may fear:

• Fourth of July fireworks
• Lightning
• Thunder
• Sirens from ambulances, fire engines, and police cars
• Car horns
• Screaming
• Door slamming
• Balloon popping
• Cork popping
• Action scenes that include gunshots or explosions
• Car screeching
• Loud impacts by machines

Phonophobia in Children

Feared responses to loud noises are fairly normal in children, but if it persists and starts to impact the child’s willingness to engage in the external world, it can be due to phonophobia.

Phonophobia is common for children on the autism spectrum.¹¹ It is important to understand the distinction between phonophobia and a hearing disorder to ensure that a child is not misdiagnosed.

Phonophobia Vs. Other Conditions of Sound Sensitivity

The difference between phonophobia and other sensitivities to sound is that individuals with phonophobia experience an emotional reaction or anxious anticipation of the sound rather than it being a neurological or audiological problem.

Phonophobia differs from other conditions of sound sensitivity, such as:

• Misophonia: Misophonia is an intense and irrational emotional response to certain sounds caused by others, such as drinking, chewing, breathing, tapping, gum popping, lip-smacking, throat clearing, nose sniffing, and clicking. Sufferers experience anger toward the person who is causing the sound and anxiety over not having control over stopping the noise.⁴
• Hyperacusis: Hyperacusis is a condition in which exposure to everyday sounds is perceived as more annoying or disturbing than normal, resulting in symptoms such as headache, fatigue, and concentration difficulties.⁵
• Loudness recruitment: Loudness recruitment describes an experience commonly associated with cochlear hearing loss and specifically with dysfunction of the outer hair cells of the organ Corti. With a rising sound level, the perceived loudness increases faster than normal.⁶
• Tinnitus: Tinnitus is a condition in which people hear sounds that are internally constant but are not externally present (not auditory hallucinations) caused by physical and neurological problems.⁷ Common sounds are ringing, buzzing, roaring, whistling, or hissing. Tinnitus and post-traumatic stress disorder (PTSD) have been found to have many correlating symptoms, such as sleep difficulty, irritability, hyperarousal, problems with concentration, behavioral and experiential avoidance, negative emotions and cognitions, and irritability.⁸

Symptoms of Phonophobia

The symptoms of phonophobia are similar to other symptoms of anxiety, especially those related to panic disorder. A person suffering from phonophobia will become highly anxious in situations that involve loud noises. Aside from fearing loud noises, individuals with phonophobia can often develop anticipatory anxiety about what will happen when they put themselves in environments over which they have no control.

Common symptoms of phonophobia may include:

• Intense startle response
• Dry mouth
• Panic attacks
• Shortness of breath
• Anxiety
• Fear
• Sweating
• Pounding heart or increased heart rate
• Chest pain
• Dizziness
• Lightheadedness
• Nausea
• Fainting
• Flight response
• Marked change in mood after hearing the loud sound

What Causes Phonophobia

Like all specific phobias, there is not a singular cause for phonophobia. Researchers believe genetics and a family history of anxiety disorder, trauma, and life events are said to play a role in the cause. One study found that phonophobia can commonly develop after a traumatic brain injury or concussion.¹⁰

Complications of Living With a Fear of Loud Noises

When an individual has phonophobia, they begin to associate the external cue (i.e., noise or sound) and the distressing emotional response they have to it. People will want to avoid any situations where they may re-experience the negative event, especially if there is trauma involved. This can cause them to avoid family get-togethers, work events, or community gatherings.

If left untreated, phonophobia can lead to substantial complications and limitations in a person’s life. People can develop anxiety, depression, social isolation, interference in school and work performance, and have an overall poor quality of life.

How Is Phonophobia Diagnosed?

While phonophobia is not at this time recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnosis of phonophobia is made using the criteria for specific phobia that include factors related to fear of loud noises or sounds. Receiving a proper diagnosis is key to starting and maintaining an effective treatment plan.

Diagnosis criteria for phonophobia include:

• A persistent fear of loud noises that are excessive or unreasonable. The fear is triggered by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
• Exposure to the feared item or situation almost always leads to immediate anxiety or distress caused by the fearful situation, which may take the form of a panic attack. In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
• The person recognizes that the fear is excessive or out of proportion to the actual threat posed. In children, this feature may be absent.
• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
• The avoidance, anxious anticipation, or distress during the feared situation(s) interferes significantly with the person’s normal routine, work (or school) functioning, social activities, or relationships, or there is marked distress about having the phobia.
• The fear is persistent, typically lasting for at least six months.
• The anxiety, panic attacks, or avoidance associated with the sound or situation are not better accounted for by other mental disorders, such as obsessive-compulsive disorder (OCD), PTSD, social phobias, panic disorder, etc.

Depending on how the problem is described, your doctor may refer you to an audiologist or recommend psychological help to manage the symptoms.

Treatment for Phonophobia

Psychotherapy is generally the first step when developing a treatment plan for phonophobia. Through therapy, a person can begin to identify dysfunctional thoughts and beliefs and make changes to their behaviors. While there are no accepted medications used to treat phonophobia, if it has overtaken a person’s functioning, medications for anxiety and antidepressants may be useful.

Treatment options for phonophobia include:

• Exposure therapy: Exposure therapy consists of directly facing the feared situation without performing any anxiety-reducing mental or physical behaviors to reduce the anxiety. Consistent practice will result in the brain habituating (getting used to) the sound or noise. Someone might cue up the sound on video and listen to it repeatedly, which allows the person to hear it more objectively and not to be feared or avoided.
• Cognitive behavior therapy (CBT): With CBT for anxiety, the focus is identifying and changing cognitive distortions related to causing or maintaining the effects of phonophobia on people’s lives. Once the thought patterns or dysfunctional beliefs are identified, preferably at the moment, they can be restructured to reflect more reasonable and rational ways of managing the problem.
• Medication: Anxiety medications, antidepressants, and beta blockers can help with some of the symptoms associated with phonophobia. These medications regulate the neurotransmitters that have been overly active in the brain regions responsible for mood and stress. People describe the effects of the medications as taking the edge off or even helping the thoughts go away.
• Mindfulness-based stress reduction (MBSR): MBSR is a practice wherein the mind is trained to focus on the here and now through various techniques. Some of these are using the five senses to objectively describe aspects of the environment, performing mindful body scans, meditation, yoga, and mindful movement exercises.
• Acceptance and commitment therapy (ACT): ACT works to help people accept their circumstances as they are and then identify strategies that will effectively help them move forward.

Finding the right therapist is important because when an individual trusts and respects their therapist, the treatment is more effective. An online therapist directory can help match you to a professional who is experienced with treating phonophobia. Therapy for phonophobia may be done on a short-term basis as long as you practice the techniques daily.

How to Cope With a Fear of Noises

In addition to proper treatment, there are healthy coping mechanisms an individual can practice that can help them cope with their fear of noises. Developing healthy coping mechanisms is important to ensure the individual does not rely on avoidance coping, which will ultimately exacerbate their symptoms.

Here are some ways a person can cope with phonophobia

• Breathwork: Diaphragmatic breathing or box breathing helps regulate the nervous system and calm anxiety
• Mindfulness: Mindfulness geared towards anxiety can help to ground people in the here and now through the use of any of the five senses. Doing so enables people to take a more observational rather than emotional stance on what is going on around them from one moment to the next. Mindfulness apps, such as Headspace, are an easy way to begin practicing these skills.
• Meditation: Meditation practice helps reduce stress caused by mental, emotional, and physical reactivity to thoughts and feelings. For individuals who fear loud noises, a walking meditation in a nearby park can be a great way to regulate while mildly challenging oneself.
• Exercise: Exercise can help with anxiety that develops due to phonophobia. The benefits of exercise include physically working off stress and experiencing the emotional benefits of endorphins set off during workouts.
• Sleep hygiene: Proper sleep hygiene is another strategy for managing stress. When rested, the mind and body are better prepared to manage daily challenges. Sleep deprivation only adds another emotional and cognitive level of vulnerability to anxiety and mood.
• Earbuds and headphones: Using earbuds or sound-canceling headphones can help people when they are in triggering situations. They help reduce the level of reactivity and intensity of the sounds.
• Support groups: Support groups specifically for phonophobia may be hard to find, but groups for phobias in general or that focus on anxiety symptoms are conducive to helping with phonophobia.
• Relaxation techniques: Relaxation techniques such as progressive muscle relaxation and journaling about one’s anxiety have been found to help manage phonophobia symptoms and stress in general.

In My Experience

Phonophobia is a very treatable condition, and the sooner people enter therapy, the sooner they will get control back over their lifestyle and quality of life. People do not have to be limited by the fear and anxiety related to loud sounds and noises. People can learn how to manage their anticipatory anxiety when going out, as well as cope with unexpected triggers when they happen.