The Psychological Model of Misophonia

The Psychological Model of Misophonia

By: Ezra Cowan, PsyD

Misophonia is a debilitating condition involving experiencing an intense aversive reaction in response to everyday sounds. The reaction usually involves a feeling of anger or even rage towards the individual making the sound or trigger. It may be hard to believe this havoc-wreaking condition is way more common than originally thought. Since everyday sounds are basically unavoidable, the condition results in many avoidance of everyday interactions. Misophonia is currently not a formal diagnosis, but it causes just as much dysfunction as many of the other conditions classified in diagnostic manuals.

How do people develop misophonia? There are a few theories on this question, and many of them seem to have an assumption that it is mainly a neurological condition with a malfunction of the brain that causes an overreactive response to certain types of triggers such as chewing or slurping. While solid evidence suggests there is a neurological component in misophonia, and it is important to continue to understand misophonia and its relation to the organic brain, there seem to be other components that relate to the development and maintenance of misophonia. My extensive research and clinical work have led me to believe that misophonia has a very strong psychological component and thus, if understood properly, can be treated with psychotherapy. The goal of this article is to explain why I believe misophonia can be viewed, at least partly, as a psychological condition.

Psychological Clues in Misophonia

When I first started researching misophonia in 2018, I noticed certain patterns emerging in the research, which all had a very strong psychological flavor. Here, we will review some of them.

Selective Triggering

Individuals with misophonia tend to experience a misophonic reaction in response to specific people conducting the trigger. For example, it is very common for people to only get triggered by close family members such as a parent or a sibling. This phenomenon, sometimes referred to as selective triggering, puts into question why only some people might be triggering and not others. It is a very important question that needs an adequate answer in order to develop a proper theory explaining misophonia. In my view, selective triggering can be best explained through psychology in the following manner. If someone is annoyed at one person for a specific reason (unrelated to the triggering stimuli), then they are more likely to find other things about them annoying. I think most people can relate to this idea; when we are annoyed at someone, we get annoyed at them for things unrelated to other original catalysts of the annoyance. It does not, however, explain why someone reacts with the level of anger and distress to triggers. Still, I believe it opens the door to looking for more understanding beyond the biological/neurological explanations of misophonia. This leads to the next intriguing characteristic of misophonia.

 Misokinesia and Misophonia

Another finding that shows up consistently in the research is the high prevalence of people reporting experiencing a misophonic response not just to sound-based triggers but also to visual-based ones as well. This latter phenomenon, also called misokinesia, is the experience of reacting with anger and distress to everyday sights such as repetitive human motions. There does not seem to be any difference between how sufferers respond to sounds or sights—it is the same reaction. In other words, the emotional and physiological reactions in misophonia and misokinesia are the same. This begs the question—is the issue an auditory one? Is it a general sensory issue? It is not immediately clear. However, this finding is important enough that any explanation of misophonia needs to explain this phenomenon in the model adequately. From my perspective, psychology can offer a strong explanation here, too: it is not the perceptual route that is malfunctioning but rather how a person reacts to stimuli in general. That is, it might be related to a person’s general disposition towards experiencing unwanted experiences. This leads to the question: what type of disposition might lead one to react to everyday phenomena with such anger and distress as characterized by misophonia? Interestingly, there is a growing body of research on misophonia and personality that may shed some light on this.

Personality and Misophonia

Another consistent finding in the research, which I find more intriguing than the first two, is that there seems to be an extremely high comorbidity rate between individuals who reported symptoms of misophonia and certain personality traits. The ones with the highest rates are the personality traits of rigidity and inflexibility. Multiple studies measured personality and misophonia, and they consistently show this finding. It is indicated by the very high rates of obsessive-compulsive personality,  perfectionism, and other personality and anxiety conditions, which all involve rigidity. Just to put it into perspective, one study found that 97% of the participants with misophonia reported significant levels of clinical perfectionism. A hallmark feature of perfectionism is having things go differently than one’s expectations and standards—inflexibility.

These findings are very hard to ignore and, again, require a substantive explanation, which, from my perspective, can be best explained through psychology. Specifically, it is very possible that someone with a relatively inflexible disposition will find everyday annoying sounds more annoying than the general population due to having difficulty simply letting the sounds be there. An inflexible person tends not to let these things slide by.

For example, two people are waiting in line at the supermarket. The people in front of them currently checking out realize that they forgot something, and one of them runs to get it from the aisle and is back in 30 seconds later. Both people standing in line are not happy that it happened. However, one only feels a little annoyed, and the other is very angry. In psychology, we would call the latter person somewhat inflexible-there is little tolerance for things that deviate from the expected rules.

(It should be noted that rigidity and inflexibility are characteristics that everyone has to varying degrees. In this context, when the research is finding of these characteristics in association with misophonia, it means that individuals are presenting with greater degrees of a very common characteristic. Further, and this is really for a broader discussion, from a psychological perspective, rigidity is a trait that often emerges when a person is faced with some pain, which also involves a desire to protect oneself from that pain. People are generally very slow to compromise on allowing themselves to get hurt—in other words, they become inflexible. So, really, when a person is rigid, they are ultimately protecting themselves from some type of hurt—usually interpersonal in nature.)

If individuals with misophonia also exhibit characteristics of rigidity, as strongly suggested by the research, then it can shed light on why individuals with misophonia find everyday annoying sounds more irritating and angering than other people.

If we combine the phenomenon of selective triggering and rigidity, a psychological context can begin to be etched to explain misophonia. Specifically, when someone does something or a few things that make someone unhappy combined with rigidity, there will be a heightened feeling that the sound is wrong. There is a bias of sorts to find what is otherwise an everyday occurrence as unacceptable. Chewing goes from unnoticed or slightly annoying to disgusting. The sound is considered less acceptable and thus more angering.

However, this still does not adequately explain why individuals with misophonia experience the level of anger and rage that is typical of misophonia. Here, too, I believe psychology has an excellent explanation.

 Ironic process theory

Before explaining more, I have a simple request for you: Do NOT think of a white bear.

What happened? Did you do think of a white bear?

If you are like 99% of other people who respond to this question, you, too, also thought of a white bear. This reaction is termed the white bear phenomenon and at times, referred to as the ironic process theory. The idea that we think of the things we do not want to think of is believed to play a huge role in forming many psychological conditions. In psychology, often, you get what you don’t want. (It makes sense technically because you need to bring to your attention what you don’t want to be aware of).

How does this relate to misophonia? The individual who is upset by the triggers (due to being annoyed at a specific person combined with a general inflexible disposition) will find themselves hearing a sound that annoys the average person and thus more likely to try not to notice it. Because people, at their very core, don’t like to be uncomfortable, it makes sense that one would try not to notice the very annoying sound. In other words, avoid the triggers.

From my perspective, this is where the problem really starts. This is where the white bear phenomenon kicks in: The individual starts trying not to notice the sounds, which results in hearing them more. This naturally leads to a greater desire to escape the discomfort and “stuckness” with the sound, which leaves the individual more and more stuck. Avoidance begets avoidance. The sound goes from being one of billions of perceptual stimuli in the room (which are largely filtered out by the brain) to the ONLY thing that is being focused on. This is the equivalent of someone putting a microphone in their mouth when they are eating and having another individual listen to it at full volume through headphones that offer every detail of what is going on. Thus, when the triggering individual makes their sounds, combining these factors leaves the misophonia sufferer feeling overwhelmed by the sensory and emotional experience.

Once triggers are associated with such difficult feelings, it makes sense that the misophonic reactions generalize to other people and triggers. The phenomenon of generalization is well-researched and understood in the context of anxiety and trauma conditions, and would make sense that plays a role here as well.

In summary, due to the coalescence of selective triggering (annoyance at specific people), relatively inflexible disposition, and white bear phenomenon, I believe that misophonia has a very significant psychological component. More importantly, this understanding can inform how to treat misophonia utilizing psychotherapy.  To this end, it serves as the foundation for the psychological therapy for misophonia, which has helped many people heal from misophonia called experiential acceptance and stimulus engagement (EASE).