What is Misophonia?

Misophonia 101

By: Ezra Cowan, PsyD

What is Misophonia?

Misophonia is a term to describe a collection of symptoms that most notably involves experiencing a very aversive response to specific sounds. This reaction often involves a feeling of irritation, annoyance, anger, or rage towards the individual(s) making the sounds. Sometimes, it can stir up feelings of wanting to hurt or punish the person making the sounds. While there is a very wide range of examples of sounds that can trigger this aversive reaction, there are some sounds that are reported at higher rates. Sounds that are emitted by other people while eating are consistently reported as the most common triggers.

Examples of Misophonia Sound Triggers (MSTs):

• Chewing

• Crunching

• Lip-smacking

• Slurping

• Sipping

• Breathing

• Tapping

• Clicking

• Sleeping-related sounds (e.g. heavy breathing)

• Footsteps

Hierarchy of Annoyance: Who is the Most Triggering?

Usually, closest family members. Individuals with misophonia often report that when their misophonia initially developed, they were only triggered by a few people. This usually involves people from one’s immediate family, such as a mother, father, or sibling. Over time misophonic triggers can “spread” to other people as well and eventually include anyone making the triggering sounds. However, not all triggers are equal, and some people are more triggering than others. Some research indicates that a person’s “triggering level” can vary such that one day, the person is very triggering, and on another, that person is not triggering at all.

People also report being triggered by non-human sources, such as the humming of the fridge or an air-conditioning unit and a barking dog.

 What Does Misophonia Feel like?

When individuals with misophonia hear a triggering sound, the experience is often described as “being attacked.” Indeed, individuals feel that the person making the sounds is doing so intentionally. They report experiencing a feeling of being trapped, panicky, and overwhelmed. There is also a considerable amount of anxiety about future triggers, and they are often hypervigilant in preparation for the next “misophonic attack.” People often report a physiological response such as the body tensing up and some other reflexive behaviors.

 What is the Most Common Response to Misophonia Triggers?

The most common response to the sound triggers is anger. At times, it can be a mild irritation or annoyance. Often, however, the experience is described as intense anger and rage. People often feel the desire to punish or hurt the individual making the sound in response to the misoponic sound triggers (MSTs). This reaction is something that individuals with misophonia struggle with because they often view themselves as relatively easy-going individuals, and experiencing such feelings can in of itself be highly discomforting.

 How Do People Cope with Misophonia?

Because the experience of misophonia is so aversive, individuals with misophonia try to figure out how to make life as functional as possible. Some cope by using headphones to mask the sound. Thus, they might go to work and have music or white noise on continuous play to block out any MSTs in the background. Many cope by eating alone. Some are lucky to have supportive friends and family who are willing to accommodate their misophonia needs by reducing any triggering noise. However, by large, the avoidance of misophonia often leads to reduced functioning and a lower quality of life. For example, it is difficult to go to a movie theater while blasting white noise into the ears to mask the sound of popcorn chewing.

 Negative Effects of Misophonia

Besides the terrible suffering individuals with misophonia experience from the triggering sounds, there are also unfortunate ramifications that come from coping by avoidance. When individuals avoid situations that are “trigger heavy,” the price can be doing less of what they want to do. They might spend less time with family as a result. They might close themselves off in their room and not go out with friends. Indeed, they may not go to work. Avoidance and reduced engagement can also lead to depressive symptoms and, in extreme cases, thoughts about committing suicide. These are only a few examples of the negative effects of misophonia.

 How Does Misophonia Impact Relationships?

This depends on many factors. Many relationships suffer simply due to the differences that emerge surrounding the eating, especially when one of the sufferer’s partners has a hard time accommodating their behavior to reduce MSTs.  The idea that everyday sounds can be so aversive is something that many people find difficult to relate to. The misophonic response is something that people who do not have misophonia have a hard time relating to, and it is common for people to dismiss the issue and even accuse the person of faking a problem. Thus, relationships can suffer. However, many people with misophonia figure out a way to make the relationship work through effective communication and the willingness of an empathetic partner.

 Does Misophonia Get Worse or Better Over Time?

Misophonia tends to “spread” and generalize to more people, situations, and new sounds, which can make it increasingly more difficult to deal with. Often, however, people learn to adapt to their situation. It should be noted that misophonia symptoms tend to get worse when one is experiencing increased stress.

Misophonia a Form of OCD?

Research does not support the view that misophonia is a form of OCD.  Some view it as similar due to the structural similarities between the two conditions. For example, they both have triggers that elicit a negative emotion, which lead to action that clearly functions to reduce the unwanted emotion. They also both interfere with a person’s ability to function fully. However, the similarities end there. Misophonia, unlike OCD, involves a response of anger towards a person making a sound. In contrast, OCD is mainly about anxiety about something bad happening or feelings of incompleteness (“not just right feelings”). This distinction is important because anger leads to a very different response than anxiety. Anger involves a desire to hurt or punish the person that caused the anger, and OCD pushes the individual to reduce uncertainty. Learn more about OCD. 

Is Misophonia a Recognized Diagnosis?

Misophonia is currently not a diagnosis. This does not mean that misophonia is not a real and debilitating condition. It usually takes time for a strong body of research to emerge to support the development of a formal diagnosis. Research into misophonia is very young—the term misophonia was only coined in 2000!  The good news is that there is an increasing interest in understanding misophonia with more and more research coming out every year. The main effects of the lack of formal diagnosis is that the research tends to get less funding from major funding sources and insurance companies are less likely to cover treatment.

 What Causes Misophonia?

There are several theories regarding the cause of misophonia, one of which I have developed. Many researchers believe that misophonia is a neurological condition that causes sensitivity to certain sounds. While I do think there are likely some neurological or biological components, based on my extensive research into the literature and my clinical work, it seems there is minimal research supporting the claim that misophonia is a neurological disorder. It seems, rather, a host of psychological and contextual variables primarily causes misophonia. This led to developing the psychological model for misophonia (PMM). Click here to learn more.

 Is There a Treatment for Misophonia?

Yes. I treat misophonia with a form of acceptance-based cognitive-behavioral therapy (CBT), which is based on a highly detailed model of misophonia that explains how it first develops and then stays around. The therapy protocol was recently published in the Journal for Obsessive-Compulsive and Related Disorders. The treatment protocol is called experiential acceptance and stimulus engagement (EASE) which is designed to address the factors that keep a person “stuck” with the unwanted triggers and offers a set of choices that a person can utilize to become “unstuck.” It gives the misophonia a set of tools that frees them from getting triggered. This protocol has helped many people gain control of their symptoms and live a more relaxed, socially connected, and vibrant life.