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Misophonia

What Is Misophonia?

Misophonia is an extreme emotional and physical response to seemingly innocuous, repetitive sounds like chewing, lip-smacking, and breathing. Translated from Greek as “hatred of sounds,” people with the disorder experience a fight-or-flight response to these noises, along with physical tension, disproportionate anger, and hatred or disgust toward the person responsible for the trigger noise. Even noises made by pets can be a trigger, and sometimes just seeing a reminder of the sound can be as upsetting as the sound itself.

Misophonia has only recently gained traction as an area of study, and many aspects of the condition remain a mystery. While the exact prevalence is unknown, one preliminary study revealed one in five American college students experienced misophonia. Symptoms typically begin in childhood or adolescence and increase in severity, but the condition can also emerge later in life.

The causes of misophonia are still unclear, but fMRI studies suggest the disorder is associated with overactive brain connections between auditory pathways and regions responsible for regulating emotions.

The Experience of Living with Misophonia

child yelling at dinner table

People with misophonia recognize that their reactions are excessive or unwarranted, and that realization can lead to further distress. People with misophonia often try to cope with the disorder by avoiding the triggering sounds that bother them. They may remove themselves from situations like family meals or work cafeterias, wear headphones in public spaces, or isolate themselves to avoid distressing noises altogether.

If they cannot avoid a troubling noise, they may become confrontational by demanding that the offender stop making the noise. Triggers can be especially upsetting when they come from family, friends, or coworkers.

The emotional and physical consequences, coupled with anticipation of and strategies to avoid triggers, can disrupt daily functioning. Problems with work and relationships arise when coping mechanisms become untenable, for example cutting class or quitting a job.

In addition to social isolation, some people with misophonia report a lack of support from family members or partners, who may delegitimize the condition by claiming the person is just “making up” the problem for attention.

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Diagnosis and Treatment Options for Misophonia

woman getting hearing exam

Researchers are currently exploring therapeutic options for misophonia. There's no one-size-fits-all treatment, and it may involve help from several different providers.

A psychiatrist may prescribe medication for certain symptoms, such as obsessive thinking, but all medications would be for off-label use, as the FDA has not approved any drug to specifically treat misophonia. An audiologist may use sound therapy to reduce the perception of triggers and provide noise-masking devices.

A therapist can help patients learn healthy coping strategies for the emotional fallout from misophonia. Studies show that strategies derived from cognitive behavioral therapy, dialectical behavioral therapy, and acceptance and mindfulness techniques can reduce the severity of misophonia by challenging intrusive thoughts and cultivating relaxation to counter feelings of anger and rage.

The disorder is not currently listed in the Diagnostic and Statistical Manual (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Diagnosis, therefore, typically consists of an informal assessment. An audiologist can test a patient’s ears to rule out other audiological disorders. For example, misophonia is distinct from hyperacusis, which causes discomfort or pain from hearing everyday noises at regular or loud volumes, and occurs regardless of the situation, whereas misophonia is often context-dependent. If the onset of symptoms is sudden, it may be important to visit a neurologist to rule out other conditions.

The compulsive avoidant behaviors related to misophonia are also seen in obsessive-compulsive disorder (OCD). In fact, misophonia most commonly co-occurs with OCD, which has led researchers to propose adding misophonia to the obsessive-compulsive spectrum of disorders.

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