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Misophonia: Is It Me or Is It the Sound?

Considering the acoustic qualities of sounds may be important in misophonia.

Those of us with misophonia often ask, “What is wrong with me? Why do I react so strongly to sounds?” Similarly, audiologists, therapists, and doctors familiar with misophonia look at the individual in order to find “the problem.” Yet, we very rarely stop to think about the actual sounds to which we are over-responsive. Is there something inherent in these sounds that might underlie Misophonia?

In their original description, Pawel and Margaret Jastreboff (2001) characterized misophonia as a disorder in which patterned-based sounds were associated with unpleasant experiences, or people. They suggested that the auditory and emotional parts of the brain were atypically connected, or unusually responsive to one another. Since then, there have been many case studies exploring misophonia. There have also been a small number of experimental studies measuring how people with misophonia physiologically react to sound (e.g., Edelstein, Brang, Rouw & Ramachandran, 2013). Most of these studies consistently demonstrate that upon exposure to specific sounds, the part of the nervous system that mediates fight/flight is activated. People with misophonia do not immediately and consciously register that this is happening (LeDoux, 2015). However, the body is reacting as if it is under threat.

In addition, preliminary brain studies demonstrate that misophonia may relate to differences in myelination (Kumar et al., 2017). Myelin is a substance in the brain that helps nerve signals communicate with one another more efficiently. Thus, more myelination can facilitate more communication between the parts of the brain that process sound and autonomic nervous system arousal (as well as accompanying emotions and thoughts). However, we still don’t know if the greater myelination was there in the beginning, or if it developed because of reactivity to sounds.

The Jastreboffs’ hypothesis relating sound sensitivity to emotions is supported by the more recent studies. However, it may be clearer to say that certain sounds activate the defensive motivational system (fight/flight). In addition, this neurological reaction occurs before we know it is happening, and we experience a range of uncomfortable physical sensations, as well as associated emotions and thoughts.

Researchers have speculated a great deal about the thoughts and feelings of people with misophonia. Psychologists have often noted that people with misophonia are likely to “avoid and/or ruminate over” sounds, and that this is characteristic of personality or psychological pathology. First, it is not maladaptive to avoid that which one perceives as painful or harmful. On the contrary, it is adaptive. We are “wired” to avoid that which may be harmful or toxic (LeDoux, 2015). Unfortunately, we live in a world wherein sound avoidance is almost impossible, and also leads to social isolation as well as a great deal of difficulty across numerous domains of daily living.

When we think of “misophonic” sounds, we are often referring to “other people's” sounds, and many people often associate particular sounds with others. Most of us have read in the popular press about “chewing rage” or “the disorder in which other peoples’ sounds drive you crazy.”

Yet we don’t read about the acoustic features of these sounds in the popular press, or even within academic research. Is it a coincidence that most people with misophonia share an aversion to very similar sounds (as well as associated visuals)? Is it possible that everyone with misophonia associates these particular sounds with something negative, or is there something about these sounds that may be associated with an auditory processing problem? It may be obvious that I am not quick to jump on the personality disorder bandwagon, or even point the finger of psychiatric pathology at those with misophonia. Instead, I think it is useful to turn that idea on its face.

What if something in the nature of the typical misophonia sounds underlies the disorder? What if misophonia is not related to anxiety, obsession, or any particular personality trait, but has to do with differences in how people receive and process sounds? Let’s take a look at one possibility.

Most often, people report that “body sounds” or “mouth sounds” are the worst. As we all know, chewing causes aversive reactivity among most people who have misophonia. Yes, chewing, gum-snapping, coughing, and throat-clearing are “body” and “mouth” sounds.

However, they are also repetitive sounds. What might repetition have to do with misophonia?

Auditory gating is described as the ability to filter out sounds that are unnecessary in one’s environment. Earlier studies of children who are over-responsive to general sensory stimuli demonstrate impairment in auditory gating (Davis & Gavin, 2007). In addition, in studies specific to misophonia that focused on pre-attentive auditory processing (e.g. Schroder, et al., 2015), gating difficulties may be inferred. So, what does this mean?

We are always surveying our environment in order to pick up on cues that may signal danger or threat, although most of the time we don’t know we are doing so. We do this naturally without any conscious awareness. We are wired to pay attention to novel, or new, sounds as they enter our surroundings. As the sound repeats, however, we automatically “close the gate” if it is a sound that we do not have to worry about. In other words, while we attend to and become very alert to new sounds, as our brains unconsciously determine that the sound is not toxic or harmful, we pay less and less attention to it. Our minds automatically relegate it to the background.

With this process in mind, it makes sense that repetitive sounds would be problematic for those of us who are sound-sensitive. As many others filter or gate sounds, those with misophonia may not. Without gating, the individual becomes overloaded with stimuli, and this drives the nervous system to respond as though it is under threat.

A lack of efficiency in auditory gating may be at the root of misophonia's responsivity, or it may simply be a part of the issue. Certainly, not all typically reported misophonia sounds are repetitive. There are other acoustic features that we should consider. In addition, some of the typically reported sounds are not repetitive. However, if auditory gating (or any other acoustic features) is involved in misophonia, we can begin to re-think what triggers us. Is it people's sounds or mouth sounds that trigger misophonia, or is it inefficient gating that starts the process by which people associate distressing sounds with people?

While repetition and the relationship to auditory gating is only one avenue to explore, it illustrates a very important distinction. We often hear people say that a specific person is a trigger. This often engenders anger toward that particular person(s). When we think of people as triggers, we also tend to engage in thinking that makes the situation worse, not better. For example, the discomfort related to the sound (i.e., heart rate increase, sweating, feeling a rush of adrenaline throughout the body) may be blamed on “the rude person in the office chewing gum.” Simultaneously, we wonder, “What is it about my personality that makes me so intolerant?"

I would so much like to see research that focuses on acoustics, and specifically auditory gating. Personally, as an individual with misophonia, I would prefer to examine the source of the reaction prior to assuming the reaction is inextricably bound to my personality and/or a “mental disorder."

Full references available upon request.