Imagine sitting in a quiet room when suddenly, you hear the clicking of a pen. Would this annoy you? For someone with misophonia, specific sounds – be it the click of a pen, the tapping of a foot, or the sound of chewing - can trigger an emotional response ranging from discomfort and anxiety to anger and panic.
Misophonia is a neurological condition, which can be loosely translated to the “hatred of sound”, characterized by strong emotional reactions to certain sounds. These sounds don’t necessarily have to be loud to cause an emotional response. Sounds people might be sensitive to include:
- Chewing
- Throat clearing
- Coughing
- Slurping
- Sniffing
- Humming
- Tapping
- Pen-clicking
Origins of Misophonia: The Jastreboffs’ Model
The term “misophonia” was first coined by Jastreboff and Jastreboff in 2001 [1]. While working in their audiology clinic, they noticed some of their patients had extreme reactions to everyday sounds like keyboard typing, coughing, or pencil tapping. These patients reported feelings of irritability, anger, or disorientation, along with physical signs of stress such as a faster heartbeat, muscle tension, and sweating.
This was different from what the Jastreboffs had seen with other forms of hearing disorders such as hyperacusis (hypersensitivity to certain frequencies and volume ranges), tinnitus (ringing in ears), and phonophobia (fear of sounds). They noticed that the troublesome sounds were often repetitive and pattern-based, and that triggers varied from person to person and in different settings.
From this observation, the Jastreboffs suggested that these reactions may be learned over time, triggered in certain situations.
This means that the intense feelings people with misophonia experience when they hear certain sounds may be a blend of biological, environmental factors, and past experiences. So when a person reacts strongly to the sound of chewing, it’s possibly because their brain connects sounds to emotions, memories, and learning in a unique way.
Diagnosing Misophonia
Figuring out if someone has misophonia involves gathering a lot of information about when it started, what sounds trigger it, how the person reacts, and if they have any other health conditions. Checking their hearing is also important, though it can be tricky since people with misophonia might have normal hearing or different levels of tolerance to loud noises. Currently, there isn't a straightforward test for misophonia; instead, it often requires a mix of different methods.
Misophonia isn’t officially listed in the main manual of mental disorders, the DSM-5 [3]. However in 2022, a group of scientists agreed on a clear definition of misophonia, which was an important first step to finding ways to diagnose and treat misophonia.
Underlying Causes of Misophonia
Although the causes of misophonia are not fully understood, there are several theories:
Dysfunction in the Brain
Research suggests that misophonia might be more about what's happening in the brain than the ears. A study in 2017 found that the anterior insular cortex (responsible for emotions and processing sounds), becomes more active in people with misophonia when they hear sounds that trigger them [4]. This activity then stirs up other brain areas linked to memories, fear, and other emotions. So, the strong reactions people with misophonia have to certain noises could be because of the increased activity in the brain’s emotional and memory centers. Interestingly, people with misophonia were also found to have more myelin, a substance that helps speed up signals in the brain, though it’s not clear if this is a cause or a result of misophonia.
Learning Responses
There's also the possibility that misophonia could develop as a learned emotional response to certain sounds. For example, with repetition, a person might learn to link a simple sound like clicking a pen, with certain emotions like anger or anxiety. Initially, the sound is just background noise, but over time, it can turn into a trigger, setting off emotional reactions without any obvious reason. It might also be possible that forpeople with misophonia, the brain’s pathways that link hearing sounds to feeling emotions have become “overtrained” to react to certain sounds. This means that overtime they learn to respond more intensely to specific sounds.
So who is at risk?
- Family history: individuals with a family history of misophonia or related hearing conditions may be at a higher risk.
- Other sensory processing disorders: people with other sensory processing issues, like those seen in autism spectrum disorder, might be more at risk of developing misophonia
- Mental health conditions: those with anxiety, obsessive-compulsive disorder (OCD), or other related mental health conditions may have a higher risk of experiencing misophonia.
- Age of onset: misophonia often starts in late childhood or early adolescence, but can develop at any age.
Treatment
Treating misophonia can become individualized as what works for one person might not work for another. However, there are several therapy modalities and strategies that have shown promise in helping individuals manage their reactions to trigger sounds:
Therapy
- Cognitive Behavioral Therapy (CBT): involves identifying and challenging negative thoughts associated with specific sounds and developing coping strategies
- Tinnitus Retraining Therapy (TRT): adapted from a method used to manage tinnitus, TRT combines counseling and sound therapy to help individuals reclassify triggering sounds as neutral, reducing their emotional impact
- Exposure Therapy: in a controlled setting, gradual exposure to trigger sounds can help reduce the intensity of reactions over time.
Management Strategies
- Sound masking: using white noise or earplugs to drown out the triggering sound
- Mindfulness and relaxation techniques: practices such as mediation, deep breathing, and progressive muscle relaxation can help reduce overall stress and anxiety levels, making it easier to cope with trigger sounds
Misophonia is a complex and real condition that is more than just a dislike of certain sounds. As awareness grows, the hope is that more light will be shed on this condition, leading to better classification, understanding, and treatment methods. Through continued education, open conversations, and supportive care, we can create a more accommodating world and make life a bit more harmonious for those with misophonia.
Sources Used
Jastreboff, M. M., and Jastreboff, P. J. (2001). Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia. ITHS News Lett. 2, 5-7
Schroder, A., Van Diepen, R., Mazaheri, A., Petropoulos-Petalas, D., Soto de Amesti, V., Vulink, N., & Denys, D. (2014). Diminished N1 auditory evoked potentials to oddball stimuli in Misophonia patients. Frontiers in Behavioral Neuroscience, 8. https://doi.org/10.3389/fnbeh.2014.00123
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Kumar, S., & Griffiths, T. D. (2017). Response: Commentary: The brain basis for Misophonia. Frontiers in Behavioral Neuroscience, 11. https://doi.org/10.3389/fnbeh.2017.00127
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