Misophonia Might Be the Cause of Your Sensitivity to Sound

Misophonia, also called selective sound sensitivity syndrome, is a condition in which certain sounds trigger an outburst marked by irritation, anger, or aggression. People with misophonia react in an extreme and often emotional way to certain "trigger" sounds. Reactions range from annoyance, running away, or even rage with some individuals lashing out violently.

Misophonia is a poorly understood, and under-researched, condition. The term misophonia did not arise to describe the condition until the year 2000, although the condition was described much earlier as selective sound sensitivity syndrome. Awareness of the disorder has increased since several news stories aired nationally on the disorder in 2011.

Symptoms of Misophonia

The primary symptom of misophonia is an extreme reaction in response to other people making certain sounds. These reactions may include:

• Anger 
• Avoidance
• Annoyance
• Disgust
• Verbal or physical aggression

The response a person with misophonia has to these triggers is often called "autonomic" and sometimes compared to the body's "fight or flight" response.

The fight or flight response is also called the acute stress response. It is the body's natural way of responding to a situation it deems threatening.

A number of things happen as part of this response:

• The hormones adrenaline and norepinephrine are released
• Heart rates and breathing rates increase
• Muscles tighten
• Blood vessels constrict
• Pupils dilate
• Alertness and awareness increase

Research has shown that people with misophonia also experience increased blood pressure, heartbeat, and body temperature.

All of these responses are the body's way of preparing to respond to the threatening stimulus. It is unclear why a person with misophonia might respond in a similar manner to a triggering sound but researchers believe this response is involuntary.

People with misophonia may go to great lengths to avoid being exposed to triggering noises. They may isolate themselves socially, or invent interesting coping mechanisms. Some may wear headphones or produce other noises to drown out triggering sounds.

Diagnosis of Misophonia

There are currently no established diagnostic criteria for misophonia and the condition is not recognized as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Proposed diagnostic criteria were published in 2013 and researchers suggested that the disorder be classified as a separate and discrete psychiatric disorder. The researchers note that while misophonia resembles some other conditions such as specific phobias, OCD, and intermittent explosive disorder, none of these conditions fully fit the symptoms patterns that are characteristics of misophonia.

The proposed criteria suggest that misophonia is characterized by:

• Anticipating that a certain sound will result in irritation, anger, or disgust
• Feelings of anger initiating a loss of control
• Avoidance of known triggering sounds or tolerating this sounds with extreme anger, discomfort, or disgust
• Significant distress that interferes with normal daily activities
• These feelings are not better explained by another mental disorder or medical condition

While there is no official diagnosis, your doctor may be able to recommend treatment options that can help you manage the symptoms of the condition.

Causes of Misophonia

The exact causes of misophonia are not known, but there are a number of factors that may play a role.

• Brain chemistry: Some research suggests that people with misophonia may have greater connectivity between the anterior insular cortex (AIC), an area of the brain important in emotional processing, and the auditory cortex.
• Other mental conditions: People who also have obsessive-compulsive disorder (OCD), Tourette syndrome, and anxiety disorders are also more likely to have misophonia.  
• Tinnitus: Misophonia is more common in people who also have tinnitus, a condition in which people hear noises, often a ringing sound, that no one else can hear.
• Genetics: Misophonia tends to run in families, so it is likely there is a genetic component that increases the risk of developing the condition.

Despite increased awareness of the disorder, research on misophonia is very limited with most information coming from extremely small studies and case reports. Epidemiological evidence is also lacking.

Some studies suggest that the incidence of misophonia is much higher than professionals have previously thought but many people only have mild symptoms for which they do not seek treatment.

Types of Misophonia

While misophonia is sometimes compared to another condition called hyperacusis, misophonia triggers tend to be soft everyday sounds, in fact, many of them seem to involve bodily functions. The following are common triggers:

• Breathing
• Chewing
• Clicking
• Dishes clattering or spoons scraping on dishes
• Dogs barking
• Fingernail clipping
• Fingernail tapping
• Gulping
• Lip-smacking
• Nose wheezing
• Nose whistling
• Slurping
• Sneezing
• Sniffing
• Snorting
• Whistling
• Yawning

It is interesting to note that in the case of bodily functions such as yawning or lip-smacking, the sound often only triggers a response when it is produced by another person. Like hyperacusis, many people with misophonia also suffer from tinnitus.

Treatment of Misophonia

There are currently no established treatments for misophonia. However, some treatment options that may be beneficial include:

• Cognitive behavioral therapy (CBT): This approach can help people change some of the negative thoughts and associations with the sounds that typically trigger a response. One study published in the Journal of Affective Disorders found that almost 50% of people with misophonia who were treated with CBT experienced a significant reduction in symptoms.
• Medications: While there is no medication approved to treat misophonia, medications may be prescribed to treat co-occurring conditions such as anxiety or depression.
• Tinnitus retraining therapy (TRT): This approach involves wearing a device to produce attention-diverting noises, therapy to teach people to ignore the noises, and relaxation techniques to minimize the automatic stress response. While traditionally used in the treatment of tinnitus, TRT may help people with misophonia learn to better tolerate certain triggering noises.

Coping With Misophonia

There are also lifestyle changes, coping strategies, and relaxation techniques that can help you manage the symptoms of misophonia.

Some strategies you can try:

• Wearing earplugs in situations where you will be exposed to a trigger noise
• Using a white noise machine to help block out certain noises
• Wearing earphones in case you start to feel overwhelmed
• Turning on music or the television for some background noise
• Practicing good stress management techniques
• Adjusting your setting so that you are exposed to trigger noises less frequently 
• Having a plan in place for when you feel an outburst is imminent, such as leaving the room or practicing a relaxation technique such as deep breathing or visualization

You may also find it helpful to talk to others about the condition. People will be better able to avoid making certain noises around you—such as chewing gum or whistling—if they know that it might trigger a negative reaction.