What is Misophonia

Misophonia, which translates as “hate or dislike of sound,” is defined by selective sensitivity to specific sounds, which is followed by mental pain and, in extreme cases, fury, as well as behavioral responses such as avoidance. Misophonia develops as a result of a psychological process we refer to as “conditioning.” It is the formation (acquisition) of a reflex response to predictable/repeated stimuli, in this case, stimuli present themselves as a particular sound. Symptoms of misophonia can arise when your body reacts emotionally or psychologically to sounds. “Mios” means hate, and “phonia” means sounding in Greek. Misophonia is a form of conditioned behavior developed as a physical reflex via classical conditioning with misophonia triggers as an induced stimulus and several other factors. This relatively new psychiatric disorder has been linked with an obsessive-compulsive spectrum disorder and posttraumatic stress disorder. A stimulus and an emotional/physical condition are combined in the process for misophonia to occur. Misophonia is common amongst people that present an obsessive-compulsive disorder, affective disorders, and anxiety disorders, while no correlation has been properly established. People with misophonia can also present eating disorders and other mental health problems related to trauma that has affected their auditory cortex, turning common sounds into trigger stimuli that provoke an emotional response due to the cognitive restructuring they’ve undergone through. Misophonia, like OCD, manifests differently in each individual. Misophonia can range from mild to severe and excessive sensitivity to specific auditory triggers. These sound triggers are frequently quite specific, including sounds linked with ordinary human activities such as chewing, breathing, swallowing, striding, lip smacking, tapping, and speaking (sometimes specific spoken sounds). Any repeating sound can be perceived as a stimulus, the sounds related to eating and chewing are the most common. Misophonia can impact daily life, which is why understanding how or why it developed and implementing coping mechanisms, seeking treatment and healing is key to overcoming it.

Identifying Misophonia

Currently, there are no official criteria for diagnosing misophonia, since more studies regarding the cognitive processes it entails, and this disorder has been only studied over the last couple of decades. However, misophonia is most appropriately categorized under the “Obsessive-Compulsive and Related Disorders.” In 2013, clinical observations led to proposed diagnostic criteria. While said criteria may be too restrictive, especially when trying to diagnose in youth, the following offer a rough guideline for general misophonia symptoms that may be used to identify misophonia in an individual:
  • Hyperarousal, irritability, anger/outbursts, or anxiety may accompany hypersensitivity to the presence or anticipation of a specific sound.
  • Purpose avoidance of sound triggers or stimuli
  • The individual’s sensitivity, emotional experience, and/or behavioral response results in significant distress or impairment of daily activities such as tantrums, disrupted educational/professional functioning, and social engagement avoidance.
  • There is no psychological illness that explains the behavior or symptoms
These factors are provided as guidelines for determining the likelihood of misophonia. Formal misophonia diagnostic criteria will hopefully be developed through consensus committees of professional doctors and scientists. At the moment, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorization within the “Other Specified Obsessive-Compulsive and Related Disorder” category is the most relevant. Evaluation by a medical practitioner with audiological or possibly neurological knowledge is recommended as part of the assessment process to identify any possible hearing or nerve system issues. This is important to ensure misophonia is treated separately from hypersensitivity to sounds of a specific intensity/volume, which is more common in people with autism spectrum disorders. While there are no official diagnostic criteria, misophonia does affect multiple people, and understanding that the lack of categorization does not mean it is not real is essential to properly treat the symptoms.

Misophonia: A Traumatic Event Consequence

For people diagnosed with Misophonia, some sounds activate arousal and cause them to be angry, upset, or need to escape. Misophonia can be caused by traumatic brain injury, which often results from a traumatic event that can be related to an accident, or abuse situation. While physiological investigations need to dive deeper into the potential underlying mechanisms of what provokes auditory stimuli, some progress has been made.

Misophonia has also been associated with abnormal functional connectivity, which results in a decreased sound tolerance, therefore making trigger sounds the cause of an emotional response. Misophonia is linked with visual stimuli that allow a person with a specific misophonia trigger to anticipate the sound that makes them react.

How is misophonia related to childhood trauma?

Misophonia trauma often develops in childhood in response to sounds made by a parent or other family member. For a yet-to-be-explained reason, the noise itself causes pain, which increases when affecting an individual who is a struggler with stress tolerance.

Children experience a heightened state of their limbic system, which leads to an abnormal reaction to the auditive trigger. The sound itself causes distress and strengthens as a trigger when it affects a person already struggling with stress tolerance.

A particular sound like “my father’s voice” can often trigger distress when the sound itself is linked to abusive and traumatic situations the child was dealing with. For example, if the father used to yell or change his tone of voice before abusing the child or mother, it will create a fear reaction and in turn, become a trigger sound for the child.

While misophonia may begin at home, it can progress, permeating into a person’s life outside of the family setting.

Trauma is known to diminish our distress tolerance and increase autonomic nervous system activation and dysregulation (ANS). We are more likely to develop misophonia if our emotional regulation and ANS health are disrupted by trauma.

According to the Misophonia Institute, the illness is more common in persons who suffer from worry, stress, or obsessive behavior. The anxiety spikes up, the distress tolerance diminishes, and there is an increased sensitivity to sound stimuli.

Is Misophonia linked to Post Traumatic Stress Disorder?

PTSD is the only disorder with the most severe misophonia symptoms reported. PTSD has a higher prevalence amongst people than any disorder and can be seen in 15.38%. It is linked with severe hypoponia symptoms.  

How can Misophonia impact your life?

Misophonia can present as an extension of a generalized anxiety disorder, and affect the way an individual conducts in social situations. It can impair the ability to properly function and concentrate in an educational or professional environment, and it can also negatively impact interpersonal relationships. For example, a person may avoid restaurants, social gatherings, or reunions due to the increased possibility of hearing an excessive amount of eating sounds. Hatred, rage, fear, panic, and overwhelm are some of the most extreme emotions misophonia can trigger, particularly in children and teenagers.

Selective Sound Sensitivity Syndrome

Misophonia does not present itself in all situations, certain sounds will evoke intrinsic emotional responses, but it does not apply to everything. Since misophonia presents itself differently in every person, it’s important to recognize how it is manifested. In some cases, the extreme sound sensitivity of misophonia is associated with a specific individual’s activities, such as “how my brother eats” or “the voice of my sister”. In other cases, the presentation may be more widespread and refer to a generalized group of people or events. For example all men’s voices, all barking dogs, all the clocks ticking, any typing sound, etc.  

Trigger Sounds

A trigger sound will create an emotional response from the body that has a limited sound tolerance, and misophonia will be triggered for specific sounds. These sounds can be as simple as eating noises, chewing sounds, lip smacking, slurping, and more. Patients suffering from misophonia describe encounters with triggering sounds that bring them discomfort, distress, or rage. Instead of anxiety/fear, affected persons link the auditory trigger with annoyance, disgust, or even pain. The magnitude of the disruption is not always proportional to the length or volume of the sound trigger, and even a visual trigger that anticipates the sound will lead to a heightened response. When exposed to seemingly low-intensity sounds, certain youngsters may experience an overwhelming outburst. Avoidance and/or withdrawal from sound triggers or situations/stimuli that are likely to result in exposure to the sound is the most typical behavioral response.

Healing yourself and getting Misophonia under Control

Misophonia is a poorly understood sickness that dramatically impacts the lives of those who suffer from it, including their families or loved ones. This condition has neurological and physiological consequences, and it is asymptomatic in a wide range of psychiatric diseases. Those who have suffered from misophonia for many years are still unaware of its prevalence and severity. It may aid in identifying other pathways that lead to misophonia. Clinical diagnosis of misophonia requires a thorough diagnosis of trigger reactions and co-morbid conditions in patients. Questionnaires can provide a useful way of determining the severity of a particular case if implemented correctly. This auditory sensitivity can be detrimental to everyday life if everyday sounds are a trigger for you. Some options to incorporate when dealing with misophonia, once you’ve identified it through proper diagnostic criteria, are:
  • Sound Therapy
  • Breathing Sounds
  • Sensory Stimuli
  • Pleasant Sounds
  • Ear plugs
  • Tinnitus Retraining Therapy
  • Cognitive behavioural therapy
While more research must be conducted to properly identify the causes and solutions for this physiological response, misophonia can be reduced by tending to the psychological trauma that may be behind it.