Misophonia

While hyperacusis and misophonia can occur concurrently, the subconscious negative evaluation of these sounds is different, so they are separate and distinctly different conditions. Both conditions involve an abnormal perception of loudness and awareness of intolerable sounds, and distress following exposure to these sounds. Both conditions have the potential to escalate, so that an increasing range of sounds become intolerable.

What is Misophonia?

Misophonia is a strongly aversive response or abnormal sensitivity to certain specific sounds, irrespective of their volume and usually made by other people.  People with misophonia struggle to tolerate specific sound triggers.  Common trigger sounds include:

  • The sounds of other people eating/breathing/swallowing etc.
  • Repetitive sounds (eg a pen tapping, keyboard tapping).  For some, visual triggers of repetitive movements can develop.
  • Dogs barking
  • Neighbour’s music
  • Noise from a nearby factory

Exposure to those trigger sounds in people with misophonia involuntarily induces disproportionally high levels of anger or rage, along with strong reactions of irritation or disgust.  Misophonia is enhanced by trigger sounds often being perceived as an intolerable intrusion into one’s sense of personal space, as well as by hypervigilance towards trigger sounds and anticipatory anxiety about trigger sound exposure.

Misophonia involves an abnormal perception of loudness and a heightened awareness of trigger sounds.  

Misophonia is not listed in the current DSM-5 or ICD-10 systems but is currently being investigated with regard to classification as a discrete psychiatric disorder.  While misophonia overlaps with many features of obsessive-compulsive disorder (OCD), as the immediate involuntary post trigger sound exposure response is anger/rage, misophonia differs to anxiety disorders such as OCD and phobias. 

What can cause Misophonia?

Misophonia often stems from a specific instance in childhood or teenage years where a sound made by a family member elicited a strongly negative reaction of irritation and/or disgust.  This reaction has the potential to escalate, at both a conscious and subconscious level, so that those everyday sounds begin to appear unnaturally prominent and increasingly annoying/disgusting, and an increasing range of trigger sounds can become increasingly intolerable. 

Exposure to those trigger sounds in people with misophonia involuntarily induces disproportionally high levels of anger or rage, along with strong reactions of irritation or disgust.  

Those affected can feel overwhelmed, embarrassed, ashamed and guilty by the intensity of these emotions and fear their ability to control them or resent being exposed to their trigger sounds.

Misophonia is enhanced by trigger sounds often being perceived as an intolerable intrusion into one’s sense of personal space, as well as by hypervigilance towards trigger sounds and anticipatory anxiety about trigger sound exposure.

People with ADHD, autistic spectrum disorder (ASD) and sensory processing disorders are neurologically vulnerable towards the development of misophonia.  In these groups, misophonia can develop in childhood, often as a result of being readily distracted or overwhelmed by multiple sounds heard simultaneously or having auditory processing difficulties filtering out unimportant sounds. 

How common is Misophonia?

Online forums, support groups and media attention in the last few years have raised awareness of misophonia, suggesting it is more widespread and can potentially encompass a more severe level of a reaction than was originally considered.

Treatment for Misophonia 

While there are predisposing factors increasing vulnerability, misophonia is an acquired condition, not hardwired from birth.  The important element to consider is that our brain is a highly plastic organ, constantly reorganising and developing new neural connections.  This means that we are able to retrain our brain to, at least partially, reverse the process which has led to misophonia. 

Misophonia desensitsation involves:

  • Understanding the central auditory pathway, including the mechanisms of misophonia
  • Management of hypervigilance towards the auditory environment 
  • Sound enrichment strategies, including the creation of a “safe space” where sound enrichment strategies can be used to create an “auditory bubble” providing a cocoon to shield from trigger sounds and detachment from the environment.
  • As misophonia is different to anxiety disorders and OCD, we advise against a graded exposure approach, which has been detrimental in some  patients.   

FAQs

The immediate involuntary response with misophonia following trigger sound exposure is anger/rage, so while there are overlaps with anxiety disorders such as OCD (obsessive compulsive disorder) and phobias, misophonia is considered a separate condition. 

People with misophonia are however often anxious about being exposed to their trigger sounds in an attempt to avoid the intense emotions experienced after exposure.

Misophonia often stems from a specific instance in childhood or teenage years where a sound made by a family member elicited a strongly negative reaction of disgust or annoyance or intrusion. Some degree of monitoring or vigilance towards this sound can subsequently develop, reinforcing the subconscious negative evaluation of the trigger sound as important, so that the sound remains highlighted.   

As this trigger sound is likely to be inevitable, repeated and unavoidable in the home environment, this reaction has the potential to escalate, at both a conscious and subconscious level. As a result, an increasing range of trigger sounds can become increasingly intolerable, developing into misophonia. 

Sound enrichment has been found to be effective in supporting misophonia desensitisation, using a Tinnitus Retraining Therapy protocol. The aim is to surround trigger sounds with a neutral sound, which is easily ignored and heard via a device worn by the person with misophonia. 

Hearing aids can be programmed to produce a sound or connect via Bluetooth to a smartphone app and are a discreet, although expensive, way of implementing sound enrichment. Other Bluetooth devices can be used.

While there are predisposing factors increasing vulnerability, misophonia is an acquired condition, not hardwired from birth. 

The brain is a highly plastic organ, constantly reorganising and developing new neural connections. This means that there is the potential for the brain to be retrained, at least partially, to reverse the process which has led to misophonia. 

The intuitive reaction towards a trigger sound is to be vigilant about avoiding that sound.

Additionally, environmental monitoring and increased alertness towards trigger sounds reinforces the subconscious negative evaluation of these sounds as important. Sounds in our environment, including trigger sounds, are pervasive and frequently unavoidable. Misophonia will be enhanced by avoidance and trigger sound vigilance.

Coping strategies are important to control escalation. A personalised understanding of the auditory pathways involved in the process of misophonia development and escalation can help stop the escalation and is an important first step towards desensitisation.

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