Misophonia

What is Misophonia?

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

  • The sounds of other people eating/swallowing/drinking/sniffing/ breathing etc.
  • Repetitive sounds (eg a pen tapping, keyboard tapping).  
  • Dogs barking
  • Neighbour’s noises/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 and/or disgust and distress.  A misophonia reaction 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.

Typically, the trigger sounds made by family members and heard in the home elicit the strongest reaction.  This does not mean that children/teenagers can selectively control their misophonia reaction.  It also does not imply that negative interpersonal relationships within the family are necessarily the basis for inducing this strong reaction.  This home-based or family-based reaction in many cases appears to be related to the combined effects of the pervasive nature of sound, sharing the family space within the home or a sense of violation of the sanctuary of the home, and auditory hypervigilance influencing subconscious auditory processing. 

Misophonia overlaps with many features of obsessive-compulsive disorder (OCD).  However, as the immediate involuntary post trigger sound exposure response is anger or rage, misophonia differs to anxiety disorders such as OCD and phobias.  For this reason, a graded exposure approach is often not effective.  

Misophonia is not listed in the current DSM-5 or ICD-11 classification systems but is currently being investigated with regard to classification as a discrete disorder.  In 2022, a group of clinical and scientific misophonia experts convened to create a consensus definition of misophonia (Swedo SE et al. Consensus Definition of Misophonia: A Delphi Study. Front Neurosci. 2022 Mar 17).  They determined that misophonia should be classified as a disorder, and not a symptom of another condition or syndrome.   

Misokinesia is defined as a strongly aversive response to visually perceived movements, which may be associated with auditory trigger sounds, or be repetitive or involve excessive fidgeting, and can develop as a secondary reaction to misophonia.  Exposure to these visual triggers in people with misokinesia involuntarily induces a similar reaction to misophonia triggers – disproportionally high levels of anger or rage, along with strong reactions of irritation and annoyance. 

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.  Vulnerability is increased if this occurs at a time of heightened stress/trauma or in a situation where the sound is unavoidable eg. in a car.

This reaction has the potential to escalate, so that those everyday sounds begin to appear unnaturally prominent and increasingly annoying/disgusting.  An increasing range of trigger sounds can become increasingly intolerable. 

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

Misophonia is further 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.

Those affected can feel overwhelmed by the intensity of these emotions.  They may fear their ability to control their emotional reaction.  They may resent being exposed to their trigger sounds.  They are often embarrassed, ashamed and guilty about the impact this has on the people around them, particularly their families.  

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.

What are the Misophonia treatment options?

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 desensitisation involves:

  • Understanding the central auditory pathway, including the mechanisms of misophonia

  • Management of hypervigilance towards environmental sounds

    • Sound enrichment strategies. This includes the creation of a portable “safe space” using sound as a shield from trigger sounds and to allow detachment from an unsafe environment
    • Advice on the use of earplugs, including hearing aids set up as electronic filters/Bluetooth devices

As misophonia is different to anxiety disorders and OCD, we advise against a graded exposure approach, which has been detrimental in some patients. 

Looking for misophonia treatment in Melbourne?

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FAQs

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

People living 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.  This is highly effective not just at an auditory level, but at more subtle neurological and psychological levels.

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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