What is Misophonia?

Misophonia is a condition characterized by an intense dislike or hatred of sound, and people afflicted with this condition have a tendency to demonstrate highly negative emotions, physical reactions, and even thoughts, all of which are triggered by specific sounds. Misophonia is sometimes known by its alternative names of Select Sound Sensitivity Syndrome, or more simply put, Sound Rage.

The trigger needed to initiate an intense or violent reaction from someone afflicted with misophonia can be something which most people consider innocuous, like fingernails scraping a chalkboard, or simple sounds like chewing, whistling, or yawning. Although it’s outside the realm of sound, the condition can also be triggered by repetitive motions like observing someone fidgeting or wiggling their foot.

In its milder forms, misophonia might make someone feel anxious or uncomfortable, and possibly even disgusted at the noise or the motion. It has also been known to motivate the sufferer to flee the situation entirely, so as to escape from the trigger source.

More intense reactions are also very possible, and these include fear, panic, anger, hatred, and even rage. These kinds of reactions can reach extreme levels, agitating the afflicted person to a state of extreme emotional distress wherein he/she feels it necessary to stop or even kill the source of the offensive noise. Misophonia victims have also described reactions which make them feel the like their skin is crawling, and in worst-case scenarios, they might even have thoughts of suicide.

As is evident from these kinds of reactions, people afflicted by the condition can have very limited social lives, since they need to avoid whichever sounds trigger the condition. That can mean a complete avoidance of social settings like restaurants or crowds, and even avoidance of family members or friends, who might become sources of the offending sounds, and trigger an episode. Because an episode could involve fleeing, crying, or verbally and physically abusing the sound source, there could potentially be a great number of situations and many people which must be avoided, so that the triggers do not initiate negative reactions.

Misophonia Causes

As a general rule, misophonia is a condition acquired by a person between the ages of 9 and 13, and it generally persists throughout their lifetime. It is much more common with girls than with boys, and the onset of the condition can be relatively sudden, often occurring within the space of a few days or weeks.

Contrary to what was originally thought, misophonia is not triggered by any single event such as a loud, offensive noise experienced during the years of susceptibility. Although doctors and scientists are still not certain of exactly what causes the condition, it is known that it’s not any kind of physiological problem associated with the ears themselves.

Current thinking is that the condition is a combination of mental and physical responses in the brain, which trigger external reactions from the rest of the body. The fact that no physical damage to the ears is detectable makes misophonia a very difficult condition to diagnose, especially since in almost all cases, a victim’s hearing will test normally and show no signs of impairment. For this reason, misophonia is often misdiagnosed as a variety of other conditions, such as obsessive-compulsive disorder, bipolarity, or even pronounced anxiety.

There is a school of thought surrounding misophonia that it may be caused by some kind of dysfunction within the limbic system, which interprets sensory input and generates the fight or flight instinct in a person. If the limbic system were to become damaged in some way, it could develop an inappropriate association between some kind of sensory input like a sound, and that fight or flight reaction.

Anyone who has experienced this kind of damage to the limbic system might therefore develop an aversion to whatever sensory stimulus the limbic system links with the emotional response. This would make it entirely possible for a perfume to smell like poison, or for the sound of someone chewing their food loudly to become terrifying to a person suffering from the disorder.

In the same way, if the limbic system were to associate a particular sound with danger, it could produce a reaction from someone to flee the source of the danger, or to want to destroy it. In any case, when these kinds of associations are made by the limbic system, it will always result in a negative reaction to the trigger sound by the person experiencing it.

Misophonia Symptoms

The symptoms of misophonia are varied, and range from very mild symptoms to extreme reactions. In the beginning, there is usually one sound which elicits an observable reaction from an affected person, but over time other sounds can be added to this collection, creating a larger trigger set.

When any of these sounds are encountered by someone with misophonia, the victim can become mildly agitated, or might become so deeply affected that panic or rage become the observable symptoms. Both fight and flight responses are potential reactions to any of the sounds in a victim’s trigger set. These responses could be either defensive or offensive in nature, often depending on other aspects of someone’s personality.

Some victims make every effort to distance themselves from the trigger sound, so as to eliminate the source of their agitation, and curtail their own negative response. On the other hand, some misophonia sufferers will become extremely aggressive and attempt to destroy an inanimate object causing the offensive sound, or they may want to fight the person causing the sound.

It’s hard for anyone who is not afflicted by the condition to relate to the level of aversion actually experienced by someone who is. There’s a very strong emotional element associated with a trigger sound, always producing a negative reaction in the sufferer which is far more intense than an unaffected person can fathom.

Unfortunately, it is very often the people who are closest to a misophonia victim who produce the sounds or motions considered to be so objectionable to the afflicted person. This fact often results in a need for the sufferer to remove himself/herself from the company of those people who create the sound triggers, and cause the highly negative responses.

There are any number of potential sounds in a work environment or in a school setting which can set off a misophonia sufferer, and this can also be very stressful to deal with. People who are sensitive to what a sufferer is going through can help to limit or eliminate the visible symptoms which characterize an episode, but not everyone is quite so accommodating or thoughtful, so potential causes of an episode abound in almost every social setting.

Misophonia Treatments

Because misophonia can affect an afflicted person’s life on a daily basis, treatment becomes very important in managing a person’s involuntary reactions. Although there are relatively few centers around the country where misophonia can be specifically treated (there are currently less than 20 altogether), these clinics provide sound therapy for victims of the condition.

Misophonia clinics also offer psychological counseling in tandem with the sound therapy, to help patients overcome their natural reactions to offending noises. One tactic of this therapy involves establishing background noises which cancel out the specific offensive noise which is a trigger for an episode for any given patient.

This concept can then be extended to provide a victim with a device similar to a hearing aid which creates the same kind of counterbalancing sound in your ear that would effectively remove the offending sound. Most often, an offsetting sound which is very soothing is chosen, something like a babbling brook, or a continuous waterfall noise, either of which can override the trigger sound. In the same manner as the special hearing aid style devices with cancellation noise, people afflicted with misophonia are often recommended to wear earplugs or headsets, so that trigger sounds can be tuned out and avoided altogether.

Medications are sometimes involved in the treatment program as well, including a number of antidepressants which have been shown to be effective, such as doxepin bupropion, duloxetine, and venlafaxine.

Certain lifestyle factors are also thought to contribute to the intensity of reaction episodes, so treatment programs often include coaching on how to change your lifestyle to minimize or eliminate potential triggers. It has been shown that getting plenty of sleep and including regular vigorous exercise can reduce the stress and anxiety which often leads to more intense episodes. While this does not eliminate the source of an offending noise, the reduction of anxiety can have a mitigating effect on the severity of reactions.

People who have relatively severe cases of misophonia are advised to set up quiet areas in the home, their ‘safe spots’, where potentially offending noises cannot easily penetrate, and where traffic is drastically limited from other family members.

One last treatment option is to seek out support from others who are similarly affected. There is even a national organization known as the Misophonia Association, which has outlets throughout the United States and holds yearly conferences that bring together doctors and patients who have an interest in the condition.

At these conferences, contacts can be made with a great many others who suffer from misophonia and can provide ongoing support. There are also a number of online forums and social media groups comprised of misophonia sufferers, whose sole reason for existence is to provide mutual support for each other and to help make life easier for those afflicted.

Misophonia Prevention

Misophonia is one of those conditions which is virtually impossible to prevent, primarily because it is not yet understood what causes the condition in the first place. While empirical evidence demonstrates that almost all sufferers of the condition acquire it during pre-teen and teen years, there is virtually no evidence available which points up how the condition is actually acquired.

Scientists believe that misophonia occurs in some people as a result of how their brain processes sound, and how it is coupled with emotional responses managed by other parts of the brain. While a significant amount of research is currently ongoing to explore the relationships between sound processing and emotional responses in the brain, there is not yet anything definitive which is known.

Since the cause has proved to be so elusive, prevention is not yet part of the misophonia catalog, nor can it be anticipated anytime in the near future. This being the case, any kind of treatment program must focus on the present mitigation of symptoms, or the removal of sounds in the trigger set for a patient.

Counseling is also somewhat effective, and medications do help to decrease stress levels which add to the intensity of reactions, but these two also focus on managing symptoms rather than on any kind of prevention tactics. Until more is known about the intricacies of how the brain processes sound and produces an emotional response to those sounds, any kind of prevention potential must be deferred until the future.

Last Reviewed:
September 17, 2017
Last Updated:
September 17, 2017
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