What is misophonia?

Misophonia is an increasingly common problem we are seeing in audiology services. Also known as Selective Sound Sensitivity, it consists of a strong emotional response to certain types of sounds.

Trigger sounds have a number of features in common, but most strikingly they are almost always human generated noises which are under voluntary control. A common trigger, for example, is sniffing. However, no one with misophonia has ever told us that involuntary common noises, such as a rumbling tummy at lunchtime, is a trigger. It is this perceived choice that someone has about whether to make a noise or not (to sniff) that may lie at the heart of misophonia.

Emotions

Misophonia is a strong emotional response to the presence or anticipation of a sound. There are three key emotional responses: anger, disgust and anxiety, with anger being the predominant emotion.

Emotions have evolved to help us understand the world around us and to help us in choosing how to respond to our environment. By understanding these three key emotions, we can begin to make sense of what is happening psychologically in misophonia.

Anger is about trespass and rule breaking. Someone has done something to us that is wrong or unfair in some way. For someone with misophonia, there are often a number of rules being broken that concern acceptable standards of behaviour. Sniffing, for example, might be seen as rude, selfish, thoughtless and a sign of a bad upbringing.

Disgust, in its most basic form, aids us in avoiding ingesting something that might be dangerous. The sight and smell of rotting food is revolting and this emotion guides us not to eat it. In misophonia, disgust is often felt at the sight or sound of someone chewing their food with their mouth open, for example, or when we hear or see someone sniffing. There is a powerful urge to get away from the person exhibiting this disgusting behaviour or to stop them from doing it.

Anxiety is all about something threatening being about to happen (maybe immediately or even years ahead). People with misophonia are not anxious about the sounds that trigger misophonia. But they may feel intensely anxious about having to endure the anger and distress they experience when hearing these sounds.

Physical response

These intense emotions are accompanied by high levels of arousal - the fight or flight response. There is a release of adrenaline and a supply of energy to respond to the threat. This is typically experienced as a fast heart beat, rapid shallow breaths, tension, hotness, shakiness, and sweating. It is almost as if our brain goes off-line. People describe this as an instantaneous and overwhelming physical and emotional response.

How does misophonia begin?

People are referred to us with misophonia from childhood through to adulthood. Whether we see them as children, teenagers or adults, the problem of misophonia almost always developed during childhood or adolescence with one or more people in the family being the main trigger for misophonia. Over time, the range of sounds that leads to a misophonic reaction and the people who cause it, can broaden.

As children and teenagers, challenges arise in managing this difficulty at home as a family and at school. The difficulties can be most challenging at home with high levels of anger and aggression. Siblings and parents can be greatly affected by these difficulties. In their attempts to help their children, families can be left feeling stuck, stressed and exhausted. Young people often feel they have to contain their anger at school, and so misophonia is usually not as much as a problem in that environment.


As adults, trying situations can develop in flat shares, at work, on public transport and within intimate relationships. People with misophonia try to avoid situations where they know they will be exposed to trigger sounds. This can be distressing, with people isolating themselves from families, friends and social gatherings. Work environments, such as open plan offices, can be a minefield of triggers. Tensions can develop within intimate relationships and couples can find it difficult to share normal activities together, as someone breathing or eating can become infuriating. Equally, the experience of living with someone with misophonia can be challenging. Imagine having the most fundamental aspects of living such as how you eat or breathe criticized. These conflicts can be felt as deeply hurtful and can lead to devastating consequences for children, siblings and parents, and within friendships and couples.

Without doubt misophonia is a challenging condition to live with, both for the person with misophonia and those around them. Although it is not well understood and we don’t as yet have a well-established set of interventions, there are some things that can help, and you can read more about that here.