For many individuals, a familiar sound suddenly begins provoking intense anger. Parents often report that their child seemed to “explode” at a certain sound without warning. Although misophonia may appear to emerge abruptly—like a switch being flipped—evidence supports the view that it develops through a person’s interactions with the world. Research indicates that genetic factors can make some people more susceptible than others to developing misophonia,[i] yet experience with specific trigger sounds is still necessary for the condition to form. Somewhat surprisingly, it does not take long for a misophonic trigger to develop.
Earlier explanations sometimes linked misophonia to traumatic events, but accounts from individuals experiencing the condition suggest otherwise. People commonly describe neutral, everyday interactions as the starting point of their first triggers. One person recalled sitting next to a grandmother who was gently sniffling in church; over time, that sound became the individual’s first trigger. Another person reported developing misophonia in response to a beloved stepfather’s chewing—an association formed without any trauma involved.
A striking case involved a woman who remembered her brother smacking his lips at the table. Their father would reprimand him each time, creating a consistent sequence: lip-smacking followed by the father’s raised voice. The girl experienced a physical and emotional response whenever her father scolded her brother, rooted in her own internal plea of “Don’t yell, Dad.” Her brain began to pair the sound of lip-smacking with that emotional and physical reaction. Initially, her responses occurred during dinner when reprimands happened, but her first clear memory of a trigger came at breakfast—where no reprimand occurred. Her brain recognized the sound, anticipated the emotional response, and reacted automatically, even in the absence of any yelling.
The following cases further illustrate how misophonia can develop.
John’s Story
Consider the case of John, an individual encountered at several misophonia conferences.[ii] Now a middle-aged adult with misophonia, John recalled the development of his first trigger. He shared a bedroom with his brother and experienced significant anxiety as a child. One night, he was unable to sleep. His brother, who had allergies, was breathing with an audible nasal sound. After hours of hearing this, John moved to the couch to sleep. From that night on, he felt triggered whenever he heard his brother breathe. This type of experience, in which one stimulus (a sound) begins to cause a reflexive response, is known as Pavlovian or classical conditioning.
The nasal breathing became associated with the physiological response[iii] stemming from John’s distress—whether that distress was muscle tension, anxiety, the inability to sleep, or the irritation caused by the sound. When he later heard the sound, it elicited the conditioned physical and/or emotional response. Evidence suggests that it is primarily the physical reflex, rather than the emotional component, that becomes linked to the trigger.
Carla’s Story
Carla, age 10, arrived at the clinic with a primary misophonia trigger of her brother chewing. She reported feeling immediate rage when she heard the sound, though she did not initially recognize a physical reflex. Carla frequently argued with her brother at the dinner table. Her mother noted that Carla would often stand, extend both arms, and demand that her brother stop staring at her, displaying noticeable tension in her arm and leg muscles. During these conflicts, she also heard her brother’s open-mouth chewing.
In a clinical setting, a low-intensity recording of chewing caused a visible jerk in Carla’s arms and shoulders. When asked what she felt, she described a contraction of the muscles in her arms and legs, with no accompanying anger, rage, disgust, or milder emotional precursors. The trigger appeared to activate the same muscle groups that contracted during arguments with her brother. This supports the hypothesis that misophonia develops as a Pavlovian conditioned reflex, in which the initial response to a trigger stimulus is physical.
Connor’s Story
Connor, age 24, sought treatment for severe auditory triggers—chewing, sneezing, mouth breathing, and lip smacking—as well as a visual trigger of someone touching their glasses. He developed misophonia while serving in the Marines in Afghanistan two years earlier and also carried a diagnosis of PTSD.
During patrols and in confined eating areas, Connor was repeatedly exposed to these sounds in stressful conditions. When evaluated, his initial reflexive response to triggers involved his head turning sharply to the right and a contraction of muscles in his right arm, forming a fist. This response occurred regardless of the side from which the sound originated. The reaction resembled an orienting response to perceived danger on his right side. Notably, his misophonic triggers did not elicit PTSD responses.
Bill’s Story
Bill, in his early 30s and in good health with no history of mental health difficulties, presented with misophonia triggers that included mockingbird chirps and, to a lesser extent, other bird calls. One year earlier, mockingbirds had nested near his bedroom window. Their distinctive characteristic of singing both day and night prevented him from sleeping, and over time he developed misophonic responses to each of the five distinct mockingbird calls.
Following this, he experienced an expansion of triggers to other bird sounds, though these were less intense. His physical reflex consisted of a “chill” sensation on his upper arm and a feeling on the sides of his head.
Paul’s Story
Paul, a middle-aged professional in good health, accepted a position in which he frequently received stressful phone calls. He developed a chest-muscle contraction reflex to the phone’s default ringtone. This contraction likely accompanied the emotional stress associated with the calls.
He changed the ringtone to avoid the reflex, yet the response developed to each new tone. Eventually, he switched his phone to vibrate only, and the reflex developed to the vibration as well. He also reacted to phone rings on television, demonstrating that the reflex was elicited by the sound itself, independent of who was calling or why. Paul described the reaction as an involuntary chest-muscle jump and expressed irritation with the reflex. Although the reflex did not impair his functioning, it was still aversive. Any such conditioned muscle-contraction reflex prompted by sound may be considered a misophonic reflex.
Misophonia – An Aversive Conditioned Reflex
These cases support the conclusion that misophonia is an aversive Pavlovian conditioned reflex that forms when a person is in a state of distress while exposed to a repeating sound. In most cases, the sound contributes to or intensifies the distress. In Carla’s case, it is unclear whether the sound itself caused distress, but it occurred in the presence of the person who was the source of her distress.
To develop the reflex, two elements must be present: distress and exposure to repeated sounds. One pathway occurs when a distressing situation includes an irritating sound that escalates the distress.
Imagine an open hand representing baseline distress: a slight stress response (hand partially closed), followed by exposure to a crunching sound (more closed), repeated exposure (further closed), and another repetition (fully clenched). The intense muscle contraction becomes paired with the crunch sound. Later, even a single crunch may prompt the brain to partially reproduce that contraction. This automatic muscle response to a trigger sound characterizes misophonia.
Another pathway occurs when an individual already has tight muscles or a reflexive physical response for any reason and is simultaneously exposed to a repeating sound. In such cases, the brain may pair the unrelated muscle tension with the sound, producing an acquired misophonic reflex.
Both scenarios align with the principles of classical conditioning. Viewing misophonia as a conditioned reflex clarifies how the condition develops and how new auditory or visual triggers emerge.
[i] Wu, Lewin, Murphy, & Storch, 2014; Fayzullina et al., 2015
[ii] Dozier, 2015b
[iii] Donahoe & Vegas, 2004