Many people with misophonia are (or at some point have been) encouraged to be tough and put up with triggers. Misophonic people (especially children) don’t want to be isolated, and they want to stay where the action is, even with the triggers. Parents or significant others have told them that they should ignore the triggers. Often those with misophonia don’t want to cause trouble, and so their first approach to triggers it to do nothing but try to tolerate them. The desire to tolerate being triggered may stem from the hope that they will get used to the trigger, and that they will acclimate to the trigger as a person does many other stimuli. But a person does not habituate to triggers. With repeated episodes, the distress becomes greater and greater rather than smaller and smaller. A common response on the Misophonia Coping Survey, which I ask my new patients to fill out, is that they “leave the room after attempting to tolerate the sound.” Often, this response is rated higher than “immediately leave the room to escape the sound.”
The overall severity of a person’s misophonic response is often based on the severity of a single trigger experience plus the number of triggers experienced per day. Other than trigger stimuli, a person with misophonia does not have unpleasant responses to sounds or sights. In fact, if you magically transported a misophonic person to a world where their triggers never occurred, they would perceive their self as no longer having misophonia. So my first rule of misophonia management is to reduce the number of triggers a person experiences per day. We will discuss several ways to do this below.
Being triggered is not a good thing, because it makes the misophonia response worse. It actually does this in two ways. First, it strengthens the actual reflex that hits you (that you feel) when you are triggered, and second, whenever you are being triggered, any repeating sight or sound in the environment can become a trigger. You don’t want a stronger response to triggers, and you don’t want any new triggers, so you want to avoid getting triggered. If you are in a trigger situation, you want to escape, get away, move away, or ask them to stop, but you really do not want to tolerate full strength, real-world triggers.
