Misophonia is characterized by an extreme, involuntary anger or disgust response to a typically occurring sound or visual stimulus. These stimuli are known as trigger sounds or visual triggers. The most common trigger sounds involve eating and breathing, but any repeating sound has the potential to become a trigger.
With this basic definition, misophonia appears to have a single cause (the trigger) and a single response (the intense emotion). This pattern is reported by most individuals who experience the condition. The emotional response feels so strong and immediate that it often masks what is actually occurring in the body.
Based on extensive clinical observations, Tom Dozier found that a hidden physical reflex occurs before the emotional reaction. The trigger stimulus elicits this physical reflex, which is why individuals “feel” the trigger. When the stimulus is perceived—auditory or visual—the autonomic nervous system activates the neural pathways responsible for the person’s specific misophonic muscle reflex.
This reflex can feel like an instantaneous jolt or shock in the affected part of the body. The sensation is inherently aversive; repeated stimulation can escalate from irritation to distress, and eventually to intense anger. This chain of events illustrates how misophonia develops and why even a single occurrence of a trigger can provoke a strong emotional response.
The physical reflex often goes unnoticed because the emotional response is so overpowering and occurs so quickly. These emotions are also conditioned reflexes, known as Conditioned Emotional Responses (CERs). Although many individuals assume the emotion is their first reaction, the physical reflex actually occurs just before the anger or disgust sets in.
Identifying this initial physical reflex requires using a very mild trigger—something extremely brief and weak enough to avoid producing a strong emotional response. This should be done in a controlled setting where only one trigger will be presented. Recorded triggers can be especially helpful because the volume can be lowered until the individual no longer reacts. Gradually increasing the volume with single, brief repetitions will eventually reveal a subtle reflexive twinge. The location of that twinge corresponds to the individual’s misophonic physical reflex.
Misophonia Institute developed an app for iPhone and Android, the Misophonia Reflex Finder (purple head icon), to assist individuals in identifying this physical reflex. The app is available free on iTunes and Google Play. A voice recorder may also be used to create short trigger samples that can be played at controlled volumes to help pinpoint the reflex.
Some treatments focus primarily on reducing the emotional response without altering the underlying physical reflex. Other treatments directly target the physical reflex. In most cases, when the physical reflex is eliminated or significantly weakened, the emotional response also decreases substantially.
Watch the video, “Misophonia Reflex Response,” for a visual explanation of how triggers often elicit a physical reflex before the emotional reaction surfaces.
The Misophonia Institute offers an app to help people identify physical reactions that might occur in their body prior to the typical emotional response.