How Misophonia Develops
For many, a common sound suddenly starts making them angry. Several parents have said that all of a sudden their child exploded when they heard a certain sound. So misophonia may seem to happen automatically, like someone turned on a light switch, but data supports the view that misophonia actually develops in individuals through experience with the world around them. Research indicates that there are genetic factors that make one person more likely than another to develop misophonia.[i] But even though there are genetic factors, it still requires experience with the trigger sounds for misophonia to develop. But, somewhat surprisingly, it doesn’t take long to develop a misophonic trigger.
I initially thought misophonia was caused by some traumatic event. I was wrong. People told me things like, “I sat by my grandmother in church and she was sniffling and her sniffling became my first trigger.” Another person told me that they developed misophonia to their stepfather chewing his food, and that they dearly loved their stepfather (no trauma here).
A woman shared that when she was a little girl, her brother would smack his lips, and their dad would reprimand him. Brother smacks the lips, daddy yells at brother; brother smacks the lips, daddy yells at brother. So brother smacks, daddy yells, she cringes (a physical/emotional response). She was getting this physical/emotional response that went with her feeling, “Don’t yell, Daddy.” Her lizard brain began pairing the sound of her brother smacking his lips with her physical response that happened when daddy yelled, because she was a sensitive little girl. Her lizard brain learned to respond to her brother’s lip smacking at the dinner table, but the first trigger she remembered was her brother smacking his lips while eating pancakes at breakfast. At the dinner table, her response was to daddy being upset, but at breakfast, daddy wasn’t there. There was nobody to yell, but her little lizard brain heard that smack and jerked her body.
The following are some cases that illustrate how misophonia can develop.
Consider the case of John, an individual I met at several misophonia conferences.[ii] Now a middle-aged adult with misophonia, John recalled developing his first trigger. He shared a bedroom with his brother. John suffered from anxiety as a child. One night, he was unable to sleep. His brother had allergies and his breathing produced an audible nasal sound. After hours of hearing his brother breathe, John went to the couch and slept. From that night on, he was triggered whenever he heard his brother breathe. This type of experience, where one stimulus (sound) starts to cause a reflex response, is called Pavlovian or classical conditioning. The nasal breathing sound became associated with the physiological response[iii] from the distress John experienced (i.e., specific contracted muscles) and/or the emotional distress experienced from anxiety, inability to sleep, and annoyance aroused by hearing the breathing sound. When he heard the sound later, it elicited the conditioned physical and/or emotional response. It seems that it is more the physical reflex response than the emotional response that becomes associated with the trigger (nasal breathing).
Carla, age ten, came to the clinic with a primary misophonia trigger of her brother chewing. She said that when she heard the trigger, she felt immediate rage but no physical response. Carla often had conflict with her brother at the dinner table. Her mother reported that when arguing, Carla would stand, extend both arms, and demand that her brother stop staring at her. This was behavior that included tight arm and leg muscles. In this setting, she also heard the sound of her brother’s open mouth chewing. At the clinic, a low-strength recorded trigger stimulus caused a visible jerk in Carla’s arms and shoulders. When asked what she felt, she reported feeling the contraction of muscles in her arms and legs, but no anger, rage, disgust, or weaker precursors of these emotions. It seemed that the trigger stimulus caused the contraction of the same muscles that were contracted when she was arguing with her brother, which supports the hypotheses that misophonia develops as a Pavlovian conditioned reflex and that the initial reflex response to a trigger stimulus is a physical reflex.
Connor, age twenty-four, came to the clinic for treatment of misophonia with severe auditory triggers of chewing, sneezing, mouth breathing, and smacking lips, and a visual trigger of someone touching their glasses. He had developed misophonia while serving in the Marines in Afghanistan two years earlier. He reported that he also had a current diagnosis of PTSD. In Afghanistan, it was common to go on patrol as a squad, and upon returning to base to be in close quarters for eating. When tested for his initial physical misophonic reflex, his head visibly turned to the right, and he reported that he felt contraction of the muscles in his right arm and made a fist. The response was the same whether the trigger sound originated from his left or right side. This response seems similar to orienting to a sound of danger on his right side. The misophonic triggers did not elicit PTSD responses.
Remember Bill’s story that I mentioned briefly in Chapter 7? Bill was in good health, in his early thirties, with no history of mental health problems. He presented with misophonia trigger stimuli of mockingbird chirps and lesser triggers to some other birds. One year earlier, mockingbirds had built their nest near Bill’s bedroom window. Mockingbirds have a unique characteristic of singing both day and night. The singing prevented Bill from sleeping and, over time, he developed a misophonic response to each of the five distinct calls of the mockingbird. Since then, he experienced an expansion of trigger stimuli to other (but not all) birds, though the misophonic response to other bird chirps was less severe. Bill’s physical reflex was a “chill” on his upper arm and a sensation on the sides of his head.
Consider the case of Paul, a middle-aged professional in good mental and physical health. He accepted a position in which he often received phone calls about problems he needed to handle. Paul developed a chest muscle contraction reflex to the default ringtone of the phone. It may be presumed that the chest muscle contraction was a physical response that accompanied the emotional reaction associated with the stress of the phone calls. He changed the ringtone to one which did not elicit the reflex; however, in time, the chest muscle contraction reflex developed to the new ringtone. He changed the ringtone several times, with the same result each time. Finally, he set his phone to vibrate only, and the reflex developed to the vibration ring of the phone. He also triggered to the ring of a phone on television, so it was clear that the sound elicited the reflex, independent of the caller or purpose of the call. In Paul’s own words, “I hear the ring and my chest muscles jump, and I don’t like it!” Paul’s presenting problem was limited to his irritation with the physical reflex. He did not experience any emotion similar to those accompanying the stressful phone calls. This reflex did not restrict or impair his activity in any way, but was still an aversive reflex to a typically occurring sound. I propose that any aversive muscle contraction reflex to sound or other stimuli could be termed a misophonic reflex.
These cases support the assertion that misophonia is an aversive Pavlovian conditioned reflex that develops when a person is in a state of distress and hears a repeating sound. In most of these cases, the sound could be a source or contributing factor for distress. In the case of Carla, it is not clear that the sound contributed to her distress, but the sound was being made by the person who was the source of her distress.
To develop the reflex, you have to have a state of distress and hear some repeating sounds. One way this happens is to experience distress where there is also an irritating sound that increases the distress.
Think of my open hand as a distress indicator: I got a little distressed (fist 25% closed), I heard a crunch (fist 50% closed), I heard the crunch again (fist 75% closed), I heard the crunch yet another time (fist very tight). I now have this extreme tight-muscle distress that is paired with the crunch sound. The next time I hear that crunch my lizard brain may not pull the muscle 100% tight, but it may pull it 25% or 50% tight. That jerk of the muscle to the trigger sound is misophonia.
The other possible situation is when you have tight muscles or a reflex for any reason and hear a repeating sound, which will create the acquired reflex in your lizard brain. So simply being put in distress while hearing a repetitive sound may also create misophonia.
Both of these scenarios are explained by the fundamental neurological process called classical conditioning that we discussed earlier in this chapter. Viewing misophonia as a conditioned reflex helps us understand how misophonia develops and how new triggers develop, including visual triggers.
[i] Wu, Lewin, Murphy, & Storch, 2014; Fayzullina et al., 2015
[ii] Dozier, 2015b
[iii] Donahoe & Vegas, 2004