For a person who suffers with misophonia, his or her personal triggers are a central fact of life. A trigger is a sound or sight that causes a misophonic response. It may be a sound someone makes when chewing, a slight pop of the lips when speaking, or a person whistling. For a person with misophonia, a trigger causes an involuntary reaction of irritation, and if the trigger continues, the emotions quickly become extreme anger, rage, hatred, or disgust. These emotions are jerked out of the person, and trying to stay calm when being triggered is futile.
The immediate negative emotions to a trigger are the hallmark of misophonia. Along with the emotions come physiological (bodily) actions that go along with such emotions. These include increased general muscle tension, increased heart rate, sweating, and feelings of overwhelming distress. When the trigger ceases, the emotional upheaval generally continues. Many people continue to hear the sound in their mind and replay the experience in their mind. While it may only take a few minutes for a person to become extremely distraught from the triggers, it can take hours for the person to calm down and resume normal life.
The impact of misophonia can vary from almost nothing to debilitating. I met a man who has only one trigger, and it’s the sound of a spoon stirring a glass of iced tea. The tinkle sound is intolerable for him, but no one in his family drinks iced tea, so he rarely hears that trigger. His misophonia has little to no impact on his life. On the other hand, I met another person who also has only one trigger, and it is ruining her life. Her trigger is the sound of two or more women talking to each other. As a student in a mostly female discipline, she is subjected to this trigger continually at school, making her school experience hellacious.
Triggers, Triggers, and More Triggers
Misophonia triggers generally start with a familiar person and a familiar sound. It is something in the person’s life. I conducted a survey of individuals with misophonia in 2013 in which two-thirds said their worst trigger was an eating/chewing sound, and 10% were breathing sounds. The remaining 25% had a variety of “worst triggers” including bass through walls, a dog barking, coughing, clicking sounds, whistling, parents talking, sibilance (the sound produced when saying words such as sun or chip), and someone typing on a keyboard. This is by no means a complete list of triggers. In fact, it is virtually impossible to make a complete list because a trigger can be virtually any repeating sound or sight. Although much less common, triggers can also be touch, smell, and vibrations.
Triggers are sounds we hear in everyday life. Eating sounds and dinner table sounds are very common in our lives, and are the most common triggers for misophonia. The second most common triggers are breathing or nose sounds, such as nose whistles, heavy breathing, sighing, snoring, and anything associated with breathing. But really, a trigger can be any repeating sound. And the list of known triggers is like the list of all repeating sounds in the world.
It’s not that these sounds become triggers because of the sound itself. They become triggers because the person hears the sound in a specific situation and they develop a misophonic response to that sound.
As mentioned, we find that triggers start with one sound or one person making a particular noise, and then the trigger spreads to similar sounds, other places, anyone making the already offensive sound, and sights associated with those sounds. So with time these triggers spread and spread. We will cover this in detail in the chapter on Developing New Triggers.
Misophonia can start with a visual trigger, but this is very rare. In fact, I have seen only one report of misophonia starting with a visual trigger. Generally it starts with an auditory trigger, and then visual images that occur immediately before the trigger can become a visual trigger. For example, if I trigger to chewing, then seeing someone put food into their mouth could become a trigger. I could also develop a trigger to seeing someone bring food toward their mouth or to picking up a potato chip.
Images that occur with the trigger can also become trigger stimuli. For example, jaw movement associated with chewing is very commonly reported as a visual trigger by someone who triggers to gum popping.
Visual triggers can even be images that occur repeatedly after being triggered, although this is less common. Also, we find that repetitive movements such as leg jiggling or hair twirling are common trigger stimuli, but it’s not clear why. I had a patient suggest it was because it was a nervous behavior.
Common Misophonic Triggers
Sound (Auditory) Triggers:
- Sounds of people eating – all forms of chewing, crunching, smacking, swallowing, talking with food in mouth
- Sounds made at the table – fork on plate, fork scraping teeth, spoon on bowl, clinking of glasses
- Sounds of people drinking – sipping, slurping, saying “ah” after a drink, swallowing, breathing after a drink
- Other mouth sounds – sucking teeth, lip popping, kissing, flossing, brushing teeth
- Associated sounds – opening chip bags, water bottle crinkling, setting a cup down
- Breathing sounds – sniffling, snorting, nasally breathing, regular breathing, snoring, nose whistle, yawning, coughing, throat clearing, hiccups
- Vocal triggers – consonant sounds (S and P especially), vowel sounds (less common), lip pop, dry mouth voice, gravelly voice, whispering, specific words, muffled talking, several people talking at once, TV through walls, singing, humming, whistling, “uh”
- Home sounds – bass through walls, door slamming, refrigerator running, hair dryers, electric shavers, nail clipping, foot shuffling, flip flops, heavy footsteps, walking of people upstairs, joint cracking, scratching, ticking clocks, pipes knocking, baby crying, toilet flushing
- Work/school sounds – typing, mouse clicks, page flipping, pencil on paper, copier sound, pen clicking, pen tapping, tapping on desk
- Other – farm equipment, pumps, lawnmowers, bouncing balls, back-up beepers, traffic noise, beep of car locking, car door slamming
- Animal sounds – dogs/cat grooming, dogs barking, rooster crowing, birds singing, crickets, frogs, animal scratching, dog whimpering
Sight (Visual) Triggers – jaw movement (chewing), hand touching face, scrolling on smartphone, pointing, leg jiggling, hair twirling, putting food into mouth, drumming fingers, blinking eyes
Odor (Olfactory) Triggers – certain scents (rare)
Touch (Tactile) Triggers – touching a keyboard, touching certain fabrics (rare)
Other Triggers – vibration from anything such as bass, bumping desk, kicking chair, heavy footsteps