Misophonia is a condition where a person has a severe sensitivity to specific soft sounds and visual images. When a person hears the sounds, the person has a very strong emotional reaction such as hate, anger, anxiety, rage, and resentment and physiological distress. People who suffer with misophonia often report that they feel the person is intentionally making the sound, even though when they are calm and away from the sound, they usually acknowledge that the conclusion at that time was not accurate.
A person experiencing misophonia generally has excellent hearing. It is not a sensitivity to the volume of sound, but an emotional and physiological reaction to specific sounds. At first it is generally the sounds of specific individuals that cause the reaction, but it usually spreads to the sounds made by others and to additional sounds. The chewing sound of a friend may be annoying, while the chewing sound of a parent elicits (forces automatically) a strong reaction and is intolerable.
What causes misophonia? The misophonic reaction appears to be an involuntary physical and emotional reflex caused by the sound. The sound directly activates the Autonomic Nervous System which is located in the brain stem and the Limbic System which is associated with emotion. This is a direct connection between the sound and a reflex reaction. Think of the sound as causing the same reaction as a hard poke in the ribs with a stick.
Behavior science explains this physiological reaction as a “respondent” or “reflex” behavior that has been acquired or developed by pairing the sound with a distressed (stress, anxiety, etc.) physiological condition. When these two things happen at the same time (distress and the sound), it creates neurological wiring in the brain that causes the misophonia reaction when the sound is heard again. I call this an acquired reflex because it is not an innate or inborn reaction (did not exist at birth). It is a reflex because it is a direct connection from a sense (hearing) to the Autonomic Nervous System and the Lymbic System.
We see that misophonia is actually a double reflex. We think of misophonia as an extreme emotional (reflex) response, and it is. The brain imaging study by Dr. Sukhbinder Kumar, The Brain Basis of Misophonia (2017) provides evidence for the emotional reflex response of misophonia, and it is driven by the vmPFC which is an emotional learning brain structure. But there appears to also be a physical reflex that occurs, which is usually a skeletal muscle flinch. The physical reflex can also be deeper inside the body. There are reports of individuals with stomach, intestine, or esophagus constriction, urge to urinate, or a sexual sensation. This will be discussed more on other pages. A study of the physical reflex of misophonia (Dozier & Morrision, 2017, Phenomenology of Misophonia: Initial Physical and Emotional Responses) was published in the American Journal of Psychology.
Once again, what causes misophonia? Misophonia seems to occur more frequently in a person with a higher level of anxiety, stress, or compulsive behavior. The reaction often develops first to a parent or family member where the person has a high level of anxiety or distress (physiological state of distress) and they repeatedly hear the sound. It also seems to happen when a person cannot escape from the sound, such as at the dinner table, in a car, or even laying in bed. In rare cases, the original misophonia trigger has been a repeating visual image (body movement).
With most sounds, the sound is taken into the brain and then the person makes a thoughtful response. The person considers the meaning of the sound and then responds. This is called a “high road” response. (It goes through the higher part of the brain before the person reacts.) For example, a person says to you, “I hate you.” You have to first think about the words and the meaning. You then respond based on the meaning. In this case, if words are a reply to “Your feet stink,” then you know it is joking or name calling, and you don’t have a negative emotional response. If you perceive the person is serious and the person is important to you, then you may have a strong, negative emotional response, such as crying.
Once the misophonic response is established for one sound, other sounds seem to be added over time. Because of this, those with misophonia often have a number of sounds that cause the reflex reaction, and it may impact many aspects of their lives. Without treatment, the prognosis for misophonia is grim. The misophonic responses usually get worse and worse, and the negative impact on the person’s life gets progressively greater.
But… There is reason for hope. In the past 3 years, there have been new treatments developed. We also have cases where existing treatments (Cognitive Behavioral Therapy or CBT) has been successfully applied to misophonia. More individuals are conducting research on misophonia, and our understanding of misophonia is improving. At the 1st International Misophonia Research Symposium held in August, 2018 in Pleasanton, California, presentations were give which showed effective treatment of misophonia using a new hypnotherapy protocol (Sequent Repatterning) and the results of the Fordham University study by Dean McKay which employed stress management and a carefully designed exposure technique. If you want to see these presentations, you can join the Misophonia Association and you will receive the videos as a thank you gift.
For more information on misophonia treatments, see the pages under the Treatment tab on this website.