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Misophonia: Causes, Symptoms & Treatment

Misophonia is a condition in which specific everyday sounds such as chewing or lip smacking trigger intense emotional reactions including anger, disgust, or anxiety.

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Things worth knowing about "Misophonia"

Misophonia is a condition in which specific everyday sounds such as chewing or lip smacking trigger intense emotional reactions including anger, disgust, or anxiety.

What is Misophonia?

Misophonia (from Greek misos = hatred and phone = sound/voice) is a neurological and psychiatric condition characterised by intense negative emotional responses to specific, often repetitive everyday sounds. The term was coined in the early 2000s by neuroscientists Pawel and Margaret Jastreboff. Unlike general sound sensitivity (hyperacusis), misophonia is triggered by particular sounds known as triggers, rather than loud sounds in general.

Causes

The exact causes of misophonia are not yet fully understood. Current research suggests abnormal sensory processing in the brain, particularly in regions responsible for emotions and autonomic responses.

Neurological factors: Neuroimaging studies show increased activity in the amygdala and anterior insular cortex in people with misophonia.
Genetic component: Evidence of familial clustering suggests a possible genetic predisposition.
Psychological factors: Misophonia frequently co-occurs with anxiety disorders, obsessive-compulsive disorder (OCD), or Tourette syndrome.
Conditioning: In some cases, the condition develops after a negative experience associated with a particular sound.

Symptoms

Symptoms of misophonia can vary widely in severity. Common trigger sounds include chewing, lip smacking, sniffling, breathing sounds, keyboard typing, or pen clicking.

Emotional reactions: Intense disgust, anger, anxiety, or panic as an immediate response to trigger sounds.
Physical reactions: Increased heart rate, sweating, muscle tension, or an overwhelming urge to leave the situation.
Avoidance behaviour: Individuals avoid social situations such as shared meals or public places to escape trigger sounds.
Social impairment: Strained relationships with family members, friends, or colleagues.

Diagnosis

Misophonia is not yet listed as a standalone diagnosis in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-11, but it is increasingly recognised within the medical community. Diagnosis typically involves:

A detailed clinical interview (medical history) conducted by a specialist in audiology, psychiatry, or neurology.
Standardised assessment tools such as the Amsterdam Misophonia Scale (A-MISO-S) or the MisoQuest scale.
Ruling out other conditions such as hyperacusis, tinnitus, or anxiety disorders.

Treatment

There is currently no single standardised treatment guideline for misophonia. However, several therapeutic approaches show promising results:

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy is currently the most thoroughly studied approach. It helps individuals understand and modify their emotional responses to trigger sounds and gradually reduce avoidance behaviour.

Tinnitus Retraining Therapy (TRT)

Originally developed for tinnitus, TRT is also used in misophonia management. Through desensitisation strategies and sound generators, it aims to reduce the intensity of reactions to trigger sounds.

Dialectical Behaviour Therapy (DBT)

Elements of DBT, particularly mindfulness exercises and emotion regulation techniques, can help individuals better manage intense emotional reactions.

Pharmacological Treatment

There are no medications specifically approved for misophonia. In cases where anxiety or OCD co-exists, selective serotonin reuptake inhibitors (SSRIs) may be prescribed.

Living with Misophonia

Many individuals develop personal coping strategies to manage daily life. These include wearing headphones, playing background music or white noise, and openly communicating with those around them about the condition. Early education and a supportive environment can significantly improve quality of life.

References

Jastreboff, M. M. & Jastreboff, P. J. (2002). Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia. ITHS News Lett., 2, 5-7.
Schroeder, A. E., Vulink, N. C. & Denys, D. (2013). Misophonia: Diagnostic Criteria for a New Psychiatric Disorder. PLOS ONE, 8(1), e54706. https://doi.org/10.1371/journal.pone.0054706
Brout, J. J. et al. (2018). Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda. Frontiers in Neuroscience, 12, 36. https://doi.org/10.3389/fnins.2018.00036

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