Misophonia: When Ordinary Sounds are Upsetting
M. is in her teens, and is so distressed by the sounds of family members eating or breathing that she can no longer enjoy meals with her family. The whole family is suffering from M’s outbursts for sounds that don’t bother anyone else.
Do you get upset, irritated or very angry when you hear people:
- Eating or chewing with their mouths open?
- Typing on a keyboard?
- Making other soft sounds that don’t seem to bother anyone else?
If so, you may have misophonia.
Many of us have had the experience of hearing sounds that make us feel uncomfortable. The sound of fingernails scraping across a chalkboard makes many people cringe. Sirens or smoke alarms make our hearts beat faster. Being very aware of certain sounds, and reacting strongly to them may have been very helpful to early humans. This may have helped them survive, by being alert to warning signals of possible danger.
However, in misophonia, this sensitivity is to an extreme. People experience an intense dislike or sensitivity to certain sounds. They can react to these sounds with distress, fear, stress, anger and even rage.
Family and friends may find misophonia hard to understand. Since they don’t have the same problem, they typically have troubles understanding why the person is triggered by sound. They may express their frustration and lack of understanding by saying things such as, “Just get over it!” or “Stop being so sensitive!” “Stop being so controlling!”
Top Misophonia Sound Triggers
Top triggers for those with misophonia (Schröder, 2013):
- Eating sounds (81% of those with misophonia)
- Loud breathing or nose sounds (64% of those with misophonia)
- Finger or hand sounds (59% of those with misophonia)
Interestingly, humans make most of the sounds and sights that trigger misophonia. A dog slurping down a bowl of food or similar does not usually provoke a misophonic reaction.
In addition, some people are triggered by seeing someone repeating certain physical actions, such as shaking their knees (11%).
Misophonia literally means, “hatred of sound.” It is also known as Selective Sound Sensitivity Syndrome (“4S”).
Misophonia is part of a group of sound tolerance difficulties (decreased sound tolerance). Other conditions in this group are:
- Hyperacusis: where people are more sensitive to all sounds in general (for example, normal sounds seem too loud).
- Phonophobia: Fear of certain sounds.
It is believed that about 3% of the general population has misophonia (Jastreboff, 2014).
Most people report their symptoms start in their ‘tweens', around age 9-12.
Step 1: In misophonia, the person's ears work normally at hearing sounds.
Step 2: However, when the sounds are processed by the brain, they appear to trigger the limbic system, turning on the 'fight/ flight’ alarm system. People report feeling upset, to the point of being irritable, afraid or angry.
Misophonia also appears to occur more commonly in people with certain conditions such as
- Sensory processing problems aka sensory processing disorder (SPD)
- Autism spectrum disorder (ASD);
- Post-traumatic stress disorder (PTSD);
- Obsessive compulsive disorder (OCD).
- Brain injury.
Q. I get really stressed when my sister chews (especially when she chews salad), but it doesn’t happen with other people. Is it still misophonia?
A. Yes, in fact Misophonia usually starts with just one person or just one sound, and can progress from there.
Q. I am really sensitive to my family’s chewing sounds, however I also find that other sounds are too loud when they reach a certain level. Is that normal?
A. Yes, misophonia can be present with another condition called hyperacusis, which is sensitivity to loud sounds. Both can occur at the same time.
Q. Is it ok for me to wear musician filters or noise cancelling headphones without music to deal with my misophonia?
A. No, having musician filters or noise cancelling headphones without sound can make the misophonia WORSE. Pleasant background sound or music are better tools in dealing with misophonia.
Q. I heard that a white noise machine can help with misophonia. Is that true?
A. It depends; some people like the white noise machine, and some people find it overwhelming. Listen to your brain. If the white noise machine is enjoyable, use it! If not, a household item that makes a similar noise like a fan might work. Try having a fan on and seeing if the sound it makes is more enjoyable, or at least more tolerable..
Wondering about misophonia?
Start by seeing an audiologist with experience in misophonia, hyperacusis or tinnitus (ringing in the ears).
- The audiologist will take a careful history, and check your hearing. It’s helpful if the audiologist works with a team of professionals familiar with misophonia and sensory processing disorder, autism spectrum disorders, post-traumatic stress disorder and brain injury.
- Examples of other professionals might include an occupational therapist (OT) with experience in sensory processing disorders.
Take good care of your brain
- Get enough sleep.
- Eat a healthy, nutritious diet.
- Get enough exercise (at least 60-minutes a day).
- Avoid the triggering sounds. This usually means moving away from the sounds that are bothering you.
- When exposed to a trigger sound, it is often helpful to try to take your attention away from it.
- Having fidget toys, such as silly putty or a Tangle on hand can help in forcing the brain to stop focusing on the trigger sounds.
- Have background sound around 24 hours a day, 7 days a week. Background sound can be played with headphones, a tabletop speaker or it could be a fan/dehumidifier. Background sound will help reduce the prominence of trigger sounds. The background sound does not have to be loud: it has to be at a comfortable level (which can vary from day to day).
- Educate family members about misophonia. Explain that your distress caused by certain sounds is a condition known as misophonia, and it is due to the way your brain is wired. Consider showing them information (like this handout) or websites about misophonia (see below for a list).
- Join a support group for misophonia on social media. It can help to share and normalize your experiences with misophonia with others.
Since misophonia is a relatively new condition, researchers are still learning about what may be helpful. As most of these therapies aim to help reduce the reactions of the brain to trigger sounds, therapy for misophonia is generally a process and takes time and patience. In the meantime, the following treatments appear to be helpful:
- Tinnitus Retraining Therapy (TRT) or Misophonia Retraining Therapy (MRT):
- Usually given by audiologists,these interventions are a mixture between targeted counselling and sound therapy where one of the first steps is to ask the person to never be in silence.
- Following this, the person has to identify pleasant sounds and these will be combined with background sounds to help reduce the importance of trigger sounds for the nervous system therefore reducing the responses to those triggers (Jastreboff, 2014).
- Talking therapies: Talking therapies such as cognitive behaviour therapy (CBT) can help by changing the way that people they think about and respond to disturbing sounds. It can help with problem solving, and can help people express their needs and distress in more helpful ways.
- Other treatments that may help:
- Desensitization Therapy
- Hypnotherapy (hypnosis)
- Relaxation or mindfulness exercises
- Dozier Trigger Tamer App, is a mobile application created by Thomas Dozier of the Misophonia Treatment Institute (misophoniatreatment.com). The app is designed to help the brain ‘rewire’ itself to overcome the sound sensitivity. The app uses soothing music along with ‘trigger sounds’ to help the user to gradually become less sensitive to distressing sounds.
M. sees an audiologist who has experience treating misophonia. It is an incredible relief to know that she is not alone, and not simply crazy or being difficult.
After counselling, sound therapy, and homework activities, she is finally able to tolerate sitting around other people when they are eating.
At home and school, she no longer gets angry and upset when people chew food. And more importantly, she is finally able to enjoy a meal with her family, something that had become problematic for the whole family.
The Misophonia Association
Tinnitus Practitioners Association
Oregon Tinnitus and Hyperacusis Treatment Center
Jastreboff, P., & Hazell, J. Tinnitus Retraining Therapy Implementing the Neurophysiological Model. Cambridge University Press, 2004.
Jastreboff P et al.: Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia). In Seminars in Hearing, 35(2), 2014.
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Written by Caryn Bursch (Doctor of Audiology), Fauve Duquette-Laplante (Audiologist) and and members of the Mental Health Information Committee of the Children’s Hospital of Eastern Ontario (CHEO), an interdisciplinary group that includes psychiatry, psychology, child/ youth care, social work, nursing, and occupational therapy.
Special thanks to Freepik (www.flaticon.com) for various icons used in this article.
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Information in this fact sheet may or may not apply to you. Your health care provider is the best source of information about your health.
Date of Last Revision: Dec 22, 2020