By Dr. Mercola
Many people cringe when they hear the sound of nails on a chalkboard. This reaction, which can feel almost physically painful, gives an example of what people living with misophonia deal with every day.
Misophonia means “hatred of sound,” and it’s a condition in which normal, everyday noises cause extreme emotional and even physical distress. The sound of a person chewing, breathing or yawning may act as a trigger.
Other often-intolerable sounds to people with misophonia include the sound of someone fidgeting or tapping their fingers, but virtually any noise — from dripping water to crinkling plastic — can lead to significant discomfort.
Those Affected by Misophonia Often Suffer in Silence
It was only relatively recently — around 2000 — that misophonia was given a name. Husband-and-wife research team Margaret and Pawel Jastreboff reportedly coined the term misophonia,1 which is sometimes referred to as “mastication rage”2 as well as selective sound sensitivity syndrome.
In 2013, a study involving 42 people with misophonia revealed that many similar symptoms and experiences were shared among the group.3 For instance, the triggering stimuli were all sounds produced by humans.
Sounds made by animals did not typically cause distress, nor did sounds made by the patients themselves.
The most offensive sounds included:
- Eating-related sounds like lip smacking
- Loud breathing or nose sounds
- Typing on a keyboard or pen-clicking
In some cases, even watching a visual trigger, such as someone eating or rocking their leg, was enough to trigger misophonia symptoms. Negative reactions were felt immediately upon witnessing the trigger. This included:
- Anger (with some patients becoming verbally or physically aggressive as a result)
Patients reported feeling a loss of self-control. They knew their aggressive reactions and feelings of disgust toward the noises were excessive and unreasonable, but felt they could not help it.
As a result, all of the participants said they would actively avoid triggers by wearing headsets or earplugs or avoiding social situations.
In addition to causing social isolation, many people with misophonia feel daily stress because they’re anticipating coming into contact with a trigger. (Misophonia is believed to be distinctly different from phonophobia, which is a fear of loud noises.)
What Causes Misophonia?
Misophonia is not related to a problem with your ears but rather is related to how sound affects your brain. The Jastreboffs described it as an “abnormally strong reaction … of the autonomic and limbic systems resulting from enhanced connections between the auditory and limbic systems.”4 They continued:
“Mechanisms of misophonia could involve enhancement of the functional links between the auditory and limbic systems, both at the cognitive and subconscious levels.
Alternatively, tonic high level of activation of the limbic and autonomic nervous systems may result in strong behavioral reactions to moderate sounds.”
People with misophonia have described that symptoms began during childhood in association with disgust felt when they heard family members chewing (the average age of onset is 13).
Some have also noted that people with misophonia tend to show traits of post-traumatic stress disorder (PTSD) or obsessive-compulsive personality disorder (OCPD). The definitive underlying causes of misophonia remain a mystery, however. Researchers wrote in PLOS One:5
“One can imagine a process of recurrent conditioning following these repetitive annoying events that eventually results in misophonic symptoms or avoidant behaviour.
… Another hypothesis is that OCPD predisposes to misophonia … there appears to be an obsessional part, the focus and preoccupation on a particular sound, and an impulsive part, the urge to perform an aggressive action.
Both aspects should optimally be explained within one single causal model, which currently is too ambitious.”
Tinnitus, Misophonia and Hyperacusis May Be Related Conditions
Researchers are in the process of teasing out what appears to be a complex relationship between misophonia and its “sibling” conditions: tinnitus and hyperacusis.6
Tinnitus, or chronic ringing in your ears, is becoming increasingly common in young people (where it was once considered primarily a condition in those 50 years or older). Among youth, those with tinnitus had significantly reduced tolerance for loud noise and tended to be more protective of their hearing.
Reduced sound level tolerance is a sign of damage to the auditory nerves because, when nerves used to process sound are damaged, it prompts brain cells to increase their sensitivity to noise, essentially making sounds seem louder than they are.7
Hyperacusis, meanwhile, is reduced tolerance to sound in which a person feels physical discomfort when exposed to some sounds. Research conducted by the Jastreboffs suggests hyperacusis and tinnitus often co-exist. They noted, “Most frequently, significantly decreased sound tolerance results from a combination of hyperacusis and misophonia/phonophobia.”8
The causes of hyperacusis are unknown, but it could be due to functional changes within the central nervous system as well as increased anxiety or emotional response to sound.9 Hyperacusis has also been linked to exposure to certain sounds, head injury,stress and certain medications.10
Is There Help for Misophonia and Hyperacusis Sufferers?
Many misophonia patients try to live with their symptoms by lessening exposures to offensive noises. You can try wearing earplugs or headphones to tune out sounds, for instance. There are also hearing-aid-like devices that create a white-noise sound that may help reduce your reactions to sounds.
Psychological counseling and sound therapy are often recommended. The latter is often used for tinnitus (tinnitus retraining therapy) and may also work for other forms of decreased sound tolerance.
The idea behind sound therapy is to turn the offending sounds into neutral stimuli so they no longer provoke a negative response.11 In the case of hyperacusis, many of those affected live with the condition by wearing earplugs. This may actually backfire, however, by making your auditory system even more sensitive to noise, worsening hyperacusis.12
Some experts recommend a desensitization approach like tinnitus retraining therapy for hyperacusis. The therapy involves exposing you to a variety of sounds (in different frequencies, durations and volumes) so that ultimately your reaction to them lessens. According to the Jastreboffs, desensitization therapy alone will not relieve symptoms of misophonia.
For misophonia relief they recommend a different approach — “systematic exposure to sounds, associated with a pleasant situation, with gradually increasing sound levels.”13
If you struggle with misophonia, hyperacusis, or any sensitivity to sound, perhaps the greatest relief of all will come from knowing you’re not alone. There are many support groups available around the U.S., and if you can’t find one to attend in-person you can join in a discussion with other misophonia sufferers online.