Misophonia: The Ultimate Auditory Ailment

You sit down at the dinner table, ready to enjoy an amazing Friday night feast with all your distant relatives. From the taste of the mashed potatoes to the smell of the clam chowder, everything is perfect, except for one thing: the constant sound of people slurping, chewing, and smacking their lips. You attempt to push through the sounds, but to no avail. You run off to your room and go on the internet to determine the cause of your ailment.

Millions of people report having issues with everyday sounds, even to the point where common noises become intolerable for them. This disorder is called misophonia, and it affects from six to 20 percent of people, though many may not know they have it. Misophonia, which is typically not serious, is marked by an emotional or physiological response to hearing certain sounds. Common trigger sounds range from those of the human body—most notably breathing and chewing—to inanimate sounds such as rubbing styrofoam or nails on a chalkboard. Misophonia is a relatively new, minimally researched condition. It was classified as a medical disorder in 2001 by Dr. Pawel Jastreboff, but is not currently considered a mental disorder. Others consider it to be an obsessive-compulsive spectrum disorder.

Certain sounds triggering feelings of annoyance and distress in one case of misophonia may be completely tolerable for others. Misophonia’s severity varies from person to person depending on numerous factors; it is more common in females than males, and its severity tends to decrease with age. Despite these findings, scientists do not currently have a concrete explanation for these trends. Misophonia usually develops in childhood or adolescence, typically after six years of age. It is suspected that misophonia develops through a process known as conditioning, an automatic response when repeated exposure to a stimulus reinforces it and develops a recurring reaction to subsequent stimuli.
Though misophonia is relatively common, it is a lifelong condition with no cure. Typical symptoms include anger, anxiety, sweating, and an increased heart rate in response to trigger sounds. However, in extremely rare cases of misophonia, behavioral changes can occur. These behavioral changes can include avoiding social interaction—and in turn, avoiding trigger sounds—or a loss of self-control in someone with severe misophonia. Misophonia can be linked to other mental disorders, specifically obsessive-compulsive disorder (OCD), which is characterized by intrusive thoughts (obsessions) and repeatedly destructive coping behaviors (compulsions). OCD and misophonia are extremely similar, as those with OCD can experience similar symptoms to those of misophonia—obsessions and compulsions in response to trigger sounds. Some researchers even consider misophonia an effect of OCD, hypothesizing that they can be treated similarly.
The brain’s auditory cortex, which controls hearing, reacts similarly to trigger sounds in those who are affected by misophonia and those who are not. Research has shown that those with misophonia have more neural communications between their motor controls—particularly those in the face region—and the auditory cortex. This makes sense, as misophonia triggers are usually linked to mouth and throat sounds, such as chewing. 
In addition, visual stimuli may also play a role in misophonia, as visual receptors have similar communication patterns with the motor controls of the facial region. This is linked to a condition called misokinesia, where fidgeting and repetitive actions, such as that of someone shaking their legs, can trigger symptoms similar to misophonia. This correlation means that misophonia can be intensified with visual stimuli and can even trigger symptoms in the absence of a sound. 

The combination of visual and auditory stimuli can lead to emotional or behavioral distress through the “mirror system.” This is a group of specialized neurons in the human brain that copies the behaviors of the people you are interacting with in order to better understand them. Since those with misophonia have heightened motor and visual receptor connections, an overreaction in this system can create overwhelming feelings of distress.
Despite the lack of a misophonia cure, there are treatments that can be conducted in order to combat its symptoms. One of these is called Tinnitus Retraining Therapy, originally developed to treat a similar disorder called tinnitus that causes an irritating ringing in the ears. This treatment is a form of exposure therapy in which the trigger noise is played in controlled amounts so the person can learn to tolerate it. Treatments for other mental disorders can also be applied to misophonia, such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Both of these methods are known as talk therapies in which the patient has individual or group meetings with a mental health professional to limit the effect of their mental disorder on their daily life. Both DBT and CBT seek to reframe a person’s mindset and emotional reaction to trigger sounds.
Misophonia’s obscurity as a disorder is shocking when considering how many people it affects on a daily basis. Though those who do not have the disorder may just think of it as an annoyed reaction to common sounds, further research into misophonia has the potential to determine its connection to other common mental disorders.