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Misophonia: Anger, anxiety or disgust towards "trigger" sounds

Last update on May, 29, 2023

What is misophonia?

Misophonia is a negative and intolerant reaction to one or more sounds, either loud or soft. The type of sound triggering the reaction is specific to each individual and can trigger reactions of anger, anxiety or even panic.

Misophonia symptoms

The symptoms of misophonia are generally hypersensitivity, annoyance and intolerance towards certain sounds, which consequently generate anger and aggression. Misophonia sufferers have difficulty tolerating certain noises. Typical examples are popping, chewing, swallowing noises, repeated clicking or even rubbing noises on fabric, wood or glass. Sounds perceived as unpleasant can lead to violent reactions, regardless of the volume. The range of emotions goes from simple annoyance to strong displays of aggression. 

The most common misophonia emotional and body symptoms are:

  • Exaggerated irritability
  • Bad mood
  • Annoyance or discomfort
  • Episodes of anger
  • Sweating and shaking
  • Disgust
  • Anxiety
  • Sweating
  • Heart rate increase
  • Panic episodes

The most common misophonia behavioral reactions are:

  • Overreacting to simple noises
  • Outbursts of anger
  • Tendency to move away from the source of sound that generates discomfort
  • Verbal insults to the person causing the noise (rare)
  • Non-violent or violent (rare) action to stop the sound

The sounds or noises that can trigger emotional and behavioral reactions in people suffering from misophonia are numerous and strictly depend on the individual affected. The most common misophonia trigger sounds include:

  • Nasal sounds (snoring, hiccups)
  • Mouth/throat noises
  • Breathing noises
  • Oral sounds (munching, nail-biting)
  • Children crying
  • Rubbing noises (ex: fabric, wood or glass)
  • Repeated clicks
  • Animal sounds (chirping of birds, croaking of frogs)
  • Body movement sounds (cracking joints);
  • Ambient sounds (cell phone ringtones, ticking clocks)
  • Eating/Drinking sounds

Aversion to eating and drinking noises is common. However, a simple annoyance towards these noises does not mean misophonia. Our cultural imprint and good manners at the table can make us intolerant of these sounds.

However, if we talk about a real misophonia linked to eating sounds, often misophonic individuals feel real anger for people who chew excessively loudly and can even get to react in a disgusted or, in the worst case, violent way, as anger takes over the person himself.

Even if misophonia is almost pathological in certain types of subjects, it is a disorder that can be mitigated and, in the best-case scenario, cured.

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Misophonia or hearing loss?

Do you feel a particular sensitivity to some sounds but are not sure if it is related to misophonia or hearing loss? Take a free hearing test at a Miracle-Ear Center to find out!

Diagnosis: Is there a test for Misophonia?

Specialists, including audiologists, psychiatrists, speech therapists, and psychologists, can identify misophonia. For a correct diagnosis of misophonia, the following are essential: 

  • A physical examination
  • A questionnaire relating to triggers of intolerance reactions, which scores the impact of misophonia on quality of life (ex. Misophonia Questionnaire, Amsterdam Misophonia Scale)
  • Audiological tests to verify the integrity of the auditory system: tonal and audiometric hearing test, measurement of the annoyance threshold, impedance exam, and otoacoustic emissions to exclude all those recognized medical conditions responsible for similar symptoms (differential diagnosis)

Hearing conditions to take into consideration during the differential diagnosis include: 

Misophonia is a real disorder, but it is not yet a recognized mental illness. People with misophonia may benefit from mental health therapy. Furthermore, misophonia meets many of the general criteria for a mental illness. However, this condition still needs to be studied further to refine the diagnosis, as it is not always easy to understand if a patient suffers from misophonia or simply has a slight intolerance towards certain sounds, which can also indicate the consequences of other types of diseases.

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What causes Misophonia?

Doctors aren't sure what causes misophonia, but it's not a problem with your ears. Misophonia most likely has its roots in a neurological disorder and is often linked to past experiences. A specific sound can be associated with an unpleasant situation that causes violence or anger in the person listening to it. Even though researchers aren't yet sure what causes misophonia, they do know it appears more commonly in people who also have:

  • Mental health conditions
  • Neurodivergent conditions and other brain disorders
  • Hearing-related conditions or symptoms

There is still no answer to the question, "Is Misophonia a genetic disease?" but research shows that genetics is probably a factor in cases of misophonia. 

In a study published in 2023, "A genome-wide association study of a rage-related misophonia symptom and the genetic link with audiological traits, psychiatric disorders, and personality," researchers have identified one genetic marker associated with feeling rage at the sound of other people chewing. This genetic marker is located near the TENM2 gene, which is involved in brain development.

At the same time, we cannot say that genetics is the only factor that comes into play. Misophonia develops through experience and doesn't happen solely because of a brain defect or genetic condition. So, misophonia takes both genetics and the surrounding environment to develop.

Neurodivergent conditions and other brain disorders can be potential causes of misophonia.

People with autism spectrum disorder (ASD) often experience sensory processing disorder and are more likely to have misophonia. Misophonia may be an autism comorbidity, but there is no conclusive evidence at the moment that misophonia and autism are related.

Misophonia is not even a form of ADHD, even though misophonia may often be an ADHD present as well. Individuals with ADHD frequently have hypersensitivity to environmental stimuli, including sounds. There have been researches on misophonia and ADHD that suggest a potential connection, but there is still no conclusive evidence of the connection.

Misophonia is also comorbid with Tourette's syndrome. The latter is a neurodevelopmental disorder characterized by multiple repeated motor and vocal tics, which are evident, even in a non-continuous manner, for more than 12 months. The correlation between misophonia and Tourette's syndrome has been the subject of several studies, including "Misophonia in Children with Tic Disorders: A Case Series," in which misophonia emerges as an underreported condition in children with Tourette Syndrome, contributing to emotional distress, episodic rage attacks, and tic exacerbation with a major impact on the patient's quality of life.

The association between misophonia and mental health conditions like OCD has been the subject of different studies.  One study is: "Misophonia: A Systematic Review of Current and Future Trends in This Emerging Clinical Field." The study shows that OCD is one of the mental disorders most frequently associated with misophonia; about half of people with misophonia also have obsessive-compulsive symptoms

Although many authors suggest the existence of misophonia as a distinct disease, it is important to keep in mind that misophonia shares many characteristics with OCD, like hypersensitivity to stimuli. Unlike OCD, in misophonia, external hypersensitivity does not occur in the absence of external misophonic triggers. Finally, the neural circuits involved in OCD may be similar to those in misophonia.

Misophonia is also more common in people with obsessive-compulsive traits but doesn't fully meet the criteria for a formal obsessive-compulsive disorder (OCD) diagnosis.

Misophonia is more likely to happen in people with hearing-related conditions like hearing loss, tinnitus and hyperacusis.

There's no evidence that people who experience misophonia have any type of vitamin deficiency.
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Misophonia treatment: How to deal with it

Currently, there is no specific treatment to cure misophonia. Some therapeutic approaches can help minimize the conditions. Currently, sound therapy, used for the therapeutic approach to the patient with tinnitus and/or hyperacusis, and cognitive-behavioral therapy are the most effective treatment strategies to reduce misophonia symptoms.

  • Sound therapy can be effective for people suffering from misophonia. Also known as TRT (Tinnitus Retraining Therapy), sound therapy aims at acoustic desensitization towards certain sounds, making the patient listen to certain noises daily to trigger an adaptation process that gets the ear used to their listening;
  • Counseling, led by expert personnel, has the primary objective of making the patient aware of what is physiologically happening to his hearing and how important it is to disengage attention from annoying sounds, whether they are of endogenous origins such as tinnitus or environmental such as those that cause misophonia and hyperacusis.

Earplugs can help with misophonia, but you must be careful how often you use them. Reducing the impact of external sounds can help in the case of misophonia. Earplugs allow people suffering from this condition to participate in some contexts of social life, such as crowded places or eating together with other people. However, one must be careful not to overuse earplugs, as often soft sounds can be triggers of misophonia, and the constant use of earplugs increases sensitivity to many soft sound triggers.

Earplugs can help people with misophonia in certain social contexts, but they are not an everyday method to cope with misophonia.

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Misophonia and intelligence

Like other conditions, such as ADHD and OCD, people wonder whether misophonia is linked to a higher IQ. There are currently no studies confirming this link with certainty.

However, according to Northwestern University research, the heightened sensitivity to noise from people with misophonia makes them more creative. Those who are very sensitive to certain sounds can focus on a wide range of things simultaneously, thus possessing greater skills and potential than the average.

Misophonia and hyperacusis are associated with sensitivity to certain noises. However, in hyperacusis, people react with hypersensitivity to a noise level most people find normal. The reaction is not triggered by specific noises but by the intensity of a sound. If you perceive sounds as unbearable even at normal volume, regardless of where they come from, you should consult a hearing care professional.

Misophonia and anxiety are often linked. The consequence of intolerance to some noises is an uncontrolled reaction of the subject who listens to them, which can lead to anger, anxiety, and panic. Anxiety and panic attacks are the most common emotional reactions of misophonia episodes.

Misophonia can occur in both children and adults. Often the first symptoms are identifiable between the ages of ten and twelve. Eating together at the table, for example, chewing noises become unbearable for a child who is already under stress from school, etc. Experts advise against reacting with coercion to noise intolerance in children. This could lead to a worsening of symptoms.

Sound therapy or other therapeutic measures can help children in their development. It is important for children to understand the faulty connections their brains make to eliminate the uncertainties that separate their emotions and triggers, and it becomes easier to calm down.

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