We all have certain sounds that irritate us, but for those with misophonia the body’s response is far  beyond that of irritation.  With misophonia the body’s fight or flight response is triggered by certain sounds.  It is an automatic response that doesn’t involve any cognition and the sound/trigger makes the body feel as if it is being assaulted.  I know because I have struggled with misophonia since my tween years.

It started with my mom’s gum chewing when I was 11 or 12, then went to chewing sounds by both my parents, then my high school best friend’s gum chewing, then my college roommate’s habit of eating M&M’s throughout the day, and so forth. These trigger sounds instantly invoked feelings of intense anger, disgust and anxiety along with a strong urge to flee or lash out.

The worst part was not knowing why this was happening to me. No one else seemed to have this problem, which led me to feeling embarrassed and ashamed about it.  The few times I brought it up to family or close friends it was treated as being comical or something I made up.  I wanted therapy or some sort of help for it, but my requests weren’t taken seriously.  I don’t blame my parents or friends for not being more supportive because at the time there was no name for it, they knew of no one else having this problem, and the way the symptoms manifest is confusing.

I hoped it was something I would grow out of but when it continued to persist and worsen with each passing year, I had to accept it was going to be a part of my reality for the rest of my life. As someone pursuing a career in psychotherapy (and wanting to “job shadow” and work on my stuff) I saw a number of therapists with different skill sets over the course of my 20’s.  At some point in the therapy process I would have the courage to bring up my aversion to certain sounds and was repeatedly met with bewilderment, blank stares and/or amusement…along with some empathy but no helpful insight into what it was (most considered it a form of anxiety). Then it occurred to me one day to do an internet search about my hatred of chewing sounds (this was before “Google it” was commonplace) and lo and behold there were forums a mile long of people struggling with the same thing!  I spent hours reading the posts that first night.  I laughed a lot because I totally understood where these people where coming from as they described their rage about sounds that are insignificant to the average person and how they would like to respond if there were no consequences (i.e. think adult tantrum). Knowing that I wasn’t alone was so validating and gave me hope.

Within a few years the condition had a name – misophonia. And when my son went in for some therapy five years later and I mentioned having misophonia during the family history portion of the intake process, it was the first time I encountered a therapist who knew what it was!  I was thrilled word was spreading!

Fast forward to 2013 and the Misophonia Association was formed, which among other initiatives puts on an annual conference. And research is being conducted to better understand the cause of misophonia (hopefully leading to a cure)! Studies are showing there is a brain basis for misophonia and that misophonia is a neurological disorder.

There is no diagnosis for misophonia in the DSM, but a group of psychiatrists in Amsterdam who have been researching the condition have proposed the following diagnostic criteria:

1. The presence or anticipation of a specific sound, produced by a human being (e.g. eating sounds, breathing sounds), provokes an impulsive aversive physical reaction which starts with irritation or disgust that instantaneously becomes anger.
2. This anger initiates a profound sense of loss of self-control with rare but potentially aggressive outbursts.
3. The person recognizes that the anger or disgust is excessive, unreasonable, or out of proportion to the circumstances or the provoking stressor.
4. The individual tends to avoid the misophonic situation, or if he/she does not avoid it, endures encounters with the misophonic sound situation with intense discomfort, anger or disgust.
5. The individual’s anger, disgust or avoidance causes significant distress (i.e. it bothers the person that he or she has the anger or disgust) or significant interference in the person’s day-to-day life. For example, the anger or disgust may make it difficult for the person to perform important tasks at work, meet new friends, attend classes, or interact with others.
6. The person’s anger, disgust, and avoidance are not better explained by another disorder, such as obsessive-compulsive disorder (e.g. disgust in someone with an obsession about contamination) or post-traumatic stress disorder (e.g. avoidance of stimuli associated with a trauma related to threatened death, serious injury or threat to the physical integrity of self or others).

 

So how can you support a client who presents with these symptoms?

1) Know what misophonia is in a general sense (finish reading this article and you can check that off or go a step further and watch “Quiet Please” listed in the resources below).

2) Make sure your client knows they are not alone and there is a name for their condition.

3) Share the below resources with your client.  Help your client better understand the condition.

4) Encourage your client to exercise frequently and take time to do activities/be in settings that are calming to their nervous system.

5) Brainstorm coping strategies and ways to modify their environment to minimize triggers and the effect of triggers (ex. strategic placement of white noise machines).

5) Help the client in managing the emotions that come with misophonia (shame, rage, anxiety, grief). The following treatment approaches have shown to be effective with some misophonia sufferers: CBT, DBT, mindfulness, hypnosis, somatic work, EMDR, Alpha Stim and Neurofeedback.  You may need to refer your client to someone who specializes in one of these treatments for misophonia-specific support, along with professionals in other fields who understand the condition such as chiropractors and audiologists.

6) Do systems work! In particular, work with anyone the client lives with (whether it be parents, a spouse, roommates, etc.) to help them better understand the condition and support the client in coping (along with validating their experience – misophonia is tough to live with!).

If you are an educator: Classroom settings are one of the most challenging settings for those with misophonia because of snacking, gum chewing, pen clicking, etc. Create a safe environment for students with misophonia to be able to let you know they have the condition and offer/brainstorm possible modifications so the student can better focus on what is being taught versus the sounds in the environment.

Making my condition known to all of you (especially considering my role with MAMFT) is another big step in my journey of combating misophonia.  I hope it results in more and more clients feeling understood when they present with misophonia in therapy.

One of the reasons I hold back from telling people about my condition is that I don’t want people to feel anxious about eating around me.  Fortunately, my misophonia isn’t on the severe side and my triggers are generally with those I spend a lot of time with.  Gum chewing is the exception.  It always triggers me.  So now you know to not chew gum around me.  The same goes with Oprah if you ever meet her.

Resources

Film: Quiet Please

Misophonia Facebook page: Stop the Sounds

Research Article: The Brain Basis for Misophonia

MN Audiology Clinic (source for white noise generators): The Tinnitus and Hyperacusis Clinic

Book: Understanding and Overcoming Misophonia: A Conditioned Aversive Reflex Disorder

References:

Dozier, Thomas (2015) Understanding and Overcoming Misophonia: A Conditioned Aversive Reflex Disorder. Livermore, CA: Misophonia Treatment Institute

Schroder, A.; Vulink, N; Denys, D. (2013, January). Misophonia: Diagnostic Criteria for a New Psychiatric Disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553052/

Sara Bidler, MS, LMFT has a private practice in Maple Grove, MN: Authentic Living Therapy Services, LLC. She is an Advanced-Level Somatic Experiencing Trainee.  In addition to helping people work through past traumatic experiences, Sara has a passion for helping those impacted by misophonia. She also serves as Executive Director for MAMFT.  She can be reached at sara@authenticlivingts.com.  Learn more about Sara’s practice at www.authenticlivingts.com.