Dear Therapist:

I have this "thing" where I get filled with extreme rage, frustration, and hate from hearing certain sounds like chewing loud, slurping, whistling, wiggling of feet, snoring... These sounds drive me crazy to the point where I need to leave the room or I might just yell at the person causing the trigger. People think I'm just finicky and I have to learn to deal with these noises. When I mentioned this to a friend, they said it sounds like misophonia. I was wondering what this condition is, where it comes from if there's any way to treat or get rid of it, or will I just have to live like this always?

Thank you in advance.

Response:

“Misophonia” is a little-known disorder. In fact, as far as I know it’s not even an official disorder. As I write this response, my spellchecking program underlines the word in red, indicating that it is not in the dictionary. Many doctors and therapists have never heard of misophonia. This can be frustrating for people who deal with associated symptoms.

People with misophonia typically describe their feelings as rage, anger, hate, fear, and frustration when exposed to certain sounds. Sounds emanating from the mouth appear to be the most common trigger, but other sounds can act as triggers as well.

Unfortunately, since misophonia is largely unknown, it has flown under the radar for a long time. Research and studies seem to be sparse. This means that little is known about origins, causes, treatment and interaction with other disorders. Since misophonia is often accompanied by symptoms of depression and anxiety, it can be difficult to discern primary symptoms from secondary ones. However, the specific feelings that exist for people with misophonia—and their often-extreme levels—make it difficult to simply chalk them up to a more general disorder. Along with the fact that these strong reactions often exist without other issues, this seems to indicate that it is not simply a symptom of another disorder.

As with most things, feelings exist on a spectrum. Most of us have felt “depressed” or “anxious.” Therefore, when we encounter someone who has clinical depression or an anxiety disorder, we think that we have some sense of what they’re feeling. Although we may not really understand the scope of it or some of the associated thoughts and feelings, to some extent we feel that we can relate. However, the sounds that so acutely affect those with misophonia are sounds that many of us barely even register. This can make it very difficult for us to wrap our heads around the extreme response.

Emotional reactions to external sounds also exist on a spectrum. Just like not everyone who has felt down should be diagnosed with depression, feeling strongly about sounds doesn’t necessarily indicate a problem. People with misophonia often describe the reaction as “fight-or-flight,” and as painful. Ostensibly, they feel a sense of pain, causing their instinctive fight-flight response to be initiated. This can cause an overt reaction that would appear to others to be completely out of proportion to the source of the trigger.

Perhaps a more common reaction can help to describe the feelings. Imagine someone scraping their fingernails on a blackboard. Or imagine chewing on aluminum foil. Now imagine that this continues on a regular basis but, instead of getting used to it, your sensitivity to it increases. How long would it take before you would feel like screaming?

Most of us have probably heard of posttraumatic stress disorder. Much research has been done in the area of PTSD, and treatment protocols formulated. To a large degree, PTSD has become a part of the general lexicon. Misphonia, however is generally unknown. It can be easier for many of us to relate to PTSD because we can identify an original cause—or more generally simply understand that there’s a reason for the strong emotional response. Most of us, however, have trouble connecting triggers for misophonia to the response. The process, however, appears to be very similar. Just as a firecracker can cause someone with PTSD to dive for shelter, loud chewing can throw a person with misophonia into a panic and rage.

Fairly obvious short-term solutions include distraction, attention redirection, and blocking of problematic sounds (as with headphones). Although some people use medication to treat misophonia, I wonder whether this simply masks the symptoms rather than helping the person to deal with them. Cognitive-behavioral therapy seems to be useful in helping people to reduce the severity of symptoms, although other forms of therapy might be as helpful—or even more so. Hopefully, in the near future more research will be done, leading to a better understanding of misophonia and to better treatment.

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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