Misophonia: Symptoms, Causes, and Treatment

By Meredith Hettler, LMFT, National Director, OCD and Anxiety Programs

Most of us have a sound or two that we really don’t like—sounds that send a chill up your spine, give you the “ick,” or just outright annoy you. Maybe it’s nails on a chalkboard. Or gum chewing, slurping, or snoring. But for people with misophonia, certain sounds aren’t just irritating—they can elicit intense feelings of anger and distress. 

Misophonia is a real diagnosis that can have devastating effects when left untreated. It can ruin relationships, lead to isolation and avoidance, and ultimately take a massive toll on a person’s ability to function and live life to the fullest.

Key Takeaways

• Misophonia is the common name for Selective Sound Sensitivity Syndrome, a disorder that causes a strong emotional responsive to specific sounds.
• Because the symptoms of misophonia resemble those of other sensory or mental health disorders, it is often misdiagnosed.
• Symptoms of misophonia include physiological, emotional, cognitive, and behavioral reactions.
• Lifestyle changes and treatment approaches can help people with misophonia reduce distress and function in the world more easily. 

What Causes Misophonia?

The cause of misophonia is not fully understood. However, what we do know is that it is likely a brain-based disorder. More specifically, researchers theorize that misophonia is caused by a disruption in the parts of the brain responsible for processing sound stimulation and the fight-or-flight response. 

In addition, misophonia may be connected to a specific genetic mutation, as it’s more common in those who have a family history of the disorder. And people with tinnitus and hearing loss are also more likely to develop misophonia. 

Conditions Similar to Misophonia

Misophonia is often misdiagnosed as anxiety, sensory processing disorder, psychosis, or other disorders. Therefore, people who suspect they have misophonia should seek the support of a medical or mental health professional who is familiar with the diagnosis and treatment of the disorder.

What seems like misophonia could be another condition that manifests in a similar way, such as:

• Phonophobia: a fear of sounds, such as fireworks, balloons popping, or dogs barking
• Hyperacusis: sensitivity to sound
• Sensory Processing Disorder: sensitivities to multiple facets of sensory input

While there are similarities in all these diagnoses, they are all treated differently. 

Common Misophonia Triggers

Some of the common categories of sound that can trigger misophonia symptoms in people with 4S include:

• Eating and drinking noises: chewing, crunching, slurping, gulping, smacking lips
• Breathing/mouth noises: snoring, sniffling, heavy breathing, throat clearing, coughing
• Activity noises: Tapping finger or toes on a surface, clicking a pen, typing loudly, using utensils, paper or plastic rustling
• Noises made by inanimate objects: Ticking clock, toilet flushing, water dripping, bell ringing

Symptoms of Misophonia

Misophonia symptoms fall into four main categories: physiological, emotional, cognitive, and behavioral. Physical symptoms are typically connected to strong emotional reactions, and lead to cognitive and behavioral issues. 

Physiological

• Muscle tension
• Tightness in the chest
• Racing heart
• Headache
• Goosebumps
• Sweating
• Digestive problems or butterflies in the stomach

Emotional

• Anxiety
• Feeling of needing to escape
• Anger
• Disgust
• Panic

Cognitive

• Difficulty concentrating
• Blaming oneself or others for misophonia-related distress

Behavioral

• Taking nonviolent or violent action to stop the sound, such as smashing a clock or other object
• Avoiding certain places where bothersome sounds may occur
• Abruptly leaving an environment or situation when triggered by sounds
• Aggression, such as yelling at the person making the sound

The Links Between Misophonia, OCD, and Other Mental Health Conditions

A number of different mental health conditions are linked to misophonia, including obsessive-compulsive disorder (OCD). In one study of university students, 40 percent of participants with misophonia also had OCD. Misophonia is also more common in people who have some obsessive-compulsive traits, but don’t fully meet the criteria for an OCD diagnosis. 

In addition, people with misophonia may also have anxiety and/or depression. In the same study, 9 percent of the misophonia suffers had anxiety and 10 percent had depression. Research has also shown that the condition is more common in people with autism spectrum disorder, ADHD, PTSD, and borderline personality disorder.

Furthermore, recent research shows that people with misophonia report higher stress levels. But it’s unclear whether stress contributes to the likelihood of developing misophonia, or if it’s a result of the difficulties associated with the condition. 

How to Cope with Misophonia

Lifestyle changes can be helpful in reducing the symptoms and frequency of episodes. Here are some ways to cope with misophonia:

• Seek treatment: Because misophonia can impact your life and well-being, support from medical and/or mental health professionals can make a huge positive different in your everyday functioning. Look for a medical or mental health professional, such as a psychologist, psychiatrist, or audiologist, who can make an accurate diagnosis and recommend treatment options. One place to start is the Misophonia Research Fund’s list of community resources.
• Know your triggers: Recognize what sets off your symptoms. This may include becoming more attuned to the physical symptoms that precede your emotional or behavioral reactions.
• Make a plan for dealing with potential triggers: For example, have noise-canceling headphones or earbuds available. In addition, choose locations that are less likely to have triggering noises—like selecting a table away from the kitchen or bathroom when you’re in a restaurant. You can also create playlists or access noise generators that produce white, pink, or brown noise.
• Build healthy coping skills: Deep breathing, relaxation exercises, or simply distracting yourself by engaging in an enjoyable conversation or activity can all be helpful in reducing the intensity of misophonia symptoms.

Treatment for Misophonia

Typically, misophonia requires a multifaceted treatment approach. Treatment should recognize the physical responses people with misophonia experience, as well as the cognitive, emotional and social issues that result from these triggers. While research continues to identify the best treatment for misophonia, below are some options that have proven to yield positive effects.

Progressive Muscle Relaxation

Progressive muscle relaxation (PMR) is a relaxation technique that involves tensing and then releasing muscle groups throughout the body. Hence, people with 4S can practice identifying their physical responses to misophonic triggers, both before and after being triggered. Using PMR regularly can reduce the intensity of both the emotional and the physical reactions.

Cognitive Behavioral Therapy 

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment modality that has high success rates in treating a variety of mental health conditions, including anxiety, depression, phobias, and substance use disorders. CBT helps clients identify unhealthy thinking patterns that are increasing or exacerbating negative mental health symptoms and behaviors. When used to treat this condition, CBT guides people with the disorder to create different meanings around their thoughts or feelings related to their triggers. However, CBT does not eliminate the triggers or the physical responses to triggers. 

Neural Repatterning Technique

Developed in 2013, Neural Repatterning Technique (NRT) pairs low-level triggers with a pleasant experience, as a way to reduce the physical response to the misophonic trigger. The physical response is what triggers the emotional reaction. Therefore, reducing the physical trigger can reduce or eliminate the emotional response. 

Other potentially effective treatments include Acceptance and Commitment Therapy, medication, and Tinnitus Retraining Therapy (TRT).

Does Newport Institute Treat Misophonia?

Newport does not treat 4S, but we do treat mental health conditions associated with the condition, including OCD, anxiety, depression, and PTSD. Our whole-person approach addresses every aspect of a young adult’s experience—emotions, relationships, life skills, career goals, and more.

Using in-depth assessments, our clinical team develops a tailored treatment plan for each client, including modalities including CBT, Acceptance and Commitment Therapy to build motivation for change, and Attachment-Based Family Therapy to repair parent-child relationships. Our OCD treatment utilizes Exposure and Response Prevention (ERP) therapy to create long-lasting positive change.

Contact us today to set up an assessment and get recommendations for next steps in the healing journey.  

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