That Thinking Feeling

Psychology's answers to everyday questions, in blog form!

What is misophonia?

Did you know that there’s a word for the emotion you experience when you hear fingernails down a blackboard? It’s called grima, which is a Spanish word that there’s no direct translation for in English, essentially a kind of strong disgust that is mostly generated in response to hearing high-pitched squeaking noises or touching a surface with the fingernails [i]. I feel grima when my fingernails or teeth encounter frosted glass. Now you know my kryptonite!

However, there are some noises that many people don’t find particularly bothersome, but some people really, really do: things like slurping, chewing and repetitive tapping. People who hate these specific noises to the extent that they cause negative emotional reactions like annoyance, rage and overwhelm that cause difficulties in everyday life have misophonia [ii].

 
 
Glass of smoothie with straw

Glass of smoothie with straw

 

Get ready to hear some slurpingggggg.

 

Back in 2001, in the first ever publication about misophonia, Jastreboff and Jastreboff [iii] helpfully described what it is and isn’t: it’s not being highly sensitive to all noises, which is called hyperacusis. It’s also distinct from phonophobia, the fear of certain sounds, as misophonic reactions to sounds are about dislike, annoyance and anger rather than fear – though sometimes the people who take part in misophonia studies have reported anxiety as a response too [iv]. Misophonia can happen to anyone who can hear, including people who have a hearing impairment.

Before we go any further, I want to say that I am NOT a psychiatrist or any other kind of mental health professional, and it looks like misophonia is on its way to being classified as a psychiatric condition. What I’ve written below should not be taken as medical advice; it’s just a summary of the research relating to the condition. If you think you have misophonia and you want some help, please see a medical professional.

Okay, let’s go!

 

Who gets misophonia?

Among American undergraduates, around 1 in 5 people who filled out a questionnaire about misophonia had ‘clinically significant’ symptoms [v] – in plain English, that means that their misophonia was bad enough to cause difficulties in their everyday lives, like having to leave a room where someone is making a misophonic noise, or having to cover their ears to shut it out. American undergrads make up quite a large percentage of the people who take part in psychology studies, but they’re only a tiny percentage of the world’s population, so we need to be careful about generalising from this – but if the 1 in 5 figure is true for everyone, that’s a lot of people who have misophonia.

 
 
Person with hands over their ears

Person with hands over their ears

 

Looks like we might have found someone with misophonia!

 

The same study showed that that people with high scores on the misophonia questionnaire were also more likely to show symptoms of obsessive-compulsive disorder (OCD), anxiety and depression. Similarly, among people being treated for several types of mental illness as outpatients at a psychiatric hospital in Singapore, higher levels of anxiety (but not depression, this time) were linked to more severe misophonia [vi]. Another study showed that people with post-traumatic stress disorder (PTSD) tended to have more severe misophonia than people without PTSD [vii].

It’s not really clear how misophonia is linked to mental illnesses and neurological conditions. As far as researchers can tell, though, misophonia isn’t a symptom of something else: it’s probably a condition in its own right [viii]. For example, it’s not the same thing as post-traumatic stress disorder, because it can happen without any trauma. It’s also not obsessive-compulsive disorder, because people with misophonia don’t usually have compulsive behaviours like checking or cleaning, and nor is it autism, which can involve being very sensitive to noises - but largely those which are unexpected or loud.

One possibility is that misophonia is a type of synaesthesia [iv], a harmless neurological condition in which the senses get tangled up with each other or with other aspects of thought, so that numbers have colours, words have tastes, or music has texture. In the case of misophonia, it seems feasible that sounds could have become tangled up with emotions. Supporting this idea, there is evidence that people who have misophonia are more likely to have some types of synaesthesia than people without misophonia [vii].

You might also be thinking that misophonia sounds like the opposite of ASMR, another harmless neurological condition that causes a pleasant tingly feeling when hearing certain sounds. They do seem to be related, but in fact people who have ASMR are more likely to have misophonia than others [ix]. Unfortunately, you can’t cancel out misophonia feelings by creating ASMR feelings [vii]. Instead, there are both positive and negative emotions in response to the different sounds.

 

What’s happening when someone experiences misophonia?

Quite a lot of things! Physically speaking [iv], hearing a sound that triggers misophonia typically causes a feeling of ‘pressure’ in the chest, arms, head or even the whole body, perhaps because of tense or clenched muscles. It can also cause you to get a bit more sweaty, which researchers measure by seeing how well your skin can conduct electricity (I am not making this up, weird though it sounds).


An aside about sweat and emotion

We often get sweaty when we're nervous - for example, when we're near someone we have a crush on or are about to go into a job interview. But we actually get a little bit sweaty when we experience almost any emotion because the sympathetic nervous system, which deals with fight-or-flight responses, starts getting us ready to take an action in response to that emotion, and part of that getting ready is firing up the sweat glands.

We don't necessarily get sweaty enough that we or anyone else notices, but enough that our skin gets a little bit better at conducting electricity because sweat brings ions (charged particles) to the surface of the skin.

Because our skin's sweatiness and therefore ability to conduct electricity can also be affected by things like exercise and temperature, this isn't a perfect measure of emotion. However, researchers can use it to get a bit of an insight about the extent to which someone is experiencing emotion.

 
Close-up on a person with a sweaty face

Close-up on a person with a sweaty face


If we zoom in on the brains of people with misophonia, we get some further insights. It seems likely that there are more connections between the auditory cortex (deals with sound perception) and the limbic system (deals with emotion) than there are in most people [iii]. There also seems to be more activity than you’d usually expect in the anterior insular cortex [x], which deals with emotion and the integration of sensory input. Some researchers [ii] have a theory that people with misophonia have unusual brain activity during sensory gating, the brain’s process for regulating how sensitive it is to sensory input in order to prevent being overwhelmed – this also fits with the finding that people who have misophonia are generally sensitive to sensory input.

Why are these strengthened connections and activations there? Well, it’s possible that people with misophonia initially hear a noise and at the same time feel a negative emotion; over time the connection between the two grows as the brain really loves creating associations between things that happen simultaneously, so any time you hear the noise you feel the emotion [xi]. Eventually the bit of the brain that deals with the emotional response to the noise will get activated if there’s even a hint that the bit of the brain that deals with the sound is becoming active. New triggers for misophonia might develop over time through much the same process, when a previously-fine sound happens close in time to an existing trigger sound [xii]

 

How can misophonia be treated?

Reminder: I am not a medical doctor or a mental health professional, and this is just a summary of what the research says about treating misophonia as of 2019. Please seek advice from someone who is if you think you have misophonia and want some help.

There aren’t many studies out there on how to treat misophonia, but I’ll go over what we do know.

In 2015, the usual treatment for misophonia was a common therapy used for tinnitus, called tinnitus retraining therapy or TRT [xiii]. (Tinnitus is the fancy word for hearing a sound like buzzing or ringing in your ears without an external cause.) TRT involves training people to understand what’s causing the tinnitus, then helping them to get used to the noises. It can be helpful for tinnitus, but because tinnitus is usually caused by hearing loss and misophonia is not, TRT for misophonia could well be treating the symptoms rather than the cause. Instead, it might be more helpful to try methods of changing or accepting the emotional response to the noise, like various forms of talking therapy [xiv], helping people become more resilient to stress, and working on developing compassion towards the source of the noise (usually another person).

We’re still a long way from knowing what we need to know about misophonia to treat it effectively, though. Awareness-raising will certainly help, especially for children, because their misophonia responses might be interpreted as unreasonable emotional outbursts rather than something with an identifiable cause [xii]. We also need to know more about why some sounds cause misophonia and others don’t. Most of all, we need randomised controlled trials, which will help us figure out exactly what treatments work and what don’t.

 

If you enjoyed this blog, you might also like my earlier post What is ASMR?

 

References

[i] Gallo, I. S., Fernández-Dols, J. M., Gollwitzer, P. M., & Keil, A. (2017). Grima: A distinct emotion concept? Frontiers in Psychology8, 131.

[ii] Brout, J. J., Edelstein, M., Erfanian, M., Mannino, M., Miller, L. J., Rouw, R., ... & Rosenthal, M. Z. (2018). Investigating misophonia: A review of the empirical literature, clinical implications, and a research agenda. Frontiers in Neuroscience12, 36.

[iii] Jastreboff, M. M., & Jastreboff, P. J. (2001). Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia. ITHS NewsLetter2, 5-7.

[iv] Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: physiological investigations and case descriptions. Frontiers in Human Neuroscience7, 296.

[v] Wu, M. S., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2014). Misophonia: incidence, phenomenology, and clinical correlates in an undergraduate student sample. Journal of Clinical Psychology70(10), 994-1007.

[vi] Quek, T., Ho, C., Choo, C., Nguyen, L., Tran, B., & Ho, R. (2018). Misophonia in Singaporean psychiatric patients: a cross-sectional study. International Journal of Environmental Research and Public Health15(7), 1410.

[vii] Rouw, R., & Erfanian, M. (2018). A large‐scale study of misophonia. Journal of Clinical Psychology74(3), 453-479.

[viii] Schröder, A., Vulink, N., & Denys, D. (2013). Misophonia: diagnostic criteria for a new psychiatric disorder. PLoS One8(1), e54706.

[ix] Janik McErlean, A. B., & Banissy, M. J. (2018). Increased misophonia in self-reported Autonomous Sensory Meridian Response. PeerJ6, e5351.

[x] Kumar, S., Tansley-Hancock, O., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., ... & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology27(4), 527-533.

[xi] Palumbo, D. B., Alsalman, O., De Ridder, D., Song, J. J., & Vanneste, S. (2018). Misophonia and potential underlying mechanisms: A perspective. Frontiers in Psychology9, 953.

[xii] Dozier, T. H. (2015). Etiology, composition, development and maintenance of misophonia: A conditioned aversive reflex disorder. Psychological Thought, 8(1), 114-129.

[xiii] Schneider, R. L., & Arch, J. J. (2015). Letter to the editor: potential treatment targets for misophonia. General Hospital Psychiatry37, 370-371.

[xiv] Altınöz, A. E., Ünal, N. E., & Altınöz, Ş. T. (2018). The effectiveness of Cognitive Behavioral Psychotherapy in misophonia: A case report. Turkish Journal of Clinical Psychiatry21, 414-417.