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Misophonia

What Is It, Causes, Signs, Symptoms, and More

Author: Lily Guo

Editors: Alyssa Haag, Emily Miao, PharmD, Kelsey LaFayette, DNP

Illustrator: Jessica Reynolds, MS

Copyeditor: Stacy M. Johnson, LMSW


What is misophonia?

Misophonia refers to a decreased tolerance to certain sounds and their associated stimuli. The condition has previously been referred to as selective sound sensitivity syndrome. In 2022, clinical and scientific leaders convened to develop a consensus on the definition of misophonia, ultimately agreeing on the aforementioned definition. Due to the pronounced mental suffering of individuals, the obsessive nature of the symptoms, the use of behavioral coping strategies (e.g., avoidance), and the various psychiatric treatment options, the revised definition is meant to provide guidance for clinicians who are supporting affected individuals. 

Specific sounds that trigger a reaction include bodily sounds (e.g., lip smacking, chewing, and loud breathing), clicking sounds (e.g., typing on a keyboard, pens clicking, fingers tapping, or windshield wipers), and sounds associated with movement (e.g., fidgeting). 

Misophonia is sometimes expanded to include visual stimuli, with the image directly related to the trigger sound (e.g., watching someone else eat). It is distinct from phonophobia, also known as ligyrophobia or sonophobia, a specific phobia of loud sounds. Some individuals may even have misophonia-like reactions to repetitive visual movements (e.g., leg rocking), known as misokinesia or the hatred of movement. 

People in a group smacking their lips and chewing loudly.

What causes misophonia?

The cause of misophonia is currently unknown; however, many individuals often report that the onset of the disorder is associated with a profound disgust of hearing family members eating during childhood. This supports the theory that recurrent conditioning from the individual’s environment can lead to misophonia. 

Another theory is that misophonia is part of a general hyperreactivity syndrome to sensory stimuli, explaining why both auditory and visual stimuli can evoke a negative response. An electroencephalography (EEG) study found abnormal neuronal activation in the automatic auditory processing system within the auditory cortex in misophonia patients, which might underlie misophonia symptoms. Lastly, it is suggested that obsessive-compulsive personality disorder (OCPD) is associated with misophonia since those with OCPD can have difficulties coping with impolite eating sounds, eventually resulting in avoidance.

Misophonia is associated with activating parts of the brain, specifically the right insula, right anterior cingulate cortex, and right superior temporal cortex. The insula and anterior cingulate cortex are responsible for assigning meaning to stimuli in the environment.  Individuals with misophonia can perceive certain auditory stimuli as personal harassment, thus triggering anger. The superior temporal cortex plays a role in selective auditory attention and is especially important for processing emotionally salient sounds. In those with misophonia, audiovisual stimuli trigger anger, disgust, sadness, and physiological arousal, including activating these specific brain regions. A study using functional magnetic resonance imaging (fMRI) has suggested that the increased activation of various parts of the brain (e.g., the insula, anterior cingulate cortex, superior temporal cortex) reflects unusual importance attributed to misophonic stimuli. Therefore, someone with misophonia may atypically attach meaning to stimuli that are otherwise not harmful or meaningful.

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What are the signs and symptoms of misophonia?

The signs and symptoms of misophonia include an immediate aversive physical reaction, such as irritation, disgust, anger, and loss of self-control in response to a misophonic stimulus, which can consist of someone chewing loudly, smacking their lips, or breathing loudly. Emotional responses are also accompanied by physiological changes, such as increased heart rate, blood pressure, and body temperature.  People with misophonia have reported being verbally or physically aggressive towards objects and others. 

The intensity of the anger usually leads to a feeling of loss of self-control. Individuals are typically insightful and may acknowledge their anger as excessive and unreasonable. Notably, anxiety is not experienced as a response to stimuli. Other signs include active avoidance of misophonic stimuli, including avoiding social situations or wearing noise-canceling headsets. Individuals may experience stress and discomfort daily in anticipation of an unexpected encounter with misophonic stimuli. Individuals assigned either male or female at birth can develop misophonia at any age, although symptoms typically begin in late childhood or early teenage years.

How is misophonia diagnosed?

Although misophonia is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), the current definition and a thorough history can be used as a guide to clinical diagnosis. In addition, some questionnaires exist to help quantify the severity of misophonia, like the Amsterdam Misophonia Scale (A-MISO-S) and the Misophonia Questionnaire (MQ). Though these questionnaires have not been tested for validity and there is currently no consensus for use of a specific questionnaire in helping diagnose misophonia.

How is misophonia treated?

Misophonia does not currently have a cure; however, it can be managed through various coping strategies, which include listening to music, calming sounds, or white noise when exposed to misophonic stimuli. Additionally, individuals can try using noise-canceling headphones or asking the other individual to stop making the sounds. One can attempt to distance themselves physically from trigger sounds in public, on a bus, or at a restaurant. Additionally, individuals can try using noise-canceling headphones or asking the other individual to stop making the sounds. 

Cognitive behavioral therapy (CBT) can help change underlying thought patterns associated with misophonia. Techniques learned through CBT can include distracting mantras or affirmations. Rest, relaxation, and meditation can reduce stress. A multidisciplinary approach (i.e., consulting a primary care physician, psychologist, and audiologist) can be helpful for treatment. Audiologists can use sound therapy to neutralize triggering sounds to ensure the misophonic reaction no longer occurs. 

What are the most important facts to know about misophonia?

Misophonia refers to a decreased tolerance to certain sounds and their associated stimuli like lip smacking, noisy chewing, and loud breathing. It is thought to be caused by various factors, including negative childhood experiences, general hyper-reactivity to external stimuli, and atypical activity in the auditory processing system. The signs and symptoms of misophonia include irrational anger, irritation, and disgust directed towards the individual making the sounds, increased heart rate, and physical avoidance of the stimuli. Misophonia does not currently have formal diagnostic criteria, so diagnosis is made clinically. While there is currently no cure, treatment involves coping mechanisms, such as wearing noise-canceling headphones and playing music, as well as employing calming techniques. 

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Related links

Auditory transduction and pathways
Obsessive-compulsive disorder
Phobias

Resources for research and reference

American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: Dsm-5. 

Cavanna, A. E. & Seri, S. Misophonia: current perspectives. Neuropsychiatric disease and treatment 11, 2117–2123, https://doi.org/10.2147/NDT.S81438 (2015).

Dixon, L.J., Schadegg, M.J., Clark, H.L. et al. Public awareness of Misophonia in U.S. adults: a Population-based study. Curr Psychol (2023). https://doi.org/10.1007/s12144-022-04180-x

Edelstein, M., Brang, D., Rouw, R. & Ramachandran, V. S. Misophonia: physiological investigations and case descriptions. Frontiers in Human Neuroscience 7, 296, https://doi.org/10.3389/fnhum.2013.00296 (2013).

Guzick AG, Cervin M, Smith EEA, et al. Clinical characteristics, impairment, and psychiatric morbidity in 102 youth with misophonia. J Affect Disord. 2023;324:395-402. doi:10.1016/j.jad.2022.12.083

Kumar, S. et al. The Brain Basis for Misophonia. Current Biology 27, 527–533, https://doi.org/10.1016/j.cub.2016.12.048 (2017).

Prutsman, J., AUD (2021, April 15). Treatments for misophonia. Sound Relief Hearing Center. Retrieved May 22, 2022, from https://www.soundrelief.com/treatments-for-misophonia/ 

Schröder, A., van Wingen, G., Eijsker, N. et al. Misophonia is associated with altered brain activity in the auditory cortex and salience network. Sci Rep 9, 7542 (2019). https://doi.org/10.1038/s41598-019-44084-8

Schröder, A. et al. Diminished n1 auditory evoked potentials to oddball stimuli in misophonia patients. Frontiers in Behavioral Neuroscience 8, 123, https://doi.org/10.3389/fnbeh.2014.00123 (2014).

Schröder, A., Vulink, N., Denys, D. (2013). Misophonia: Diagnostic criteria for a new psychiatric disorder. PLoS ONE, 8(1). https://doi.org/10.1371/journal.pone.0054706 

Swedo SE, Baguley DM, Denys D, Dixon LJ, Erfanian M, Fioretti A, Jastreboff PJ, Kumar S, Rosenthal MZ, Rouw R, Schiller D, Simner J, Storch EA, Taylor S, Werff KRV, Altimus CM and Raver SM (2022) Consensus Definition of Misophonia: A Delphi Study. Front. Neurosci. 16:841816. doi: 10.3389/fnins.2022.841816

World Health Organization (1994) International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) Geneva: World Health Organization.