Misophonia is an extreme emotional reaction to certain everyday sounds that most people would find relatively easy to ignore. The three main types of sounds that disturb people with misophonia are eating, nose and throat sounds, and repetitive environmental sounds like keyboard tapping and rustling paper.

Whilst many people find these noises annoying, individuals with misophonia describe an intense feeling of disgust, anger, distress, or panic that escalates while the sound is still present. This can happen even when the sound is at a very low volume.

They report physical sensations similar to a flight or fight response, including racing heart, shortness of breath, tension, feeling hot, and sometimes an unwanted groinal response. They often describe a feeling trapped, helpless, and out of control when they can’t get away from these sounds.

An individual can be considered to have clinically significant misophonia when it causes frequent distress and has an impact on daily living, work, study and/or relationships. This might include anxious anticipation of sounds before they happen, replaying sounds after the event, feeling guilty or embarrassed about one’s own reactions, thinking a lot about the person making the sound, verbal outbursts, and avoidance of things one would otherwise like to do (for fear of encountering sounds).

They might report low mood, anxiety, sleep problems, family tensions, inability to relax in the home, and trouble focusing. At the more severe level, individuals may be unable to work or attend school, have trouble maintaining relationships, feel near constant distress, and may contemplate ending their life.

Because misophonia is not well known, people often feel isolated and struggle to get support from family, friends, and health professionals.

There are many individual differences in the experience of misophonia, demonstrating the complexity of the condition.

Some people tell us they react more strongly to sounds made by those close to them, others are more impacted by sounds made by strangers.

Some have been bothered by these sounds for as long as they can remember, others recall a particular time when their reactions to sounds got a lot worse, and some can pinpoint a particular event when their sound sensitivity suddenly developed.

While one person might react to a wide range of sounds, another might only be affected by one specific sound. Some may react in certain circumstances, but the same noise may not bother them at other times. Many individuals with misophonia also report reacting to repetitive movements (misokinesia), such as leg shaking, fidgeting or blinking lights.

Severity of misophonia is measured based on the level of distress it causes and the impact it has on an individual’s life.

This description of misophonia was written in consultation with a misophonia support group on social media.

There is some evidence that cognitive behavioural therapy (CBT) can be helpful for people with misophonia. It is likely to be especially helpful for those with more severe misophonia that significantly disrupts daily living or causes distress on most days.

We think at the core of misophonia is a variation in sensory processing, which includes heightened attention to certain sounds that could be a sign of potential contamination (e.g., illness from breathing through a blocked nose, spreading illness through spit when eating with mouth open) or a potential predator (e.g., footsteps, tapping and rustling sounds). Whilst this aspect of sensory processing might not be directly changed with therapy, there is growing evidence that therapy may be helpful for people those whose reaction feels like a flight or fight type feeling, or if they feel trapped, panicked, or helpless around sounds. In particular, therapy can help if the impact of the sound exists even when the sound is not present (e.g., taking a long time to wind down from a reaction, worrying about sounds in advance, or having lasting impacts on work or relationships). Therapy may also be helpful for those with co-existing conditions that cause misophonia to be worse (or is made worse by misophonia).

An assessment at OHSPIC will include use of standardised questionnaires to assess the severity of the problem, how it impacts on daily life, what thoughts and beliefs are associated with the problem, and an assessment of other difficulties.

The main aims of CBT for misophonia are to reduce the intensity of the sufferer’s reactions to sounds and to minimise the impact that sounds have on the person’s life. Because misophonia is influenced by the individual’s past experiences, current circumstances, beliefs and personality, there is not one set protocol for therapy.

CBT at OHSPIC includes:

• Establishing a strong, collaborative relationship between the person experiencing misophonia and the therapist.
• Using the S-Five, a questionnaire for misophonia, to understand the complexities of misophonia and to monitor progress across sessions.
• Setting goals about what the person would like to change.
• Designing experiments and testing ideas.
• Exercises to shift felt-sense beliefs that the sufferer suspects may not reflect reality.
• Strategies to better identify and understand emotions.
• Identifying possible links between current feelings and past experiences, and processing any relevant memories.
• Using imagery (and humour) to reduce the intensity of the reaction to sounds.
• Reclaiming time when there are no sounds present.
• Processing and letting go of anger.
• Developing tools for communicating with important people to gain appropriate support for sound sensitivities.
• Identifying and problem solving any other issues that might be exacerbating reactions to sounds.
• Working out suitable accommodations to minimise the impact of sounds on living a fulfilling and contended life.