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What is Misophonia?

Hate Eating Noises?

It’s dinner time, and you start getting anxious because your spouse has decided to cook wings. You start wondering, will I be able to handle this? Will I need to excuse myself from the table? Will I give him death stares and say something mean? Will he start licking his fingers, chewing the meat off the bone? Will the sauce get all over his face?

I’ll just eat in the other room.

The term misophonia was coined by Marsha Johnson, an audiologist, in 1990. She was the first to name this seemingly rare and odd problem: people reacting with extreme negative emotions and reactions when faced with eating and breathing sounds. Her work quickly (as quick as things went in 1990) took off, brewing support groups across the US and Canada. They shared their struggles, triumphs, triggers and stories.

In 2000, two researchers, Jastreboff and Jastreboff, wrote the first peer reviewed paper on misophonia. They accidentally fell upon people with misophonia while working with people who had tinnitus and hyperacusis; two disorders that seem audiological in nature, but start to tread into the psychological realm. People with hyperacusis perceive sounds are louder than the objective decibel level the sound actually is. People with tinnitus report a constant humming or ringing in their ears. In order to account for their symptoms, these audiologists theorized it was their perception and appraisal of sound (or lack of sound, in the case of tinnitus) that resulted in the symptoms.

While studying these patients, they found some reacted differently to sounds. Some of their patients did not perceive sounds as louder than they “were”, but they had intense negative emotional reactions to certain sounds: ones that involved eating noises, breathing sounds, and repetitive sounds/movements.

 

What is Misophonia?

Misophonia is characterized by intense negative emotional reactions to sounds. People who have misophonia react with anger, disgust, and rage when they hear or see certain triggers. Trigger sounds are different for each person, and tend to be worse when they are done by certain family members or very close friends. People are also triggered by visual stimuli: such as observing someone chew food or watch them breath heavily.

Sounds include food noises such as:

    • Slurping
    • Crunching
    • Smacking
    • Swallowing
    • Talking with food in their mouth

Noises made during a meal:

    • The sound of cutlery on the plates
    • Glasses clinking

Sounds of people drinking:

    • Sipping
    • Slurping
    • Breathing after a drink
    • Saying “ah” after a drinking

Other mouth sounds:

    • Popping
    • Kissing sounds
    • Brushing teeth
    • Flossing

Sounds associated with food/drink:

    • Opening a bag of chips
    • Putting a cup down
    • Crinkling noise of bottle

Breathing sounds:

    • Sighing
    • Sniffling

Sounds exhausting, doesn’t it? Every person with misophonia has a different set of triggers. As well, these sounds can be triggering in one environment and have virtually no intense emotional reaction in another. You may not be able to handle your mother eating a bowl of soup: but have no problem with your friend’s slurping noises.

 

Psychiatric? Audiological? Neurodevelopmental? Where does Misophonia Fit?

The research is unclear. Some specialists think it’s a conditioned reflex that starts in childhood and builds over time. They posit children hear a certain sound and during that time, their body is stressed or anxious. Just like Pavlov’s conditioning paradigms, this neutral sound gets associated with a body sensation, like tension in the neck. Tension and anxiety in the body tends to signal to the brain “Danger! Pay attention!”

Tension → Danger! → What is going on? → Scan the environment

 

The brain is really good at associations: So in this case, it scans for what was happening and discovers, Ah! That sound! Ok, let’s remember that, that sound is no good, it made us tense.

So as this child moves through life, this sound starts to elicit and negative emotional reaction: anger, rage, disgust.

In the current literature, we are not sure if misophonia is audiological in nature, neurodevelopmental, psychological, psychiatric, or neurological. But regardless, people with misophonia have common suffering.

People with misophonia report that they can spend hours a day thinking about or coping with triggers. This can lead to significant impairments in their daily functioning. People with misophonia also avoid triggers: they may avoid eating around certain people, they may eat alone, they might isolate themselves from friends and family.

Meal time becomes challenging: there might be intense anxiety surrounding meals from all members. Is the person going to get angry? People may start to try to deliberately make less noise, but this does not always help the misophonic individual, because slowing down might be just as worse. Families may start to play loud music during dinner, eat quickly. Individuals may start wearing headphones or earplugs in an attempt to block out eating noises.

The problem is: when earplugs and music is listened to, the misophonic individual tends to devote their attention to trying to hear the sounds. It’s almost as if the sounds need to be heard.

The problem is: avoidance and adding all these extras makes life more complicated. Relying on safety and avoidance becomes isolating.

 

How Can We Get Better?

There are few randomized controlled trials about treatment options. Randomized control trials are considered the best studies in order to figure out if one treatment works better than a control group. In the few studies that exist, cognitive-behavioural therapy (CBT) has been shown to have a good effect on reducing people’s symptoms, helping them function better, decreasing their avoidance and changing their overall mood and anxiety.

In misophonia, the more you are exposed to a certain sound, the more likely it is that it will become more bothersome. In most anxiety disorders, the goal is to expose people to their triggers and have them learn it is not dangerous. In misophonia, the more you are exposed to a trigger, the worse you will feel. This is why over time, people decrease their interactions with trigger sounds (and therefore, people). Without knowing it, they are protecting themselves for further conditioning of new triggers.

In general, people present for therapy for misophonia in their 30s. By this time, they have probably been experiencing misophonia since childhood and have a variety of triggers, problems, and impairment.

The first thing I do in therapy is to explore the immediate and intense emotion or physical sensation. People with misophonia feel anger, or sometimes like a tingling sensation on their skin. In session, we may bring up an image of the last time a person’s misophonia was triggered, and explore the person’s physical reaction. Did their muscles tense? Do they shrug their shoulders, squint close their eyes? People tend to have a conditioned reflex that has developed. When this initial reaction comes up, the mind reacts with thoughts. These thoughts, which tend to be negative, further increase a person’s negative emotions or cause physical sensations in the body.

One way to help is to view the misophonic response as conditioned, then counter-condition the “reflex” by listening to the triggering sounds, in a positive context. So they may watch a video that brings them joy, and play a triggering noise every minute. Over time, the trigger stops producing a negative reaction.

On top of counter-conditioning, I take a cognitive approach by addressing thoughts and avoidance. Clients track and log their triggers, how they reacted, and how they want to react in the future. For example, instead of focusing on people eating, they learn to disengage their focus from eating to other aspects of the family meal. This exercise of focusing out can be helpful to remind the client that noises are not the only thing present.

Misophonia is a relatively newly named condition, but it’s likely that people from the beginning of time have been angered and frustrated by eating and breathing noises. Although most of us would find eating noises uncomfortable, people with misophonia have a reaction that feels uncontrollable and unpredictable.

If you or someone you know is experiencing misophobia, reach out to CMAP Health to learn more and get help. 

 

About the Author

Victoria Howarth is one of our qualifying registered psychotherapists {RP (Q)} and a therapist under supervision at CMAP Health. She has a Master’s Degree in Counselling Psychology at Yorkville University and a Master’s Certificate in Addictions and Mental Health from Durham College. She has experience coaching and counselling adults with substance use disorders with an emphasis on harm reduction. To find out more about Victoria you can view her profile.

 

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