Sounds Like Misophonia: How to Stop Small Noises from Causing Extreme Reactions

PART

Your Misophonia

CHAPTER 1

If you loved me, you’d breathe quietly

One of life’s greatest mysteries to me is how popcorn became the staple snack of the cinema. How did this happen? This is an environment where silence is paramount to the immersive experience and some genius decided to introduce a snack that is unconscionably loud, in defiance of its innocent puffy appearance. They then added salt to the popcorn – and to the wound – making it an even more compulsive treat than it was already. Don’t get me wrong, I love popcorn. I just can’t stand to hear you eating it.

Hello, I’m Jane and I have misophonia. You might recognise me. I was the one in the quiet carriage on the train this morning, glaring at that guy playing videos on speakerphone. You might have noticed me crying in the exam hall at school because someone insisted on bringing their noisiest pencil and sharpening it between every single one of the 300 multiple choice questions. I’m the person at your office who keeps removing the batteries from all the ticking clocks, even if I only use the room for five minutes. You may have stumbled across my Spotify playlist ‘Songs to drown out the sound of your family chewing’. Or, if you’re my husband, you might remember me from such romantic moments as the time I turned to you during the season one finale of The Good Place and asked, ‘Have you always breathed this loudly?’

LEARN THE LINGO: MISOPHONIA

Misophonia is a decreased tolerance to certain sounds (not to sound in general), such as loud chewing, heavy breathing, tapping and rustling sounds. It was named over 20 years ago by husband-and-wife research team Drs Margaret and Pawel Jastreboff. With the help of a linguist, they selected the Greek mis- (hate) and phon- (sound), but they have said that they did not intend for hatred to be taken literally. Pawel Jastreboff also said that the decision was influenced by, adorably, a love of miso soup.

Misophonia has also been known as Selective Sound Sensitivity Syndrome (4S), which was coined in the 1990s by audiologist Dr Marsha Johnson, who wanted a term to capture the pattern of decreased tolerance to eating sounds she had seen in several of her clients.

As for the pronunciation: I say miss-o-phonia, but I’ve heard others say mee-so, mee-zo, mizz-o and my-so. There’s no official consensus on this. So, for now at least, go with whatever rolls off your tongue the best.

After I discovered what misophonia was, I spent a good year reading all the research I could find and pondering why no psychologists were trying to solve this problem for me. Then I remembered that I, too, am a psychologist. I could be solving this problem for myself. I began experimenting with therapy techniques on myself and, when it started helping, I realised that maybe I should be trying to solve this problem for other people as well.

We started to offer therapy for clients with misophonia at the specialist NHS (National Health Service) psychology service where I was working in London and very quickly learned that there was definitely not a one-size-fits-all solution to misophonia. We’d all had our own unique set of experiences and that meant misophonia was unique to each of us. If I was going to be able to help others as well as myself, I had a lot to learn.

‘ My father would eat like an animal and then he would do awful, disgusting sounds with his teeth. I would ask him to stop and he would yell at me and do it on purpose, which made things worse.’ André, 38, podcast producer

Nerdy detour

HOW COMMON IS MISOPHONIA?

Nearly one in five people could be affected by misophonia in the UK and US. This statistic includes what we call ‘subclinical’ misophonia, which is when someone has intense reactions to certain sounds, but where it doesn’t cause daily distress or disrupt their life. When they counted both clinical and subclinical misophonia, researchers at King’s College London found that 18 per cent of a UK general population sample were likely to have misophonia, similar to the 17 per cent found in a US general population sample by researchers at Vanderbilt University. We don't know yet how many people have misophonia at a ‘clinical’ level, to the extent that their day-to-day life and mental health are significantly impacted.

These studies found that misophonia was slightly more prevalent in younger participants. This could mean that symptoms change over time, or that people find more ways of managing it as they get older. There were no major differences between men and women in the UK study, while the US study found that there were more women than men with misophonia.

Misophonia might be relatively common, but it is still not well-known. In the UK study, only 14 per cent of participants knew the term misophonia. In a study from the University of Mississippi, only 11 per cent of a US general population sample recognised the term misophonia. You are not alone, but it might feel that way.

For the last four years, I have been researching misophonia and helping clients with misophonia at NHS clinics in London and now Oxford. I am researching common themes in the misophonic experience and experimenting with what might help to improve things for me. I mean you. This is definitely not a vanity project.

LEARN THE LINGO: ME-SEARCH

Me-search is research done by someone who has a special interest in the topic because they are personally affected by the phenomenon they are studying. Some people use it to discredit the objectivity of research, but the joke’s on them, because me-searchers are often viewed as more trustworthy and credible by the communities their work is aimed towards. The misophonia research world is full of me-searchers, because for a long time there was so little funding available that it was mostly those of us with a vested interest who were working on it.

This book brings together the best of what I have learned about misophonia. Using techniques from cognitive behavioural therapy (CBT), I will help you make sense of your unique patterns of reacting to sounds. I will help you to understand your reactions better so that you feel less burdened by them, to test out techniques to make your reactions less explosive and out of control, and to try new strategies to get on with life in this noisy world. And, importantly, I will show you that you’re not alone. Every example and exercise in this book is here because someone else has been through it or tried it.

LEARN THE LINGO: COGNITIVE BEHAVIOURAL THERAPY (CBT)

Cognitive Behavioural Therapy is a group of therapies based on the idea that our cognitions (thoughts, beliefs, images, or a felt sense in your body of what’s happening), behaviour (things we do, both voluntary and involuntary), emotions and physical sensations are all interlinked. It usually involves working with a therapist (or book) to come up with theories about what is keeping a particular problem going (Part 1 of this book) and then testing those theories by trying things differently. This can involve processing uncomfortable memories by talking through, writing about or visualising those events (Part 2 in this book), looking at the situation from new angles and experimenting to find out what makes the most sense (Part 3), trying out new things to see if it affects how you feel (Parts 4 and 5) and developing tools for dealing with things the way they are (Parts 5 and 6).

I share a lot of my own experiences and how I have come to make sense of my own misophonia. I’m well aware that what I’ve been through will not be the same as what you’ve been through, but I hope you can connect with some moments. You will also hear from Adeel Ahmad, host of the Misophonia Podcast, who talks about his misophonia and what it was like for him to test out some of the exercises in the book. He also gathered case stories from the intrepid volunteers who road tested these techniques and agreed to share their journeys.

It would be professionally irresponsible to diagnose you from afar, even more so from the page. But if you’ve ever whipped your head around to see who’s daring to rustle a packet of M&Ms at the theatre, this book might be for you.

Is it misophonia or are you just grumpy?

‘In the last decade, the worst one has been my neighbours’ dogs barking. They bark a lot of the time and it has been really getting to me. I tried to reach out but it ended up in conflict with a neighbour.’ Kyle, 44, artist and art teacher

Twenty years after the Jastreboffs first published the term misophonia, a panel of experts (including one of the Jastreboffs) went through an in-depth process to come to an agreement about how to define misophonia, based on their current understanding of the research.

The ‘Consensus Definition of Misophonia’ (2022) called misophonia a disorder of decreased tolerance to certain sounds. It said that triggers which are pattern-based or have a certain meaning to the person (not necessarily a conscious meaning) cause a negative emotional, physical or behavioural reaction, with the reaction often influenced by the context. It may include coping strategies and can cause distress and impairment.

Let’s break down that definition into its parts: the disorder, the triggers, the reaction, the meaning, the coping strategies and the impact. I’ll describe these parts of the definition in more detail so that you can see whether and how each one might apply to you.

Is this really a disorder?

I’m conflicted about the use of the term ‘disorder’ to define misophonia. The panel argued that the term encapsulates how awful the experience can be for someone with misophonia and calling it a disorder could help with professional recognition of the problem for the purposes of furthering research, developing treatment and covering the cost of care. I agree that all of these are important. I know there are many individuals out there, including clients with misophonia at our treatment clinic in Oxford, whose misophonia causes so much suffering and impairment that it would fit with the concept of a disorder.

There are others who feel relief and hope knowing there is a term to describe the impact sounds have on their lives, without necessarily feeling like it is a disorder for them. Having a word to describe your experience can be incredibly validating, but less so if you don’t entirely relate to the disorder term that comes with it. Readers of early drafts of this book had mixed opinions. Some felt that classifying it as a disorder might alienate those who could feel validated to know they have misophonia but who think they don’t ‘suffer enough’ to have a disorder. Others thought that the word misophonia should only be used when the phenomenon is severe enough to be considered a disorder. If the current social media debates over the use of the phrase ‘I’m so OCD’ is anything to go by, we may well be deliberating on these ideas for decades to come.

We don’t need to decide today and, for the purposes of this book, it doesn’t really matter. Nothing described in this book is inherently wrong or bad or broken or disordered. You are the only person who can decide whether something is a problem for you. If it is, and you decide you want to try to change it, great! If you read this book and decide you’re happy with how things are, or it’s not worth changing, or it’s not the right time to do anything different, also great! I’m here to break it down in a way that helps you figure that out and to offer up ideas if you want them.

Which types of sounds can become misophonia triggers?

Some sounds are meant to demand our attention. A human scream and a lion’s roar have a quality called roughness, which makes them almost impossible to ignore. Thank goodness. Some human-made sounds are created specifically to have the same effect, like sirens, alarms and Janice from Friends. These are all sounds that are universally unpleasant to listen to, by design.

The sounds that trigger those of us with misophonia are not so easy to define. The most common trigger sounds seem to be related to eating, loud breathing, and other nasal sounds and repetitive sounds like keyboards and mobile phones. They include sounds that most people would find annoying as well as sounds that most people wouldn’t even notice.

CHECKING IN

Which of these types of sounds do you find particularly annoying?

• Eating sounds (loud chewing, smacking lips)

• Drinking sounds (gulping and slurping)

• Nose and throat sounds (loud breathing, sniffing, throat clearing)

• Environmental sounds (typing, pens clicking, muffled neighbour sounds, cutlery on plates)

• Speech patterns (certain consonants, like an S or a K sound, or repeated words like ‘um’)

Ultimately, you get to decide whether a sound is a trigger for you. You might find that one particular sound bothers you in some situations but not others. There might be someone in your life who will trigger you no matter what sound they are making and you don’t even notice when others make the exact same sounds. I haven’t included a detailed list of potential trigger sounds anywhere in the book, because some people find that when they hear about others’ triggers, they start listening out for those sounds.

Nerdy detour

WHAT DOES THE RESEARCH SAY ABOUT MISOPHONIA TRIGGERS?

There is some debate among researchers about which sounds need to be involved to constitute having misophonia. Most researchers agree that the volume of the sounds is not a key feature in making a sound a trigger (although you could argue that volume certainly doesn’t help the situation).

The classic sounds that tend to be mentioned in every article on misophonia are eating and loud breathing. In a study by Dr Inge Jager and colleagues at the University of Amsterdam, they found that all of their participants were triggered by sounds from either the mouth or nose, or both. They suggested that if there were no mouth or nose sounds as triggers, then maybe it shouldn’t be considered misophonia. Another study, by Dr Heather Hansen and colleagues from the Ohio State University, used machine learning (a type of artificial intelligence that helps researchers to make predictions about how likely something is) to see whether we could predict if someone had misophonia or not based on their triggers. They found that it was easier to predict the presence of misophonia if you looked at oral and nasal sounds, as well as other repetitive human-made sounds (think pen clicking, not the other kinds of noises our bodies are capable of) and environmental sounds (like a ticking clock), and suggesting we should consider all kinds of triggers, not just sounds from the mouth and nose.

A different research team, with whip-smart minds and fabulous hair (the research team I collaborate with at King’s College London, no bias), found that when you use fancy maths, trigger sounds cluster together in three main groups:

• eating sounds

• nose and throat sounds

• environmental sounds (e.g. keyboards, mobile phones, dogs barking)

This means that if you are triggered by one sound in a group, like heavy breathing from the nose and throat category, it’s likely that you’ll also be triggered by other sounds from that group, like sniffing and throat clearing. Some of us react to sounds from all three groups, while others react mostly to sounds from one group. We don’t know whether they cluster together in a group because there are similarities in the way they sound (like both chewing and lip smacking sounding ‘wet’), or if it’s because there are similarities in our thoughts about the sounds in each group (like believing that all eating sounds are bad manners unless being made by my cat, who can do no wrong).

LEARN THE LINGO: MISOKINESIA

Strong reactions to repetitive movements (e.g. fidgeting, blinking lights, leg shaking) can also happen. The phenomenon gets its own name, misokinesia (from the Greek roots mis-, hate, and kine-, movement). It’s another surprisingly common experience that no one seems to know much about. However, if you are triggered by a movement that reminds your brain of annoying sounds, like seeing someone chewing through a window when you can’t actually hear them, or seeing someone type on a quiet keyboard (when ordinary keyboards would be a trigger sound), then it might be part of your misophonia rather than a separate problem with repetitive movement.

What makes it a ‘misophonic’ reaction?

‘It’s very hard for me to concentrate on anything else. The annoyance is at the forefront of my brain.’ Yale, 51, software developer and father of two

Most people are bothered by the sound of loud chewing. But in misophonia you might have a ‘fight-or-flight’ type response, which is the technical term for that feeling you get when you run away because you’re afraid you might slap that cup of tea out of your slurping flatmate’s hand.

LEARN THE LINGO: FIGHT-FLIGHT-FREEZE-FAWN RESPONSE

When your brain detects you might be in danger, it can send you into survival mode. A surge of adrenaline can speed up your breathing and heart rate, getting your body ready to defend yourself against the danger (fight) or run away from it (flight). Survival mode can also involve slowing down, holding physically still or detaching yourself mentally (freeze), especially when it seems that there is no way out of the situation. Another defence mechanism is to try to calm down the attacker by being nice or lightening the mood with a joke (fawn). Once you have hit survival mode, there’s not much access to the rational part of your brain (which works too slowly to be much help when there’s imminent danger), so your reactions are likely to be automatic and not feel within your control. In therapy, we don’t typically expect you to change what you do in survival mode (although you can rehearse new survival responses in high-stakes drills, like in pilot training). Instead, we focus more on reducing the chances you will get to survival mode and help you cope with the aftermath if you do get to that level.

The emotional experience of misophonia is more complex than just the immediate reaction to trigger sounds. You might notice pre-emptive nervousness when you think a sound might be about to happen. You could have strong feelings towards the person making the sound that are about more than the sound itself. Maybe you have feelings about yourself and the way you react. There might also be feelings about your future and what you imagine will be the impact of this on your life. There are no rules about how you should feel with misophonia. What you feel is real and valid, even if you think it makes no sense at all.

Nerdy detour

ISN’T EVERYONE BOTHERED BY THE SOUND OF LOUD EATING?

In a UK general population study at King’s College London by Dr Silia Vitoratou and colleagues (including yours truly), 85 per cent of people said they had a negative reaction to the sound of loud, open-mouth chewing. So, statistically speaking at least, it’s true that most people don’t like the sound of loud eating.

But when asked about what specific emotion they had in reaction to loud eating and gum chewing, the majority of those in the UK general population study said they felt irritation or disgust. When the same question was posed to a large group of folks with self-identified misophonia, they were more likely to say they felt anger or panic. And when a person with misophonia has a disgust reaction to loud chewing, it tends to be more intense than in those without misophonia.

The study also asked about several different emotional reactions and counted the number of sounds that each person said caused them that particular emotion. They found that the higher number of sounds you said caused irritation (as opposed to other emotions), the lower the overall misophonia severity. As your score goes up in misophonia severity, you will likely say more sounds cause anger, panic or distress (rather than irritation).

This suggests that irritation is a fairly typical response to annoying sounds and maybe not a good indicator of misophonia, in the UK at least. So, the possible reactions to a tea-slurping flatmate are actually fight, flight, freeze or tut (that’s tsk, for our North American readers). While it may be a part of your misophonia (and is definitely part of mine), irritation alone may not be a reliable sign that someone has misophonia.

‘Everything was too loud, both the triggers and the yelling. I felt panicky and anxious. This was a daily thing.’ André

CHECKING IN

Are any of these emotions part of your experience with sounds?

(This is by no means an exhaustive list. For more emotion words, see the Epic Emotion List.)

• Anxiety

• Panic

• Disgust

• Distress

• Irritation

• Anger

• Frustration

• Resentment

• Embarrassment

• Humiliation

• Guilt

• Helplessness

• Sadness

• Isolation

• Shame

• Overwhelm

These emotions can have a huge range of physical sensations that go along with them. You might also find that you have a physical reaction that doesn’t seem connected to any particular emotion.

CHECKING IN

What physical sensations do you notice in relation to misophonia?

• Heart racing

• Fast breathing

• Feeling hot or flushed

• Tension

• Nausea

• Heaviness

• Queasiness

• Light-headedness

More than just emotions: what is the meaning of the sounds and your reactions in the moment?

‘It can feel like the sounds are deliberate and attention-seeking and that the other person is disrespectful. But I also know that my reaction is unhealthy and I worry I will snap one day.’ Christina, 31, fashion photographer

With all those emotions swirling around, it’s not surprising that your mind might come up with some theories about what is going on. Your theories include what it feels like is happening (your interpretation) and what it feels like it means that this is happening.

When my husband eats with his mouth open, it feels like he can’t be bothered to use good manners in that moment. If he can’t be bothered to use good manners, then that means he doesn’t respect me, which in turn means we are in a steady decline towards an inevitable divorce. Afterwards, I notice he has a blocked nose and then it feels like my contempt towards him was obvious and that means I’m selfish and uncaring, which in turn means we are in a steady decline towards an inevitable divorce. Again.

Your theories are of course highly individual and nuanced. You may have theories about why the sound is happening and what it means about the person making the sound. You may also have theories about why you are reacting this way, what it means about you that you are reacting that way, and what that means about what could happen.

Some of your theories might come fully formed as verbal thoughts in your mind, but often they will come from a feeling in your body, a felt sense that something is true, even when you know logically it’s not. You might find you have conflicting theories, feeling like it is 100 per cent the other person’s fault that you are reacting this way, while simultaneously believing you are a crazy person who is too sensitive and controlling and shouldn’t be allowed in polite company. Or impolite company, as the case may be.

‘I know it can be an irrational train of thought. Most likely they do not even realise how they sound or how often they do it.’ Christina

CHECKING IN

Do any of these types of theories sometimes feel true to you?

• It feels like there is something wrong with me and my reactions

• It feels like there is something wrong with people who make these kinds of sounds around me

• It feels like something awful might happen because of the way I react to sounds

• It feels like I will be judged or isolated because of the way I react to sounds

• It feels like it will be overwhelming and I won’t cope if I can’t get away from sounds

Avoidance and coping strategies

We have already seen that the internal experience of misophonia can be a pretty wild ride. How do you cope with all of that? This is an area of misophonia that has not been very well researched, so we don’t yet really understand the full range of behaviours that might be used in misophonia, nor how helpful these strategies are.

There are some themes in the types of strategies you might use if you have misophonia: things you do to minimise having to hear certain sounds, attempts to control your reactions to sounds, ways of letting others know that they are causing a problem, behaviours that are a retaliation to a feeling of violation, and strategies intended to try to process or solve the bigger problem of having misophonia.

CHECKING IN

Do you use any of these types of strategies?

• Avoiding, blocking or masking sounds

• Controlling or hiding my reactions

• Glaring at people or telling them off

• Asking people to change their behaviour

• Shouting or aggression

• Planning carefully in advance

• Thinking a lot about the problem

Impact and limitations of misophonia

Some of you might be able to relate to everything you’ve read in this chapter so far and still get to this section and think it’s not such a big deal. If the problem doesn’t affect you or your life too much, is it really a problem? But for a lot of you reading this, your mood, well-being and day-to-day life might be heavily affected by misophonia. There are several ways misophonia can impact your life.

CHECKING IN

Which of these areas of your life are affected by the way you react to certain sounds?

• Mood/anxiety

• Concentration

• Relationships

• Feeling bad about myself

• Work/study

• Missing out on things

• Unable to relax

• Fatigue

Do you think you have misophonia?

• I don’t think I have misophonia.

Sounds don’t particularly affect me. Even when they are really annoying, I might not like it but I can deal with it.

• I have misophonic tendencies.

I could relate to a lot of what was said here but it doesn’t have a huge impact on my life and I don’t feel bad about it.

• I think I have mild misophonia.

I have times when sounds cause a problem for me and there are some things I’d like to change if I can.

• I’m sure I have misophonia.

The way I react to sounds has a big impact on me and causes a lot of distress if I don’t take action to prevent it. I will continue to struggle if I don’t make some changes.

Chapter reflection

Which features of misophonia resonated with you? Was there anything about this chapter that you found particularly interesting? Has anything changed for you while reading this chapter?

Where to next?

In this chapter, we looked at how misophonia is more complex than it appears on the surface. We started to think about your unique experience of misophonia and the impact it has on your life. Next up, in Chapter 2, I will be talking about how there is no simple explanation for why misophonia exists. I will describe some potential contributing factors, including your genes, brain, early experiences and learning.

If you’re not so interested in the possible origins of misophonia, you might decide to skip ahead to Chapter 3, where I talk about what keeps the problem going and you will be thinking about areas for change.

CHAPTER 2

Meerkats and zombies: Some thoughts on why you react to sounds

Imagine you are a meerkat. You are standing on guard and the survival of your meerkat crew depends on you being able to detect the slightest hint of danger while the