Misophonia: when everyday sounds make you furious

Misophonia reactions depend on the specific sound and its meaning, not on how loud it is.

Hyperacusis, tinnitus and hearing loss are hearing-related conditions that can occur alongside misophonia, but they are different. An audiologist can help tell them apart.

Many people with misophonia feel guilty or ashamed about their reactions, especially toward people they love. The reactions are fast and hard to control.

• Chewing, especially with an open mouth
• Crunching
• Lip smacking
• Loud swallowing
• Slurping

• Heavy or loud breathing
• Nose blowing
• Sniffling
• Snoring
• Throat clearing and coughing

• Clicking a pen
• Loud typing
• Tapping fingers or toes
• Ticking clocks
• Utensils scraping plates

Misokinesia is a strong negative reaction to seeing small, repetitive movements like fidgeting. About a third of people in one study reported some degree of it. It often, but not always, comes with misophonia.

Reactions include anger, disgust, anxiety, fear and irritation. They can escalate quickly. Irritation is the most common reaction, while loud chewing often brings disgust.

• Faster heart rate and higher blood pressure
• Chest tightness
• Sweating or goosebumps
• Leaving the room or avoiding situations
• Snapping at people or trying to stop the sound

Violent actions are rare.

A 2021 brain imaging study found that trigger sounds strongly activated a brain area that controls mouth and face movements in people with misophonia. The researchers suggest the brain may over-mirror the actions of the person making the sound.

In that study, the hearing area of the brain responded to trigger sounds the same way in people with and without misophonia. The difference was in how it connected to other areas.

Duke Health describes misophonia as a newly recognized condition without a formal medical diagnosis yet. Expect understanding to grow over the coming years.

Some estimates suggest misophonia is more common in women. A large UK study found no difference in how common it was between men and women, though women reported stronger emotions.

In the UK study, people with misophonia were a few years younger on average than those without it.

• ADHD, autism or Tourette syndrome
• Anxiety, depression, OCD or PTSD
• Hearing loss, tinnitus or hyperacusis
• Obsessive-compulsive traits

What to say

• “This isn’t about you. My brain reacts to certain sounds, and I’m working on it.”
• “Could we play music during dinner?”
• “If I leave the room, it’s to stay calm, not to be rude.”
• “Can we agree on a signal for when I need a break?”

What helps

• Believe them; it’s real
• Agree on a few small changes together
• Don’t make the sound on purpose or tease them
• Remember their reaction is to the sound, not to you

Try to avoid

• “Just ignore it.”
• “You’re being dramatic.”
• “I can’t help how I eat!” (in the heat of the moment)

• Background music or noise at meals
• Some meals eaten separately, without guilt
• Headphones allowed at certain times
• A calm-down space
• A code word for “I need a break”

soQuiet, a U.S. nonprofit, has free resources for families, including printable explanation cards.

• A seat away from common triggers
• Earplugs or noise-reducing headphones during quiet work
• Testing in a separate, quieter room
• Permission to step out briefly
• Eating lunch somewhere quieter

Under Section 504, public schools must provide supports to students whose disability substantially limits a major life activity. Ask the school about a 504 evaluation if misophonia is affecting learning.

soQuiet offers school accommodation resources and resources for teens.

• A quiet or private workspace
• Noise-canceling headsets
• White noise machines or noise-absorbing panels
• A desk away from high-traffic areas
• Scheduled uninterrupted work time

• Flexible schedule or modified breaks
• Working from home some or all of the time
• Written agendas before meetings
• Using chat or email instead of some meetings

JAN gives free, confidential guidance on workplace accommodations and the Americans with Disabilities Act. You can contact them at askjan.org before talking to your employer.

What to say

• “I have a condition that makes certain sounds very hard for me. A quieter desk or headphones would help me focus.”
• “Could I work from home on days with lots of meetings?”

• Earplugs
• Noise-canceling headphones or earbuds
• White, pink or brown noise
• Music, a podcast or a fan

• Choose seats away from likely triggers
• Bring headphones to meals, trips and waiting rooms
• Plan a polite way to step out
• Schedule recovery time after hard events

1. Notice: “That’s a trigger. My body is reacting.”
2. Breathe out slowly, longer than you breathe in.
3. Relax your jaw and shoulders.
4. Shift your attention to another sound or to your feet on the floor.
5. Step away if you need to.

Some avoidance is healthy. But therapy for misophonia often works on patterns like avoidance and constantly scanning for sounds, because these can keep the problem going.

Online support groups can offer shared tips and less isolation. soQuiet runs free peer support groups.

In a 2020 trial with 54 adults, 37% of those who had three months of weekly group CBT improved a lot, compared with none on a waiting list. Benefits lasted a year. More research is needed.

The Duke Center for Misophonia and Emotion Regulation evaluates adults and offers research, education and treatment recommendations. Duke Health mainly uses a tailored form of CBT that targets avoidance, hypervigilance and unhelpful thinking.

Depending on needs, people may see an audiologist (who may use sound generators), an occupational therapist (for sensory therapy) or a neurologist to rule out other causes.

If you also live with anxiety, OCD or another condition, treating it may also help misophonia symptoms. Talk with your clinical provider about options.

soQuiet runs a directory of professionals who work with misophonia (misophoniaproviders.com). The Duke center also shares resources for people with misophonia and their loved ones.

Questions to ask

• “How many people with misophonia have you worked with?”
• “What approach do you use, and what does research say about it?”
• “How will we measure progress?”
• “Do you offer telehealth?”