“While many of us may find the sounds of chewing or breathing off-putting for some they're unbearable.”
Multiple chemical sensitivity is something a functional medicine practitioner has likely encountered numerous times. Whether it’s due to impaired detoxification processes nutrient deficiencies or some other reason something interferes with an individual’s ability to respond properly to environmental agents such that bus fumes cigarette smoke perfume and cologne and other strong scents can quickly trigger nausea dizziness and other unpleasant reactions. For some of these patients getting too close to the candle store at the local mall is asking for a migraine headache. But what about sounds? Are there individuals who hyper-react to certain sounds?
Indeed the phenomenon known as misophonia or “selective sound sensitivity syndrome is a preoccupation with or aversion to certain types of sounds that evokes feelings of irritability disgust or anger.” According to Paul Dion an occupational therapist who created the website misophonia.com: “This disorder is not caused by a hearing impairment and is not the same as hyperacusis which is an over-sensitivity to the volume of sounds. Misophonia elicits excessively negative and immediate emotional and physiological responses.”
Misophonia might not be a household word but it’s a common enough issue to have been the subject of at least two entries in the Well blog of the New York Times (here and here) and articles from The Washington Post and Time magazine.
To be clear the reactions of individuals with misophonia to their “trigger sounds” go far beyond mere irritation and annoyance. They may become extremely angry and agitated nearly to the point of violence with their sympathetic nervous system in overdrive. And to be clear about those triggers people with misophonia are not sensitive to all sounds. There’s a relatively small list of common culprits with room for individual variation.
As Mr. Dion explains:
“The literal definition of misophonia is hatred of sound but a person with misophonia does not simply hate all sound. People with misophonia have specific symptoms and triggers and are sensitive to only certain sounds (and occasionally to visual triggers). Any sound can become a problem to a person with misophonia but most are some kind of background noise. People call the collection of sounds that they’re sensitive to their trigger set. It is possible to add to one’s trigger set over time.
Exposure to a trigger sound elicits an immediate negative emotional response from a person with sound sensitivities. The response can range from moderate discomfort to acute annoyance or go all the way up to full-fledged rage and panic. Fight or flight reactions can occur. While experiencing a trigger event a person may become agitated defensive or offensive distance themselves from the trigger or possibly act out in some manner.”
Many of the sounds affected individuals find excruciating would be deemed benign by others—the kinds of background noise an unaffected individual might not even notice.
Examples include:
You can see that individuals with misophonia might have an especially difficult time in the workplace particularly if they work in close quarters with others or in a cubicle environment where many of the above sounds would be unavoidable. (The sounds associated with eating are especially common triggers—so much so that one paper refers to misophonia as “mastication rage.”)
The level of debilitation affected people experience is not easy for those unaffected to appreciate. Mr. Dion explained it well: “A person with misophonia is sometimes told to ‘just try to ignore that sound’ or ‘you’re just being difficult’ or ‘don’t let it get to you.’ Suggestions like these are not helpful. And people with misophonia often say that if they could simply choose to ignore their triggers they would have made that choice a long time ago.” Indeed telling someone with misophonia to ignore their trigger sounds is about as helpful as telling someone with depression to just cheer up or suggesting that someone with anxiety simply learn to calm down.
There are no effective therapies for misophonia with the possible exception of cognitive behavioral therapy. So what are the unfortunate afflicted individuals to do? “Deal with it?” That might be the only option available right now but a recent discovery regarding the possible cause of this phenomenon might lead to helpful interventions in the future. If there’s an actual physiological or structural cause for this hyper-sensitivity to trigger sounds then strategies to target this may hold promise.
According to researchers from the UK’s Newcastle University in their paper “The Brain Basis for Misophonia” in Current Biology functional MRI testing showed that compared to non-affected individuals upon exposure to trigger sounds misophonic subjects experience “greatly exaggerated blood-oxygen-level-dependent (BOLD) responses in the anterior insular cortex (AIC) a core hub of the ‘salience network’ that is critical for perception of interoceptive signals and emotion processing.” Additionally brain structural measurements of misophonic individuals showed greater myelination within the ventromedial prefrontal cortex. Researchers concluded that “misophonia is a disorder in which abnormal salience is attributed to particular sounds based on the abnormal activation and functional connectivity of AIC.”
We may not know what to do about this yet but at least now those afflicted with misophonia can rest assured it’s most definitely not “all in their head” (well it is but not in the way that sounds!) and they’re not exaggerating their response in an attempt to get attention. This might be welcome news considering other researchers have called for classifying misophonia as a psychiatric disorder and have written that it may be a symptom of some other condition such as obsessive-compulsive disorder generalized anxiety disorder or schizotypal personality disorder.
Obviously much remains to be discovered about misophonia but patients who happen to mention this seemingly odd occurrence in the clinical setting should be informed that if nothing else they’re not alone.
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