Misophonia

What is misophonia?

Are there sounds that instantly cause you to feel intense anger, anxiety or disgust? Are those emotions extremely strong, even overpowering, to the point where they’re hard to control? These are features of misophonia, a disorder where you have a decreased tolerance to specific sounds and things you can sense (see, touch, etc.) related to them.

This phenomenon can affect people very differently. Some people may only have one "trigger" sound that causes this reaction. Some people can have several trigger sounds.

People can also have reactions that are more or less severe. Some people can’t control the emotions they feel but can control their responses. Some people can't control either, causing them to react impulsively. In the most severe cases, people may not be able to do certain things or be in specific environments.

Who does misophonia affect?

Research shows that misophonia can affect anyone but seems to be more common in women and people assigned female at birth (AFAB). The estimates on how it affects people based on sex vary. They range from 55% to 83% of cases happening in women and people AFAB.

Misophonia can develop at any age, but research indicates it’s most likely to develop in the early teen years. More research is necessary to determine if other factors can affect who’s most likely to develop misophonia.

How common is this condition?

Available research indicates that misophonia may affect approximately 1 in 5 people during their lifetime.

What are the symptoms of misophonia?

The symptoms of misophonia revolve around how you react to trigger sounds. The reactions all seem to fall under the natural “fight-or-flight” instincts. That means the reactions can be:

• Emotional. These are feelings you experience, and they can be intense or overwhelming. For many, these feelings escalate rapidly, as if someone stepped on your emotional gas pedal. That means irritation or annoyance can quickly turn into anger or even rage.
• Body. These are self-protective processes that kick in automatically. Most of these are similar to what happens to you in a dangerous or frightening situation.
• Behavioral. These are actions that happen in response to trigger sounds. These are usually impulse- or instinct-driven. That means you may not have full control over them. Violent reactions (toward either people or objects) are possible, but not common.

Emotional reactions can include:

• Anger.
• Anxiety.
• Disgust.
• Fear.
• Irritation.

Body reactions can include:

• Blood pressure increases.
• Chest pressure or tightness.
• Goosebumps (gooseflesh).
• Heart rate increases.
• Sweating.

Behavioral reactions can include:

• Avoiding situations where trigger sounds can happen.
• Leaving the area when a trigger sound happens.
• Verbal or vocal reactions, such as talking or yelling at who/what made the sound).
• Non-violent action to stop the sound.
• Violent action to stop the sound (rare).

The severity of the symptoms can also vary. When the symptoms are less severe, the emotional and body reactions may be all you experience. If symptoms are more severe, the effects may be so strong that you might also have a behavioral reaction.

In very severe cases, a person may react so strongly — either with words or actions — that they don’t have time to think before they behave in a way that’s upsetting to others. In those situations, it’s common for the person with misophonia to recognize and regret what they did afterward. But they may still struggle to control similar reactions in the future.

Common trigger sounds

Any sound can trigger misophonia. However, some sounds are much more likely to be triggers. Sounds on TV, the radio or other electronic devices can trigger misophonia, but the reaction may not be as intense as it would be if the source of the sound were actually close to you.

The sound types are:

What causes misophonia?

Experts don’t know what causes misophonia. However, they suspect it may be a combination of factors. Some of these suspected factors include:

• Brain structure differences.
• Other conditions.
• Family history or genetics.

Brain structure differences

Research shows that people with misophonia are more likely to have certain differences in their brain structure and activity. One of those differences is having more connections and activity in and between certain areas of your brain.

The affected brain areas control how you process sounds and manage your emotions. Hearing and emotions are part of your brain’s built-in self-protection system. That’s why you feel and learn to associate emotions like anger, disgust and fear with threatening situations.

Misophonia is much like turning on a radio left at maximum volume. The sudden intense noise makes you react instinctively to make the sound stop. Likewise, misophonia can instinctively (and mistakenly) send you into fight-or-flight mode. That leads to emotional, body and behavioral reactions and symptoms.

Other conditions

Misophonia is more likely to happen in people with certain conditions like neurodivergence, mental health conditions and hearing-related conditions or symptoms. Listed below are some examples of conditions with links to misophonia:

Neurodivergent conditions and other brain disorders

• Attention-deficit/hyperactivity disorder (ADHD).
• Autism spectrum disorder.
• Tourette syndrome.

Mental health conditions

• Major depressive disorder (MDD).
• Obsessive-compulsive disorder (OCD).
• Post-traumatic stress disorder (PTSD).
• Borderline personality disorder (BPD).

Hearing-related conditions or symptoms

• Hearing loss.
• Tinnitus.
• Hyperacusis.

Misophonia is also more common in people who have obsessive-compulsive traits, but don’t fully meet the criteria for a formal obsessive-compulsive disorder (OCD) diagnosis. Just under 24% of people with these traits also have misophonia.

Family history or genetics

There’s evidence that misophonia might be a condition that runs in families. There’s also at least one genetic mutation that experts think plays a role. However, more research is necessary to determine if these possibilities are true.

How is misophonia diagnosed?

The American Psychiatric Association doesn’t yet recognize misophonia in the fifth (and most recent) edition of the Diagnostic and Statistical Manual of Mental Disorders (often referred to as “the DSM-5®”). However, in 2022 an expert committee created a consensus definition for research, diagnosis and treatment purposes.

A healthcare provider can recognize the most common features of misophonia by asking you questions about what you experience. Based on your answers, they can tell you if you seem to have it. However, that’s not the same as a formal diagnosis.

How is misophonia treated, and is there a cure?

While misophonia isn’t an officially recognized condition, that doesn’t mean its effects are untreatable. The similarities and links between misophonia and other conditions, such as OCD or PTSD, indicate that people with this condition may benefit from various forms of mental health therapy (formally known as psychotherapy).

While mental health therapies can’t cure a condition like misophonia, they can help you with the following:

• Identifying your triggers.
• Finding ways to minimize or prevent trigger sounds.
• Developing coping strategies and techniques to avoid impulsive reactions to trigger sounds.
• Reducing your sensitivity to existing triggers.

Treatments for misophonia-related conditions, such as anxiety or OCD, may also help with misophonia symptoms. Your healthcare provider is the best person to tell you if treating related conditions can help and what treatments they recommend.

Other things that may help

Many people with sound sensitivity conditions, including misophonia, can adapt to or manage this condition using common items, technology or adaptation techniques. Some examples include:

• Earplugs or noise-canceling headphones/earbuds.
• Listening to something to keep your brain’s hearing-related processes focused on something other than listening for a trigger sound.
• Noise generator sounds (especially white, pink or brown noise sounds).

People with misophonia may also benefit from workplace accommodations. These are items your employer can provide (such as headphones) or adjustments in policy that can help you avoid misophonia triggers or reduce the effects they may cause.

Your healthcare provider may be able to provide resources to help you acquire workplace accommodations. There are also numerous online and social media groups where people with misophonia share ideas, tips and resources that might help you.

How can I prevent misophonia or reduce my risk of developing it?

Misophonia happens unpredictably and for unknown reasons. Because of that, there’s no way to prevent it or reduce your risk of developing it.

What can I expect if I have this condition?

When misophonia is mild, it may be nothing more than a minor concern. The symptoms are manageable, and while you may still feel intense emotional and body reactions, you can control your reactions and get your emotions under control quickly.

In more severe cases, the emotional and body reactions can feel overwhelming. The resulting fight-or-flight behaviors can be very hard — if not impossible — to control. You may behave without thinking because your brain is operating on self-protecting autopilot. That can cause you to lash out verbally or even physically at whoever or whatever is making the trigger sound.

Your brain is also hardwired to form and strengthen connections that might help you protect yourself. Because of this, your reaction to trigger sounds may worsen over time, and you may discover or develop a reaction to new trigger sounds.

How long does misophonia last?

Available research indicates that misophonia is a lifelong condition. However, more research is necessary before experts can confirm this.

What’s the outlook for this condition?

Misophonia isn't dangerous or life-threatening directly. However, it can negatively affect your mental health, relationships and well-being. People with misophonia often have other mental health conditions, too.

People with severe misophonia may feel fearful or anxious about the possibility of hearing trigger sounds. These feelings can sometimes be strong enough to affect your daily routine or activities. Treatment may help you learn to cope and adapt. However, more research is necessary before experts can agree on the best ways to treat this condition and what you can do to improve your quality of life if you have it.

When should I see my healthcare provider or seek care?

Misophonia may be unpleasant or annoying but often isn’t severe enough to disrupt your life. But if your symptoms are severe enough to disrupt your life (either your social or professional activities), you should talk to a healthcare provider. They can help you learn more about your condition or find a specialist who can help you.

When should I go to the ER?

People with severe misophonia, especially those with other mental health conditions, may have a higher risk of self-harming or suicidal thoughts and behaviors. If you have thoughts like this, you should get help immediately. You should also seek immediate help if you suspect someone you know is in imminent danger of harming themselves.

To get help in these situations, you can call any of the following:

• National Suicide Prevention Lifeline (United States). This line can help people who are struggling with suicidal thoughts or impulses. To call this line, dial 988.
• Local crisis lines. Mental health organizations and centers in your area may offer resources and help through crisis lines if you’re struggling with thoughts of suicide, self-harm or harming others.
• 911 (or your local emergency services number): You should call 911 (or the local emergency services number) if you feel like you (or someone you know) are in immediate danger of self-harm or suicide. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

Is misophonia a form of anxiety?

No, anxiety and misophonia are distinct from one another. However, there can be links between misophonia and anxiety, and people may have both.

A note from Cleveland Clinic

Misophonia is a phenomenon that can be troubling, and some of the sounds that trigger it are so common it might feel like you have no escape from them. While it’s not an officially recognized condition (though there’s evidence that it should be, and many experts support recognizing it), healthcare providers still recognize what it is, how it happens and how it can affect you.

While more research is necessary to develop ways to diagnose and treat it, some treatment options for related conditions may help. You can also learn ways to manage it and limit its effects on your life. That way, you can focus more on what you enjoy and worry less about hearing sounds you dislike.