Rabbi Azriel Hauptman

Misophonia, which literally means hatred of sound, is a condition where an individual is extremely sensitive to certain types of sounds. The triggering sounds are commonly related to the mouth (such as eating, lip-smacking, chewing, breathing, etc.), but can also include other sounds such as someone typing on a keyboard. The stress experienced by individuals with misophonia can be acute, and the elicited reactions range from anger to avoidance. It is not uncommon for individuals with misiphonia to leave their jobs if the sounds of their work environment are triggering.

We have all experienced a misophonia reaction at some point during our lives. Imagine if you were trying to fall asleep and the room was extremely quiet except for the seemingly loud sound of a faucet dripping incessantly. Not only will you possibly have an extremely hard time falling asleep, you also might be tempted to take a hammer and smash the sink! People with misophonia experience these kinds of reactions on a daily basis.

If we break down sounds into three categories, it will help us grasp this disorder more clearly. There are sounds that are universally disturbing, such as a baby crying or someone screaming. There are sounds that are more or less universally neutral, such as the sound of rain. Then there are sounds that can be a little unpleasant at times, such as someone chewing loudly or breathing heavily in a quiet room. Studies have shown that individuals with misophonia seem to have the same reaction as everyone else regarding sounds that are universally disturbing or universally neutral, but can have very powerful reactions in response to sounds that are at times mildly unpleasant for everyone.

Furthermore, the context of the sound can have a significant effect on the reaction. It is common for sounds of complete strangers to be much less triggering than that same exact sound being produced by an immediate family member. There are individuals who feel like they are going to go crazy from something as innocuous as a family dinner.

This phenomenon makes sense if we conceptualize this disorder as a misfiring of the fight-or-flight system. When something feels threatening to us, our bodies switch into a fight-or-flight mode that leads to a high heartrate, feelings of agitation, and many other symptoms. The brain’s way of determining what is a danger regarding the fight-or-flight reaction is often completely different from what our conscious minds consider a threat. For this reason, people who are very close to us who make disturbing sounds seems more threatening to our subconscious mind than sounds emanating from other people.

There is no specific treatment modality that has been shown to be effective as a stand-alone treatment of misophonia. For this reason, a collection of different strategies is often needed to manage the condition. Cognitive-behavioral therapy (CBT) has shown some promise is some reduction of symptoms. This makes sense in light of the fact that misophonia has a component that is based on our brain’s perception. CBT strategies that focus on anger management and emotional arousal can also be helpful. Many individuals with misophonia manage their condition with strategies such as white noise and headphones. With a combination of coping strategies, emotional techniques, and noise management, individuals with misophonia can manage their condition to the degree that they would not need to engage in avoidance strategies, which can be detrimental to one’s social and family life and to one’s employment.

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