I am Heather Hansen, OSU-trained cognitive psychology researcher and doctoral candidate studying why people react so negatively to certain sounds (Misophonia). AMA!

Hi Heather, a couple of questions as my brother struggles with misophonia.

1. Is misophonia a learned disorder, as in is it something one develops through experience maybe as a child? Or is it something that's hardwired into people? Or both?

2. Are there strategies to help those with misophonia overcome their intense reactions to certain sounds? Exposure therapy perhaps?

Thank you!

Great questions!

1. There's not enough evidence currently to answer this question, but I'll speculate. While some researchers have proposed that associative learning is the mechanism by which misophonic triggers develop, I personally think there's more to the story. I'm not an expert in learning, but if that were the case it seems like everyone with misophonia should be able to point back to that moment in childhood where they had a negative association with chewing gum or clicking a pen, for example, and I know I certainly can't do that with (m)any of my triggers. Instead, I've seen in my own work that there are indeed "hardwired" neural differences in people with misophonia, at least as adults. Whether those differences exist from childhood and lead to misophonia or whether misophonia leads to those brain differences is still unknown currently. I'd love to do some longitudinal studies (following kids into adulthood) to better answer this question.
2. Disclaimer: I'm not a clinical psychologist, so take all this with a grain of salt. While exposure therapy might be helpful with certain phobias, I don't see its utility with misophonia, since misophonia is less of a "fear" to sounds and more of an "aversion/anger" toward sounds. In fact, I think a few case studies have tried exposure therapy and seen limited effects. There hasn't been a ton of research on treatments, but a few trials or case studies have reported benefit from cognitive behavioral therapy in their samples. Whether that's a treatment that works for everyone or whether the effects last long-term is still unknown.

Thanks, Heather! As a fellow doctoral candidate, I wish you all the best on your writing and research!

You as well! :)

So, in short, there's currently no viable treatment options? My partner has to leave the room and gets angry when they hear chewing they deem to be too loud

There are currently no misophonia treatment options backed by research, no.

Your partner may find relief from treating the symptoms of misophonia (e.g., asking their doctor about medication to cope with anger/anxiety/stress/etc.), but any misophonia "treatments" you see are typically case studies or not replicated/backed by controlled research, so take them with a grain of salt.

Why is it I freak out when my wife eats a chip but not when my dogs crunch their food? My misophponia seems to only be triggered by humans.

This is a common experience, but interestingly one that I absolutely do not share. Some people report not feeling triggered by animals or babies, because "they don't know any better!" Whereas you can tell your wife about misophonia and their chip-eating might feel like a betrayal or intentional annoyance, your dog can't internalize that it bothers you. I think this experience helps to demonstrate that there's a social/contextual component to the condition, rather than just a pure auditory aversion.

Hi Heather,

I personally hate the sound of styrofoam. When I hear it, it makes me chill and shiver. I hate to be around it.

Why would that be? On a biological level, why would my body hate that sound as it's a human invented item. I understand loud noises or something similar scaring us or making us alert but this really baffles me.

I honestly have no idea. I actually use that exact point when I give talks on misophonia -- like sure, loud/rough sounds like nails on a chalkboard or screaming could have evolutionary benefits, but why am I bothered by these other particular sounds?! Maybe the lack of direct evolutionary benefit could be what distinguishes misophonic triggers from other sound sensitivities? Idk. But I think about this a lot.

Is there a link between autism and misophonia?

This is a great question, but unfortunately the jury is still out. I think that's partially because up until recently, there hasn't been a solid consensus on how to define or assess misophonia, so its relationship with other disorders might look different depending on how you conceptualize what misophonia is.

Recently though, this work has come out demonstrating that about 35% of adults with Autism Spectrum Disorder also met criteria for "clinically significant misophonia" using a newly proposed diagnostic scale. I hope to see more validation/replication of this in the future.

Hello! This is something I identify with, with regards to chewing sounds. It's pretty awful, but I've learned to create physical distance between myself and others when eating, and my fiance knows there are boundaries when we eat.

My question is - are there correlation(s) between misophonia and other mental disabilities/conditions? i.e. depression, anxiety, etc.

Hi! Sorry you've had an awful experience with chewing sounds, but I'm glad you're learning to cope.

That's a great question, but as I answered in another spot, unfortunately I think the jury is still out as far as correlations with other psychiatric conditions goes. There needs to be more research targeting that specific question, and I have hopes there will be in the future. I can say that in my own work I still get significant misophonia discomfort that's independent from the person's experience of depression, anxiety, OCD, and stress...but I'm not trained as a clinical psychologist and that doesn't mean no relation exists.

How common is it to have misphonia to the sound of your mother-in-law's voice? (or any specific voice, really)

I'm asking seriously; there's no sound that grates on me quite like my mother-in-law's voice.

This made me giggle, but I also fully understand the seriousness of this question.

I don't think this is uncommon. Voices and/or specific speech patterns (e.g., /s/, /k/, /t/ sounds, etc.) are often triggers for people. And misophonia triggers often feel worse when done by "close others" -- your mom, sister, roommate, etc. -- often people you can't immediately escape or whom you have to interact with frequently.

I’m curious if there is a correlation between misophonia and ADHD? I found working in an office to be a miserable experience mostly due to the sounds my desk neighbor would make (sighing, gulping, chewing, popping knuckles) that I would feel intense anger or physically repulsed. I’d listen to very loud music to block out the noise to retain focus, but this probably isn’t the best solution!

Any thoughts or guidance would be appreciated!

I do not know of any research showing a correlation between misophonia and ADHD -- but there's not a ton of controlled research on comorbid conditions in general. So, hopefully that changes soon.

But also I fully relate to your office struggles. Working remotely during the pandemic was a life saver for me, for that reason. Can you ask your manager for a private/more secluded space to work? If not, headphones/white noise have been my go-to office distractors. Or, if you've got a decent relationship with your desk neighbor, have a conversation about misophonia and see if they're willing to eat elsewhere, for instance. I find that a lot of bothersome sounds (e.g., popping knuckles) are things people do absent-mindedly, and drawing their attention to it helps them consciously reduce the behavior.

What is the best way to manage those triggers? I struggle so much not getting angry whenever I hear foot step sounds. I get anxious even anticipating my upstair neighbour’s foot steps.

Oh man, the million-dollar-question. I'm not a therapist/clinician, so you might want to get advice about reducing anxiety from a professional. But I can offer anecdotal things that have helped me.

I think the biggest quality of life improvement for me has been telling people about misophonia. I mentioned this in another comment, but a lot of times triggers are made unintentionally by the trigger person. Like, unless you and your upstairs neighbor have a toxic relationship, chances are they're not purposely trying to trigger you. So maybe you say "hey neighbor, here's a thing I struggle with, can you give me a head's up when you have people over so I can leave the apartment?" or maybe "can you wear softer shoes in the house" or "can I interest you in rugs for your apartment to help dampen the sound?" (As I type that those examples sound awkward, but hopefully you get my point.) Otherwise, I've found some solace with adding pillows/rugs/soft material all around my apartment to aid with sound dampening. Or just the classic headphones and loud music as a last resort.

How can I support my partner who struggles sound sensitivities? Is misophonia a general term for sound sensitivity, or are there specific traits that make it from distinct from other sound disorders?

Ooh these are great questions. I'll address them in reverse order.

Misophonia is distinct from other sound disorders in a few ways. It's commonly compared to things like hyperacusis (sensitivity to loud sounds) or tinnitus (ringing in the ears), but I think there's compelling evidence that misophonia is not solely a "hearing" disorder, as trigger sounds vary in frequency and loudness and social context. Misophonia is sensitivity to specific sounds (i.e., not all auditory input), or sounds that occur in specific contexts (e.g., your mom chewing food but not a stranger chewing food), or even visual representations of those sound triggers without the auditory component (e.g., watching someone chew through a window).

Secondly, you rock for trying to support your partner with this. Genuinely just understanding and acceptance that this is a thing they experience and struggle with is huge. Practically, my partner and I have logistically made a few changes that make coinhabiting easier to manage -- for instance, we've swapped out our computer mice for silent mice and added padding and a rug on the wall of our office to help with sound baffling of typing noises. We also listen to a show or music whenever food is being consumed. But I think in general, just having an open and non-judgmental dialogue with your partner so they feel like they can communicate to you when something isn't working and you can both work towards a reasonable solution is the best thing.

Piggybacking on this, I am the aforementioned partner and if anyone's interested these are the mouse and Keyboard I use below. They're far from noiseless, but they're a good in-between.

We tried a bunch of different mice and keyboards, and settled on these (also, we're not in any way sponsored or paid by these companies, we just like these ones), but we'd also love to hear about other good quiet products!

For general use on my main computer I use a wired [MOJO Pro Performance Silent Gaming Mouse - Wired Gaming Mouse] since it's relatively quiet but also has a lot of buttons for gaming. Around the house more generally we use [Emopeak Silent Wireless Mouse, E2Pro-Max Optical Mice] since they are VERY quiet and they're wireless.

For a general use keyboard (I work from home and my job involves a lot of typing) I use a [Corsair Gaming K55 RGB]. I wouldn't say that it's very quiet, but it's less klick-klacky than most typical keyboards, and I think the action still feels good. It's a bit of a compromise between quiet and good to type on for a long time.

Finally, here are some pictures of the wall we built, it's made out of a mattress topper to muffle sound between our workstations in our home office and just sits on a big desk between us. https://imgur.com/a/k0ukwd4

Appreciate you <3

What is the strangest trigger you’ve seen in someone?

I have been mulling over this ever since you posted it, and I don't immediately have a good answer. Maybe because there's such a wide variety of sounds that trigger people, so any one sound doesn't feel strange to me anymore?

I'll keep thinking and come back to this...

Super interesting work! Thanks for offering to answer questions.

My questions:

Is there any link between misophonia and auditory processing disorder? If so (or perhaps just tangentially), do people with misophonia ever benefit from long-term use of selective range hearing aids, like how low-gain heading aids seem to help people with APD?

Thanks for asking questions! These are great.

I don't know of a relationship between misophonia and auditory processing disorders, but that's an area of ongoing research. The hearing aid idea is super interesting and one that a collaborator of mine is working towards -- while I think it's still a ways from being on the market, you can find a bit about her project here.

Do you feel that it is the combination of the sound with knowing what it is? For instance, I hate chewing sounds. Hate. If I hear a clicking that I think is chewing I start to get that rage feeling. But if I realize it’s actually the clicking of the ceiling fan, my anger suddenly goes away! Even though it’s the exact same sound! This happens sometimes if I’m on the phone with someone I think is chewing but realize they’re tapping a pen or something. Once I know it’s not chewing, it’s better. It makes no sense.

Yes, yes! Being able to identify the sound absolutely plays a role. If you're interested, a colleague of mine just published this research showing that exact phenomenon, and I've seen that finding in my own research, too.

This experience also assists in demonstrating that misophonia is more of a higher-level social/cognitive condition rather than a hearing disorder, since the same acoustic input can elicit different reactions depending on how you perceive it. So fascinating! Some researchers have suggested this reappraisal process be used as a coping mechanism -- so if you hear someone chewing, tell your brain it's the ceiling fan!

I am not sure I have misophonia, or simply an association developed early in life, but when I hear someone talking about themselves while smacking their lips, it makes me very angry as it comes off as extreme conceitedness. Is this misophonia?

So like, it could be. But also, it might just be a general annoyance with conceitedness.

I'd ask yourself some questions -- Does smacking lips bother you when the person isn't talking about themselves? Do you feel like the sound aversion impairs you in anyway (like, do you avoid situations because of it, or has it altered relationships), or is it mostly manageable day to day? If it doesn't impair you and is specific to conceited conversations, I wouldn't describe it as misophonia.

I've had decent relief of mine with hearing aids set up for only tinnitus relief (just white noise), but only to the extent that it bought me time to get away from my triggers before fight or flight kicks off.

Are there any "for sure" symptom relief methods out there?

I know this is a super disappointing reply, but as far as I know, there aren't any "for sure" symptom relief methods for misophonia specifically. Just like with all psychiatric conditions, some treatments (i.e., medications) work for some people and don't for others. That's just the nature of things, unfortunately.

But if you're looking for specific symptom relief, you might consider describing your symptoms (e.g., anxiety, anger) to a doctor and seeing if there might be a medication to reduce how you experience the symptom. Your hearing aid strategy is inventive though, and I'm glad it helps delay/prevent the fight or flight response!

Are there animal models that look similar to human reactions? I know you can play predator sounds to primates and they get agitated, and iirc, they don't even have to have been socialized to be afraid of the sounds.

Edit: Followup, are there examples of culturally distinct sounds, or possibly sounds prevalent in certain environments.

Oh man, this is a super cool question. I haven't seen a single study of misophonia in an animal model yet, but there's a plethora of questions that could be explored. For instance, if some primates are likewise bothered by certain noises, there may be evidence for an evolutionary role. You can also use more targeted methods in primates, like single-cell recording (via implanted electrodes in the brain) to measure things like mirror neurons (which was a recently proposed hypothesis). Or, you could test the associative learning idea and see if you could "give" an animal misophonia by pairing an otherwise neutral sound with a negative consequence (and then "extinguish" that learned relationship, if possible).

And to your follow-up, culture is an interesting component. Studies have shown that misophonia also exists in cultures where chewing with your mouth open is the norm, for instance. But you could imagine an individual's triggers would necessarily be influenced by the environment they're in -- just speculating, but a person in a rural area might be more bothered by crickets chirping or footsteps in mud than a person living in the city, for instance.

To what extent do you see therapeutic success from reframing or other cognitive strategies? If those strategies work, does it mean it wasn't 'real' misophonia to begin with?

Hmm, good question. I personally don't work as a therapist, so I don't have client evidence of certain strategies working or not. Anecdotally for me, I think reframing/cognitive strategies are helpful -- what might start as "Wow this person is so rude, they are intentionally trying to eat like a cow to bother me" could become "This person just had dental work done and is having trouble chewing, it has nothing to do with who they are as a person". Giving triggers "situational" explanations rather than "dispositional" explanations make them feel less like personal attacks/betrayals, which can sort of help reduce the negative reaction.

To your second question, I don't think treatment success invalidates someone's experience of the condition. Like, if someone had cancer and successful chemotherapy that removed the cancer, that doesn't mean they didn't have "real" cancer to begin with. I think psychotherapy approaches should be thought of in the same way.

What are the most common triggers?

Can misophonia be developed akin to PTSD?

Commonly, people report sounds from the mouth and nose (i.e., oral/nasal sounds) as being triggering. For example, sounds like chewing, breathing, slurping, smacking lips, sniffling.... you get the point. However, I'm a huge advocate that misophonia is more than just an aversion to oral/nasal sounds, so things like pen-clicking, water dripping, typing, etc. too.

Although the developmental origins of misophonia haven't been well studied, I speculate that misophonia wouldn't develop akin to PTSD. PTSD inherently requires a traumatic event, whereas misophonia does not. There may be some overlap in symptoms, but my guess is they have separate origins.

Your work is fantastic! I’ve noticed my partner has difficulties similar to misphonia. Is there a link between misphonia and ADHD?

Aww, thanks!

I answered this somewhere else, but unfortunately I don't know of any research showing a link between misophonia and ADHD. That doesn't mean there isn't one necessarily, but more research needs to specifically look at that relationship before definitive conclusions can be made.

What are your sound triggers?

Oh, so many. I've got the oral/nasally triggers (e.g., chewing, slurping, sniffling, throat clearing, etc.). And also workplace/office triggers (e.g., typing, mouse clicking, clock ticking). But I feel like I discover a new random trigger every week -- lately it's been ice rattling in a glass...

I'm sure I'll think of more as this AMA goes on lol

Does repetition of a sound differ from just hearing a sound you don’t like?

This is a super interesting question! Tagging u/ptype too.

Repetition definitely plays a role for me. Like, one drip of water isn't enough to trigger me, but water dripping indefinitely does trigger me. I tend to describe misophonia by referencing the repetitive nature of trigger sounds -- e.g., a constant stream of water in the shower or rainfall for instance is typically not as bothersome to people compared to individual drops with silent breaks in between.

To ptype's experience though, I've heard anecdotally both sides of this coin -- some people find identical or rhythmic repetition to be *more* bothersome than unpredictable sound, whereas others feel they can habituate a little easier to predictable sound rhythms and are more triggered by unpredictable variations. I have no idea why.

My 6 year old stepson doesn’t like loud noises. At his birthday party, he got upset because everyone was yelling and clapping for him. He doesn’t mind being the center of attention at all. This has been something that has come and gone over time - one year we did fireworks with no problems, the next year he couldn’t handle it. After watching him develop for a few years, it seems to me like it’s anxiety related. If he’s really happy and relaxed, he’s less likely to be bothered by a loud sound. Unfortunately, it seems to be getting worse with time. He recently started worrying a lot that he will be left behind by the adults. I don’t know where this fear comes from as he has never been forgotten or left behind that we know of. But he won’t allow anyone to leave him at home with his older sister while they run an errand. When we went trick or treating he kept telling us “don’t leave okay?” at every house.

I thought he might be on the autism spectrum but the rest of his symptoms point to anxiety more than autism. It really sucks to see him suffer, especially at such a young age. I honestly don’t even know where to begin helping him. We would send him to therapy but we have to get his biological mother to sign off on it and she won’t.

When he gets upset about the loud noises, he melts down. His face scrunches into a grimace, turns red, and the tears start. If the loud noise stops, he can pull it together pretty quickly. Sometimes the loud noise is unexpected and scares him, he jumps, then starts crying. But even when it’s expected, he melts down until it’s over.

I guess I’m just looking for any suggestions or information at all to help me understand, I don’t really have a specific question.

I'm so sorry to hear about your stepson's struggles. Just from this passage, his experiences read to me more like hyperacusis or autism than it does misophonia. If you haven't and are able, you might consider getting him assessed by an audiologist in case hyperacusis is the right diagnosis. Regardless, you're doing great and your sympathy and desire to help him is hugely appreciated!

Is misophonia linked to age or quality of hearing? In other words, are children, who have better hearing than older people, more or less affected by it? Or are older people, who may have some existing hearing loss, more prone to it? And for older people, is this perhaps why they prefer quieter settings?

So, there very well could be a link, but I haven't since compelling evidence of one.

Age-wise, misophonia commonly has an onset of around adolescence (~12years old), but not all adolescents with good hearing develop misophonia. It's also been reported in the literature that some people feel their misophonia getting worse over time and others report it getting better over time, so age alone isn't a predictive factor of how much someone experiences misophonia.

Quality of hearing wise, I know a few misophonia studies that have given hearing tests to their participants and found no significant audiological distortion. Misophonia seems to exist in people with or without normal hearing thresholds. So while these factors certainly might interact with how someone experiences misophonia, I don't think there's a direct link from one to the other.

How much of this is physiological and how much of this is irritation of perceived rudeness?

As an example I think it's rude for people to eat near other people who aren't eating because of the noise and smell but I don't know whether its the noise and smell specifically that bothers me or what I view as their being inconsiderate.

Thanks. Keep up the good work.

Personally, I think misophonia is more a physiological response rather than perceived rudeness. Like yes, externalizing anger (e.g., "That person is so inconsiderate, it's not me who's the problem") is a common response to triggers, but that alone doesn't quite explain why the aversion happens. For instance, I can still feel a physiological response to the sight of someone eating through a window in the break room, even when they are physically doing nothing "rude". Or sometimes when someone is chewing squishy foods -- with their mouth closed, perfectly politely -- I can still hear the repetitive squish and be bothered. More broadly, perceived rudeness is only relevant to misophonic triggers that are human-produced; although many triggers are, some misophonic triggers can be from a nonhuman/nature source too, which doesn't quite track with the source being "rude".

Hope that helps. Thanks for the question!

Maybe I'm reading the description & questions wrong, but what I'm gathering is "misophonia == sounds people hate"

How do you distinguish between someone with misophonia from someone that's just irritated by noise? I hate listening to shrieking babies & kids, but I've never considered it a condition

Great question. I think you can distinguish misophonia from someone that's just irritated by noise in a few ways:

1) What the noise is. Misophonia tends to refer to aversion to softer, innocuous, repetitive background sounds as opposed to sounds that are rougher/louder/higher frequency (like shrieking babies, nails on a chalkboard, etc.). The latter is a more universal experience, with a proposed evolutionary explanation (e.g., shriek = I should be alert/assess the situation); the former... doesn't have an intuitive evolutionary explanation.

2) The level of irritation. Misophonia tends to describe an impairment, as opposed to an annoyance. People with (severe) misophonia will often have deteriorated relationships, be more reclusive, have trouble holding a job, etc. It's often a fight-or-flight desire to aggressively act out or flee the situation. If someone is annoyed by a noise happening but can still grumpily continue on in their day otherwise unimpeded, it's not misophonia.

Are you only studying the "why"? I know many of us who suffer are also interested in treatments. Personally my baseline stress level affects my tolerance to nasty sounds. More stress, less it takes to set me off.

I totally get that. I'm a trained cognitive researcher, so yes, in a sense I'm mainly studying the "why" -- e.g., what's happening in the brain? what about the sound makes it bothersome? That sort of thing.

I'm also very interested in treatments, don't get me wrong. But I feel like we have to nail down *what* misophonia is before we can figure out how to treat it.

Has research shed any light on the relationship between trigger sounds and unwanted sexual stimuli? Since I was very young, chewing sounds (or just looking at someone chewing gum for example) give me very uncomfortable sensations, many times alongside absolutely undesired sexual responses from my body. It's a sensation almost of being violated, especially uncomfortable when the triggers come from people close to us, and it's something that I've seen talked about a lot in the misophonia subreddit. Can you help with some explanation on why that happens?

I wish I knew the explanation for this. Unfortunately, besides some research showing that unwanted sexual arousal is a commonly reported trigger reaction, there hasn't been anything specifically studying *why* it happens.

This answer isn't super helpful, but I wanted to acknowledge that I saw this question, because it's a good question!

Hi Heather! I've got a couple of questions:

Is there a distinction between any sounds and words? Like pet-peeves? Spoken words are sounds, so I'm wondering if it's related to the sound, the meaning of the word, or both.

Are universally-hated sounds also classified into misophonia? Like screeching chalk on a blackboard?

Eating noises. Oh. My. Dear. Lawd. Is there treatment for misophonia or is it one of those "oh, so that's what is called" and you treat the anxiety, stress, etc..?

[turns out there were 3 questions]

Hi! Thanks for the questions!

1. If I understand what you're asking, I don't think we have good evidence one way or the other whether random sounds vs. sounds with semantic meaning are more or less triggering. I've seen certain speech sounds or phonemes being reported as triggering (e.g., /s/ sounds are a common one), but haven't actually seen reports of misophonia experiences to full words.
2. Nope, I wouldn't classify screeching chalk as a misophonic sound for exactly the reason you specify -- it's universally-hated. Misophonia definitionally refers to stimulus aversion that is not universal or seen in most other people.
3. Unfortunately I think it's the latter. Currently there isn't an evidence-based "cure" for misophonia, so treating the symptoms is your best bet.

ASMR and misophonia are sometimes colloquially described as opposite conditions. It's useful for explaining misophonia to people, but I'm not sure whether it bears out. Is there actually any scientific connection?

This is a great question! I've also seen this described anecdotally, that perhaps ASMR and misophonia are tail ends of the same continuum. Most research thus far has used self-reported experiences to probe this question (if you're interested, check out some recent work here). As far as I know, there haven't been any neural or physiological studies to explore the biological similarities of the conditions.

are there any actual treatments that aren't exposure therapy? i have a psychiatrist appointment bc i can't stand sudden or disgusting noises but unsure on whether they can actually do anything abt it

Not a clinician/psychiatrist, so take this with a grain of salt, but therapeutic approaches aimed to treat misophonia are hit or miss to me. Exposure therapy is a huge miss. I've had a therapist who tried ABT (Acceptance Based Therapy), and it did not work for me. There have been a few case studies in the literature showing symptom improvement after CBT (Cognitive Behavioral Therapy), and I likewise have found some of the restructuring tools helpful. But currently there aren't any evidence-based treatments for misophonia specifically; your best bet might be to help manage your reactions/symptoms instead.

The sound of dogs licking themselves makes me irrationally angry. The same if I can see or feel it happening. I also get overwhelmed by too much noise and need to go somewhere quiet. Is that misophonia or something else?

Yup, I'd definitely call that misophonia! Dogs licking themselves is a common misophonic trigger, and if you feel anger/the need to flee when it happens, then it's right up the misophonia alley.