Carla, age ten, came to the clinic with a primary misophonia trigger of her brother chewing. She said that when she heard the trigger, she felt immediate rage but no physical response. Carla often had conflict with her brother at the dinner table. Her mother reported that when arguing, Carla would stand, extend both arms, and demand that her brother stop staring at her. This was behavior that included tight arm, shoulder, and leg muscles. In this setting, she also heard the sound of her brother’s open mouth chewing. At the clinic, a low-strength recorded trigger stimulus caused a visible jerk in Carla’s arms and shoulders. When asked what she felt, she reported feeling the contraction of muscles in her arms and legs, but no anger, rage, disgust, or weaker precursors of these emotions. It seemed that the trigger stimulus caused the contraction of the same muscles that were contracted when she was arguing with her brother, which supports the hypotheses that misophonia develops as a Pavlovian conditioned reflex and that the initial reflex response to a trigger stimulus is a physical reflex.