Diagnosing Misophonia

Misophonia is an extreme emotional reaction to typically occurring sounds. “Miso” means dislike or hatred, “phonia” means sounds, so “misophonia” means ‘’a dislike or hatred of sounds.” This rather broad name was given to the disorder in 2001 by Drs. Pawel and Margaret Jastreboff. I say “broad” because it’s not about hating sounds in general; it’s about hating only specific sounds. We call these trigger sounds. Additionally, the “hatred” of trigger sounds applies more to your involuntary response to a sound than your feelings about that sound.

This condition is also known as selective sound sensitivity syndrome, or 4S. This is the name given to this condition by audiologist Marsha Johnson, who first identified this condition in 1997. This is really a better name for the condition because there are specific and selective sounds to which the person is extremely sensitive. However, misophonia is the more popular name for this condition now, and it also includes visual triggers.

I have proposed that an even better name for this condition is Conditioned Aversive Reflex Disorder or CARD, which I will explain in a later chapter.

To define misophonia, let’s first describe what misophonia is not.

Misophonia is not a sensitivity to the volume of the sound or to how loud the sound is. That’s hyperacusis. Hyperacusis can either continue from childhood or develop in adulthood. It can be tested by an audiologist by measuring the volume at which sound becomes painful. There are specific treatments that have been shown to reduce hyperacusis.

It’s not a fear of a sound; that’s phonophobia. This is a condition in which fear is the dominant emotion. It includes the fear response from hearing a sound and the fear of being in a situation where a loud or specific sound may occur. This seems fairly common in children, such as when a child is scared by the toilet or the vacuum cleaner sound. A fear of sounds or a fear response to the sound is not misophonia, usually. I say “usually” because there are some individuals with misophonia that feel fear as part of their emotional response to triggers. Some feel fear as an immediate response to the trigger, and others experience a fear of more triggers occurring, similar to anxiety about possibly hearing more triggers. But misophonia will also include a strong anger or disgust response that accompanies the fear, and it will generally be in response to specific soft sounds which makes it distinct from phonophobia.

Sensory Processing Disorder (SPD) can cause an intolerance of loud sounds. SPD is a condition where a person has significant problems with multiple forms of sensory input such as touch, taste, smell, sight, and sounds. SPD is a general heightened sensitivity to sensory stimulation. It is not the same as misophonia, and it is not related to misophonia. A person with SPD may appear to have hyperacusis or phonophobia because of the way he or she reacts to sounds.

Misophonia is not being irritated or upset by a continuous, loud, intrusive, or an irritating sound. There are people who, when they are in a situation where there’s a repeating sound, become very upset. The sound can be soft but continuous, such as traffic noise heard inside their home. These people are generally considered a highly sensitive person (HSP). Their level of tolerance for these obnoxious or irritating situations is not as high as with most other people. And so they get upset. For example, a person living near an airport says that they have an extreme emotional reaction to the sound of airplanes flying over. This may or may not be misophonia. Misophonia is being upset (triggered) by a single occurrence of the trigger. Suppose they are not upset by the sound of a single airplane, but are upset by the first airplane in the morning, knowing that many more will follow. This is more likely to be a case of HSP than misophonia; they are upset because they know they will be hearing airplanes all day long. And the airplane noise is going to be intrusive and irritating. This person may be very, very, very distressed by the noise, and the extreme emotions may be identical to the emotions from misophonia. The level of distress does not determine whether a person does or does not have misophonia. The determining factor for misophonia is that a person triggers – has an immediate response of irritation or disgust – to a single instance of the trigger stimulus.

A person who is highly sensitive can also have misophonia. There may be certain sounds to which they are sensitive to because they are irritating sounds, but there are other sounds that are misophonic triggers.

Finally, misophonia is not reaction to a sound like fingernails on the chalkboard, a baby crying, a knife on a bottle, a disc grinder, or a female scream. It is common to be irritated by these sounds. They are some of the top ten most irritating sounds. It seems that we are genetically wired to respond to these sounds because they are similar in frequency to a baby crying – a sound which should make us take action.

With misophonia there is an immediate reaction to the trigger stimulus. The trigger stimulus generally takes the form of sounds or sights, and the stimulus causes an immediate and involuntary response. It’s a response that is jerked out of the person.

The triggers are generally soft sounds or common sights. If you don’t have misophonia or if it’s not a trigger sound you may not even hear the sound; but for a person with misophonia, when someone across the room makes a trigger sound, such as popping their gum, they are going to hear it and feel it. This is common with a misophonia trigger.

There are also strong emotions with misophonia, the most universal being hate, anger, rage, disgust, resentment, and being offended. People with misophonia want to get away from the sound or make it stop, and in many cases they are thinking of a verbal or a physical assault on the other person. Although it is extreme to think about physically hurting someone because of a sound they are making, rarely do people with misophonia act out on these impulses.