Triggers, Trigger, and More Trigger

Misophonia triggers generally start with a familiar person and a familiar sound. It is something in the person’s life. I conducted a survey of individuals with misophonia in 2013 in which twothirds said their worst trigger was an eating/chewing sound, and 10% were breathing sounds. The remaining 25% had a variety of “worst triggers” including bass through walls, a dog barking, coughing, clicking sounds, whistling, parents talking, sibilance (the sound produced when saying words such as sun or chip), and someone typing on a keyboard. This is by no means a complete list of triggers. In fact, it is virtually impossible to make a complete list because a trigger can be virtually any repeating sound or sight.

Although much less common, triggers can also be touch, smell, and vibrations. Triggers are sounds we hear in everyday life. Eating sounds and dinner table sounds are very common in our lives, and are the most common triggers for misophonia. The second most common triggers are breathing or nose sounds, such as nose whistles, heavy breathing, sighing, snoring, and anything associated with breathing. In a large survey I ran last year, 94% reported eating/chewing sound triggers, but really, any repeating sound can be a trigger. The list of known triggers is like the list of all repeating sounds in the world. It’s not that these sounds become triggers because of the sound itself. They become triggers because the person hears the sound in a specific situation and they develop a misophonia response to that sound. As mentioned, we find that triggers start with one sound or one person making a particular noise, and then the trigger spreads to similar sounds, other places, anyone making the alreadyoffensive sound, and sights associated with those sounds. So with time these triggers spread and spread. We will cover this in detail in the chapter on Developing New Triggers. Misophonia can start with a visual trigger, but this is rare. In fact, I have only talked to one person whose misophonia started with a visual trigger a friend picking at their cuticles. In a 2015 survey of 1,067 people, only nine had misophonia start with a visual trigger, such as foot wiggling, leg bouncing, hair twirling, and leg crossing. That is less than 1%. Generally misophonia starts with an auditory trigger, and then visual images that occur immediately before the trigger become visual triggers. For example, if I trigger to chewing, then seeing someone put food into their mouth could become a trigger. I could also develop a trigger to seeing someone bring food toward their mouth or to picking up a potato chip. Images that occur with the trigger can also become trigger stimuli. For example, jaw movement associated with chewing is commonly reported as a visual trigger by someone who triggers to gum popping. It is probably possible for visual triggers to develop to images that occur in the same general time of auditory triggers. For example, if a person is triggered by eating sounds, specific voice sounds may be noticed at mealtime, and because the person is being triggered by eating sounds, the voice sounds could become triggers. We also find that repetitive movements such as leg jiggling or hair twirling are common trigger stimuli, but it’s not clear why. I had a client suggest it was because it was a nervous behavior, but I don’t have any data on this. The next table shows the common misophonia auditory triggers with the percentage of participants who had one or more triggers in that category. The data is from a survey I took in 2015 with over 1,000 participants. Participants were recruited from misophonia Facebook groups, Yahoo groups, and individuals subscribed to my misophonia newsletter. Most of these individuals have misophonia that is sufficiently severe to cause their participation in these groups. Sound (Auditory) Triggers :

Sounds of people eating – all forms of chewing, crunching, smacking, swallowing, talking with food in mouth, etc. 94%
Sounds made at the table – fork on plate, fork scraping teeth, spoon on bowl, clinking of glasses, etc. 63%
Sounds of people drinking – sipping, slurping, saying “ah” after a drink, swallowing, breathing after a drink, etc. 78%
Other mouth sounds – sucking teeth, lip popping, kissing, flossing, brushing teeth, etc. 76%
Sounds associated with eating – opening chip bags, water bottle crinkling, setting a cup down, etc. 55%
Breathing sounds – sniffling, snorting, nasally breathing, regular breathing, snoring, nose whistle, yawing, coughing, throat clearing, hiccups, etc. 82%
Home sounds of people – voices/TV/music/bass through walls, door slamming, nail clipping, foot shuffling, flip flops, heavy footsteps, walking of people upstairs, joint cracking, scratching, baby crying, bouncing ball, etc. 65%
Home sounds of people – voices/TV/music/bass through walls, door slamming, nail clipping, foot shuffling, flip flops, heavy footsteps, walking of people upstairs, joint cracking, scratching, baby crying, bouncing ball, etc. 65%
Work/school sounds – typing, mouse clicks, page flipping, pencil on paper, copier sound, pen clicking, pen tapping, tapping on desk, etc. 54%
Vocal triggers – consonant sounds (S and P especially), vowel sounds (not common), lip pop when speaking, dry mouth voice, gravelly voice, whispering, specific words, muffled talking, several people talking at once, “uh”, etc. 51%
Singing, humming, whistling 48%
Animal sounds – dogs/cat grooming, dogs drinking, dogs barking, rooster crowing, birds chirping, crickets, frogs, animal scratching, dog whimpering, etc. 33%
Electronic sounds – phone ringtones, key clicks, alert tones, beeps, etc. 28%
Home sounds of equipment – refrigerator running, hair dryers, electric shavers, ticking clocks, pipes knocking, lawnmowers, toilet flushing, etc 24%
Other – Farm equipment, pumps, back-up beepers, traffic noise, beep of car locking, car door slamming 16%