Misophonia symptoms: What are the early signs of misophonia?

Overview: What does misophonia feel like?

Misophonia involves having intense emotional reactions and disproportionate responses to everyday sounds like pen clicking, pencil tapping, lip smacking, throat clearing, breathing sounds, or chewing. Healthcare providers sometimes call it “decreased sound tolerance,” “decreased sound sensitivity,” or “selective sound sensitivity syndrome.” The word itself means “hatred of sound,” but that’s too broad of a concept. 

Misophonia may affect up to 1 in 5 people. Additionally, there are no defined guidelines for diagnosis or treatment. However, there are common features in what people experience. When they hear certain types of sounds, they feel strong and uncontrollable emotions like anger, disgust, anxiety, or panic. They can have physical reactions similar to a fight-or-flight response, like elevated blood pressure, fast heartbeat, and muscle tension. They can behave very badly in response to these reactions, behavior they’re later ashamed of. In the most severe cases, misophonia can impair a person’s ability to function in daily life.

What are the early signs of misophonia?

Healthcare providers have not agreed on specific criteria for diagnosing misophonia. For this reason, it’s difficult to identify early signs of misophonia. Many of the common triggers of misophonia are sounds that irritate or annoy most people—if not everyone—like pen clicking, finger tapping, heavy breathing, eating sounds, snoring, slurping, and water dripping. A diagnosis is made based on the degree of the reaction, the selectivity of triggers, and perceptions of self-control.

Possible signs that one might have misophonia are:

• The emotional response and behavioral reactions are out of proportion to the annoying sound. Rather than irritation or annoyance, someone with misophonia feels anger, rage, panic, anxiety, emotional distress, or hatred. This can be followed by glaring, rudeness, running out of the room, hostility, explosive outbursts, or violence.

• Only some irritating sounds elicit these intense reactions. This is what healthcare providers mean by “selective sound intolerance.” If you’re saying things like, “That one particular sound always drives me crazy,” that’s what misophonia can feel like.

• Even in mild cases, people feel they aren’t in control of their emotional reactions or behaviors. The degree to which people feel they lose control helps determine a diagnosis. 

Other misophonia symptoms

There are no formal rules or guidelines for diagnosing misophonia, but symptoms are usually separated into negative emotions, physical responses, behaviors, and functional impairment. 

Emotional symptoms that are triggered by certain sounds or other sensory stimuli include:

• Annoyance

• Irritation

• Anger

• Distress

• Disgust

• Anxiety

• Fear

• Panic

Physical symptoms might include:

• Increased heart rate

• Increased blood pressure

• Muscle tension

• Chest pressure

• Sweating

When triggered, a person may respond with behaviors disproportionate to the annoyance, including:

• Glaring

• Hostility

• Angry reactions

• Leaving or fleeing

• Violence

Most importantly, healthcare professionals assess how misophonia symptoms affect daily functioning and relationships. Social withdrawal, avoiding triggering sounds, job problems, and relationship problems are all relevant to diagnosing and treating the condition.

Misophonia vs. hyperacusis symptoms

Both misophonia and hyperacusis involve sensitivity to sound. Both have some overlap in their symptoms, so the two are easily confused. 

Healthcare professionals distinguish between four types of hyperacusis. Two of them, annoyance hyperacusis and fear hyperacusis, are very similar to misophonia in their symptoms. The other two, loudness hyperacusis and pain hyperacusis, are distinct from misophonia because they don’t involve emotions or behaviors. People with misophonia don’t report that triggering sounds are too loud or cause pain. 

However, there is a big difference between the two. Hyperacusis is related to identifiable hearing loss or hearing problems and can be triggered by any sound. Misophonia is not related to identifiable hearing loss and is usually triggered by sounds that have a specific pattern. There is no pain or loudness. Instead, misophonia elicits an emotional and behavioral reaction.

When to see a doctor for misophonia symptoms

If you have uncontrollable negative reactions to specific sounds, then ask a primary care physician or other healthcare providers for medical advice. Keep a log of your symptoms and share it with your providers. If negative reactions to sounds are making life difficult, then talk to your primary care physician about being referred to a hearing specialist or a mental health professional such as a psychiatrist, clinical psychologist, or equivalent. 

Misophonia is not an officially recognized diagnosis, though doctors can diagnose and treat the condition. Diagnostic criteria for misophonia have been proposed that involve other sensory stimuli such as vision, smelling, or moving about. But there are no tests for misophonia. 

As a result, diagnosis is based on your symptoms. The clinician will diagnose misophonia based on a symptom history and a medical history. The clinician is most likely to diagnose misophonia if the triggering sounds share the same pattern, you have a strong negative reaction to the sounds, and there are no physical symptoms like pain or loudness. In the process of diagnosis, healthcare professionals will try to determine if there are any auditory disorders or mental disorders that are also present. An audiologist may perform audiological tests to see if there are hearing problems that would warrant a different diagnosis. A psychologist or psychiatrist may administer psychological tests.

Complications of misophonia

Left untreated or unresolved, misophonia can result in complications such as:

• Lower quality of life

• Problems on the job 

• Family conflict

• Social withdrawal

• Anxiety

• Emotional dysregulation

How to treat misophonia symptoms

Healthcare professionals don’t always agree on appropriate treatment options for misophonia. The treatment option chosen may depend on whether the clinician is a specialist in psychiatry, psychotherapy, neurology, or hearing.

In studies, the most consistently successful treatment of misophonia is cognitive behavioral therapy (CBT) and CBT with exposure training. As a form of psychotherapy, cognitive behavioral therapy teaches people how to regulate their emotional reactions and control their behavioral responses to misophonic triggers. CBT may also expose patients to sound triggers in order to decondition them or train them to respond differently. A similar type of therapy, dialectical behavior therapy (DBT), may be more appropriate for those who feel extreme rage in response to sound triggers. 

Additionally, a specialist in auditory disorders may try a type of therapy called tinnitus retraining therapy (TRT). This, too, is a form of exposure. The person is exposed to continuous, low-level sounds that trigger an emotional response until they learn to control and regulate their response. TRT can also be successful at alleviating misophonia symptoms.

There are no medications approved to treat misophonia, but in some cases, a medical doctor or psychiatrist may prescribe drugs for misophonia. The most commonly prescribed drugs are selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine). 

If there are other mental health conditions, these will be treated appropriately. Treatment of other psychiatric disorders may involve medications, cognitive behavior therapy, or other types of psychotherapy. Some people may notice that treatment of co-existing mental health conditions may significantly improve the symptoms of misophonia.

Living with misophonia 

While there are no formal guidelines for diagnosis or treatment, there are treatment options available that can help. People with misophonia can also try to manage their symptoms with adaptations and coping strategies, including:

• Learning their misophonia triggers 

• Developing strategies to focus on other things or other sounds when triggered

• Using headphones or earplugs

• Using white noise generators

• Talking to family members and co-workers about the condition

• Asking for accommodations for misophonia at school or work, such as a quiet desk or noise-canceling headphones

• Learning to manage stress

• Practicing relaxation techniques throughout the day

Above everything else, remember that a helpful intervention to handle any episode involving out-of-control emotions or behaviors is to use deep breathing techniques. It doesn’t matter what the cause of the emotional surge is, whether it’s a sound, bad customer service, or someone cutting you off in traffic. Deep breathing can be enormously effective at helping people who feel out of control restore control over their thinking, their emotions, and their actions.

RELATED: 10 breathing exercises for anxiety

What’s next? Additional resources for people with misophonia symptoms

Test and diagnostics

• Misophonia, Cleveland Clinic

• Misophonia: a systematic review of current and future trends in this emerging clinical field, International Journal of Environmental Research and Public Health

• Proposed diagnostic criteria for misophonia: a multisensory conditioned averse reflex disorder, Frontiers in Psychology

Treatments

• A systematic review of treatments for misophonia, Personalized Medicine in Psychiatry

• Misophonia: a systematic review of current and future trends in this emerging clinical field, International Journal of Environmental Research and Public Health

Scientific studies and clinical trials

• The brain basis for misophonia, Current Biology

• Misophonia: incidence, phenomenology, and clinical correlates in an undergraduate student sample, Journal of Clinical Psychology

• Misophonia in the UK: prevalence and norms from the S-Five in the UK representative sample, PLOS One

• Using dialectical behavior therapy to treat misophonia in adolescence, The Primary Care Companion for CNS Disorders

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