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Can misophonia be treated? What therapists say about managing the condition

6 min read
Grant Stoddard

By Grant Stoddard

Reviewed by April Kilduff, MA, LCPC

Aug 22, 2023

In 2012 the Journal of Neuroscience published a study that sought to discover which sounds people found the most annoying. To do this, the researchers put 16 participants in an MRI machine and played them recordings of 74 different sounds. They then asked them to score the sounds according to their unpleasantness. 

You’d be right if you guessed that nails on a chalkboard would appear high on that list. However, it was beaten by four other sounds: a ruler on a bottle, chalk on a blackboard, a fork on a glass, with the sound of a knife on a bottle coming in at number one. Using the MRI data, the researchers found that activity in the brain region responsible for producing emotions—increased in direct proportion to the perceived unpleasantness of the sound. 

The 16 study participants had no prior history of a neurological or psychiatric disorder. If, however, it had included people who were neurodivergent or met the diagnostic criteria for depression, anxiety, Post-Traumatic Stress Disorder (PTSD), or Obsessive-Compulsive Disorder (OCD). In that case, the study may have produced very different results. That’s because people in these categories are more likely to experience misophonia: a condition in which one or more common sounds aren’t just annoying but cause an atypical and extreme emotional response such as disgust, distress, panic, or anger. In addition, these sounds can cause bodily responses like an elevated heart rate or provoke a behavioral response. 

In this article, we’ll reveal which sounds most often cause these powerful reactions, look at the various impacts it can have on people’s lives, explain misophonia’s relationship to autism and the disorders mentioned above, and discover how misophonia can be managed. 

Misophonia in depth

Misophonia derives from the Greek words misos (hate) and phónè (voice), and according to a 2023 study conducted by researchers from King’s College London and the University of Oxford, it’s common. They found that certain sounds cause a significant problem in the lives of around 18.4% of people in the UK population. The same study also found that just 13.6% had heard about misophonia, and only 2.3% identified with the condition themselves. 

“Misophonia is interesting in that it’s not actually a diagnosis listed in the DSM [Diagnostic and Statistical Manual of Mental Disorders],” says April Kilduff, MA, LCPC, LMHC, a clinical trainer at NOCD. “It’s a disorder where someone has an extremely low tolerance and often a painful reaction to very specific sounds—often, that reaction involves anger or disgust.”

So what are those specific sounds? Once again, the 2023 study provides us with plenty of insight. Researchers found that a crying baby and the sound of cutlery were most likely to provoke a distress response, while loud chewing, chewing gum, and slurping sounds were mostly closely associated with feelings of disgust. Repetitive barking and snoring were the sounds most likely to make people angry, while tapping, repetitive sniffing, and loud breathing were identified as the most irritating. One far less common response was a feeling of panic, with the sound of footsteps provoking the biggest response. 

Impacts of misophonia

The intense emotional reactions triggered by certain everyday sounds can result in several challenges. Social situations become potential minefields, as the fear of encountering triggering sounds leads to avoidance behaviors and isolation. Everyday activities like sharing meals with family or attending social gatherings morph into distressing or anger-inducing scenarios.

The emotional toll is equally significant. Feelings of anger, frustration, and helplessness can continue to intensify when people are left without effective management techniques or treatment. Relationships may strain under the weight of misophonia’s impact, as loved ones may struggle to understand the depth of emotional distress it triggers, and perhaps alter their behaviors to accommodate the person with misophonia so as not to trigger that disruptive emotional response. Sleep disruptions and heightened stress levels can cascade into various areas of life, affecting mental and emotional well-being.

Misophonia can also lead to decreased productivity at work, strained concentration, and even career choices tailored to minimize exposure to triggering sounds. Coping mechanisms like avoidance, constantly listening to music, or wearing earplugs around the clock can become exhausting to maintain, further impacting important areas of daily life.

Disorders commonly associated with misophonia

As mentioned above, there are currently no official diagnostic criteria for misophonia. However, it has been associated with several disorders. 

Autism: Misophonia frequently occurs in the autistic population, who may also experience challenges in communication, social interaction, and repetitive behaviors. “Sensory sensitivities are a hallmark of autism, and misophonia’s heightened auditory reactions may be linked to the sensory processing differences seen in the autistic population,” explains Kilduff. 

Depression and Anxiety: Misophonia has been observed to accompany mood disorders like depression and anxiety. People grappling with depression may find that the intense emotional responses triggered by misophonia worsen their emotional distress, and they may isolate themselves even more to avoid painful sounds. Likewise, heightened anxiety levels can magnify misophonic reactions, creating a cycle of heightened sensitivity.

Obsessive-Compulsive Disorder (OCD): The interplay between misophonia and OCD is notable. OCD involves intrusive thoughts and ritualistic behaviors aimed at alleviating anxiety. Misophonia’s triggering sounds can provoke an intense need to control one’s environment, leading to a hyper-fixation on distressing sounds and compulsive actions to avoid them.

Sensory Processing Disorder (SPD): SPD involves difficulties in processing and responding to sensory stimuli, leading to atypical reactions. Misophonia’s extreme emotional responses to specific sounds align with the sensory processing challenges seen in SPD, and the heightened sensitivity shown by those with SPD can magnify the impact of misophonic triggers.

Post-Traumatic Stress Disorder (PTSD): Misophonia’s aversive sounds can also resonate with people who have experienced trauma. PTSD can heighten emotional responses to triggers, potentially amplifying the distress experienced by those with misophonia. The combination of these two conditions can lead to heightened physiological arousal and emotional reactivity.

Understanding the potential connections between misophonia and other mental health conditions is crucial for determining the most effective treatment strategies to address the multidimensional impact of misophonia.

Managing misophonia

While there’s no evidence for a complete “cure” for misophonia, people can employ various strategies to minimize its impact on their daily lives.

Anticipatory strategies: Simply preparing for situations where triggering sounds are likely can be effective. “Techniques like progressive muscle relaxation and mindfulness exercises can help people enter these scenarios with a calmer nervous system, reducing the intensity of their reactions,” says Kilduff. 

Practical accommodations: Using noise-canceling headphones or white noise machines can provide a physical barrier against triggering sounds. When they don’t interfere with daily functioning, these tools can help people comfortably engage in situations they might otherwise avoid due to misophonia.

Holistic approaches: Incorporating relaxation techniques, exercise, and stress-reduction practices into one’s routine can contribute to overall emotional well-being and help manage misophonia’s impact.

Exposure techniques: “Typical techniques of exposure and response prevention therapy (ERP) are highly effective for OCD—where misophonia is often also present—but they’re not generally helpful for something sensory like misophonia,” explains Kilduff. “We wouldn’t have someone listen to a distressing sound over and over again. But what you can use ERP for, along with other treatment modalities, is helping people learn to anticipate when their reaction to a sound might happen. From there, you can help them learn how to manage their feelings of anger or disgust, and enable them to do the things they’re avoiding. 

“We call those things values-based exposures. When people intentionally engage in activities aligned with their values and desires, even if they involve potential trigger sounds, this can help them build tolerance and reduce avoidance behaviors. It can be as simple as going to a party you’d like to go to, but where there might be a specific upsetting sound, or sitting at the dinner table with your family, even though your little brother’s chewing might be really bothersome.” 

Learn more about ERP
April Kilduff, MA, LCPC

April Kilduff is a NOCD therapist who has exclusively treated OCD and anxiety disorders, as well as their intersection with the Autism spectrum, for over a decade. Her path to this career started with her own journey dealing with panic attacks, perfectionism and a couple phobias. When not working on exposures with members, you can find her at home reading books and hanging out with her two cats or out taking pictures and traveling the world.