June 30, 2023 • 18 mins
For some people, the typical human sounds that other people make—eating, chewing or even breathing—can trigger extreme anger, rage and disgust. It’s an actual condition, called “misophonia,” and Dr. Saltz tells how to deal with it.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Some people are exceedingly
bothered by certain sounds like chewing, breathing, clicking a pen,
or typing on a keyboard. This type of sensitivity can
be a real problem. So today I am answering a
(00:49):
question from a woman who is struggling with others chewing
around her. Miss Aphonia is a disorder where people have
abnormally strong and negative reactions to the ordinary sounds that
humans make, such as chewing, breathing, tapping, which cause them
to feel intense anger, or anxiety, or even disgust. The
(01:16):
emotions can be extremely strong, even overpowering, to the point
where it might be hard to control what you do,
and people may avoid other people or even leave a
room to run away from the sound. This phenomenon can
affect people very differently. Some people have only one trigger
(01:40):
sound that causes this reaction, and some have Many people
can also have reactions that are more or less severe.
Often people can't control the emotions they feel, but can
control their responses to them, though can't control either, causing
(02:02):
them to react impulsively. In the most severe cases, one
may not be able to do certain things or be
in a specific environment because of their intolerance. Research shows
that missophonia can affect anyone, but seems to be more
common in women, with as much as fifty five to
(02:25):
eighty three percent of cases happening in women. Misophonia can
develop at any age, but research indicates it's most likely
to develop in the early teen years. There's limited information
and how often it really happens, but one study found
(02:46):
that it affects about twenty three percent of college undergraduates
that were examined. More research clearly needs to be done
to determine how common this really is. Items of mesophonia
revolve around how you react to the trigger sounds. The
(03:06):
reactions all basically fall under the natural fight or flight instinct.
It can be in any of three categories. Emotional, which
can be an intense or overwhelming emotion that can escalate
rapidly could be irritation or annoyance, but turn very quickly
(03:28):
to anger or even rage. Another area is the body
due to arousal of the sympathetic nervous system. As I
mentioned earlier, these are reactions that happen if you're, for example,
in a dangerous or frightening situation, but they're happening in
reaction to these sounds, and behavioral which is the action
(03:54):
that you do in reaction to the sound. These are
often unfortunately impul or instinct driven, meaning you might not
feel like you have control over it. So, for example,
in the emotional category, you might feel anger, anxiety, disgust, fear,
(04:14):
even or just irritation. The body symptoms can be an
increase in blood pressure, feelings of chest pressure or tightness,
getting goosebumps, having your heart rate increase, or sweating, and
the behaviors can include avoiding situations where the sound might happen,
(04:37):
leaving the area when you hear the sound, having a
verbal reaction like talking or yelling about the sound, having
some sort of action to stop the sound that is
either nonviolent or unfortunately violent, which really is rare, and
the severity of symptoms can vary when the symptom is
(05:00):
less severe, the emotional and body reactions may be all
you experience, but when it's more severe, the effect can
be so strong that you do have this behavioral response,
this feeling of I'm so uncomfortable, I've got to flee,
and in severe cases, I'm enraged, I'm in a panic,
(05:23):
I'm in a totally fearful state. Afterwards, it is common
for the person with misophonia to recognize and then regret
that what they did wasn't appropriate, but they may still
struggle in the similar situation with a similar reaction in
the future. Any sound can trigger miss aphonia, but some
(05:45):
sounds are much more likely to be triggers. While sounds
on the TV or the radio or some other electronic
device can typically trigger misophonia, the reaction is usually not
as intense as if it's a sound that it's actually
close to you in the room with you. So for example,
(06:05):
eating and drinking noises are very common, like smacking the
lips or chewing with your mouth open or crunching sounds,
slurping sounds, loud swallowing or gulping. Sometimes it's breathing noises.
This could be snoring or someone sniffing or blowing their nose,
(06:25):
just being a heavy breather near you. It could be
activity and movement noises like tapping their fingers, clicking a pen,
loud typing, or even the sound of utensils being used
to eat with. They might be mouth or throat noises
like throat clearing, coughing, and even loud kissing. Some people
(06:52):
describe having miss aphonia related to a clock or a watch,
the ticking sound, plumbing like a toilet flushing or water dripping,
ringing a bell or a phone, even animal sounds, and
the rustling of paper or plastic. Now, mesophonia is actually
(07:13):
more likely to happen in people with certain conditions, for example,
people who have attention deficit hyperactivity disorder, or autism spectrum
disorder or Tourette syndrome. And also it's more likely to
happen in people who have major depression, obsessive compulsive disorder,
post traumatic stress disorder, or borderline personality disorder. And it's
(07:38):
also more likely to happen in people who do not
have any of these psychiatric disorders, but instead have some
hearing loss or what's called tenetus, or a sound or
ringing in your ear. Or a condition called hyperacusis, an
over sensitivity to sound. It actually turns out that missiphonia
(07:59):
might be a condition that runs in families. There is
one known of genetic mutation that may play a role,
but more research is really necessary to determine if this
is even true. So with that, right after the break,
we'll get to my listener's question. Welcome back. Let's get
(08:31):
to my listener's question and see how can I help,
dear doctor Sols. My daughter, who is seventeen years old,
is a pretty typical teenager, delightful at times and not
so delightful at other times. But one thing I notice
is that she moves into well beyond not so delightful
(08:51):
territory when she is bothered by certain noises. I am
definitely not a fan of eating noises, but she's sort
of loses it and is downright nasty about it. Like
if she hears lipsmacking or chewing or god forbids, slurping,
she snaps immediately at the person and is so set
(09:12):
off she can't seem to stop being mad for a while.
Sometimes she has literally stormed off from the table. Besides
the fact that it has made our dinner times together unpleasant.
I'm worried about how she is going to handle this
out in the world, like with friends at school and
(09:33):
so on. Is there anything to help her with this issue.
Some people are more sensitive to sounds that the rest
of us find more innocuous. Eating noises actually are amongst
the sounds that bother more people, often because it is
associated with being rude, or it's associated with your mouth
(09:56):
or chewed food, or basically things that aren't especially attizing
when you're trying to eat. But for most people who
are bothered, the level of bother is simply yuck, which
they would close their mouths or not slur, but then
that thought kind of goes away and they don't feel
panic or rage. Your daughter sounds like she is feeling
(10:19):
instantly extremely angry or even panicky at the sounds, and
sometimes even needs to flee. This is a more extreme reaction,
and though she is an adolescent, an age group actually
known for more extreme reactions. That it is specific to
the sounds of eating make it more suspicious for what
(10:41):
is called misophonia. There is no way to actually test
for this problem. It's a clinical diagnosis based on what
bothers her, how much it bothers her and how much
it disrupts her life. It seems to bother her a lot,
and it is disrupting her ability to eat with her family.
(11:02):
If this is the case, it is unlikely to get
better on its own, But there are things that she
can do to help herself and have this bother her
less and be less disruptive. One thing that helps people
with misophonia is white noise, a steady stream of low
level noise that is playing for her to hear, so
(11:25):
that the eating noises sound much quieter or possibly not
heard at all. A fan in the room can provide
a white noise, a white noise machine, even an app
on her iPhone. She can experiment with this to find
something that helps and use that in the background during meals.
(11:47):
Some people even use headphones that allow her to hear
the white noise but at a lower left level that
she can still hear the conversation and participate. Also helpful
be a mental health evaluation and some therapy. The reasons
are twofold. Many people with misophonia also have either an
(12:09):
anxiety disorder or obsessive compulsive disorder, and finding out and
treating that will help her, but also because some therapists
can even treat missophonia with any one of several types
of therapy, from cognitive behavioral therapy to what's called dialectical
(12:30):
behavior therapy specific to misophonia. Check out the Misophonia Institute
online for therapists who specialize in this and who can
see her by zoom. Getting some affirmation that she is
not a bad person nor making this up will help
(12:50):
her to feel less ashamed and less likely to start
avoiding eating with anyone. On the other hand, she does
want to learn some coping mechanisms in therapy because just
experiencing it with nothing to do nothing to help, can
actually make it worse. It will also make life with
(13:11):
her more pleasant for you and the rest of the family.
I hope that was helpful. Various treatments have been proposed
for misophonia. These range from white noise devices all the
way up to hypnotherapy. There is something called tinatus retraining therapy.
(13:34):
Tinatus is a condition in which a person hears a
persistent ringing in their ears that can cause discomfort or
agitation and really interfere with their daily life. It's natural
that treatments for tenatus could possibly be extended to misophonia.
This tentatus retraining therapy involves learning to tolerate noise so
(13:57):
that it no longer causes the person as much discomfort.
Another treatment that has been applied to misophonia is cognitive
behavioral therapy. Through CBT, individuals learn to better understand their
reactions to the triggering sounds and to develop coping strategies
to manage the negative reaction they're having. It might involve
(14:20):
changing negative thinking patterns related to the triggering sounds. Another therapy,
dialectical behavioral therapy, involves learning to manage emotions through techniques
such as mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Finally,
(14:44):
some people with misophonia may benefit from relaxation techniques like
progressive muscle relaxation, which involves learning to trigger the relaxation
response by practicing alternating tensing and relaxing different parts of
the body. Some people respond really well to white noise
(15:05):
that masks the sound that the missiphonia is triggered by.
These can be ear level devices that play the sound
it might be like the sound of a waterfall or
a river, or room level devices like a fan or
a white noise machine. Some really high end white noise
(15:26):
machines can be obtained through an audiologist, which actually, while
normally being expensive, might be covered by your insurance. On
the other hand, a smartphone or ear pods headphones can
get the same effect using a sound app to play
white noise on your phone, which of course would cost less.
(15:50):
To make this most effective, the person with misophonia would
use the headphones that do not completely block outside sounds
so that they could still hear over the noise and
of course participate in the conversation going on. In general,
the goal of using these types of devices is to
add background sounds to your environment and avoid silence so
(16:14):
that triggering sounds are not as loud, or they blend
in with the white noise sounds which make them less intrusive.
These options might be best if you struggle to manage
your reactions by changing your thinking patterns alone. There are
no medications that are approved specifically for misophonia. There is
(16:36):
a paper that did follow the treatment of one patient
extremely successfully with the use of a beta blocker medication
called propranolog, but it's important to discuss medication with your
doctor to see if there might be an option that
could be helpful, and of course one patient does not
an actual study make Other forms of therapy have been
(17:00):
tried with misophonia, things like hypnotherapy, biofeedback, and neurofeedback. Sometimes
you need a combination of specialists to help you, an
audiologists who specializes in ear issues, a psychologist, and even
sometimes in odolaryngologist who is a type of physician who
(17:21):
deals with ear issues. You could also visit the Misophonia
Institute online to learn more about the condition and what
can be done to help it. This institute includes a
treatment provider directory that lists providers based on your location
and also their profession and their specialization. They can assess, manage,
(17:44):
and then select a training and treatment that can be
done remotely by phone or online. And importantly, they do
offer resources for children who sometimes do develop missophonia in
terms of comedy at school and also parenting coaches. So
if you're a parent struggling to find help for your
(18:06):
child living with missophonia, this could be a good option
for you. Do you have a problem I can help with?
If so, email me at how Can I Help at
senecawomen dot com. All centers remain anonymous and listen every Friday,
to how can I help with me Doctor Gail's Saltz
These are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Some people are exceedingly
bothered by certain sounds like chewing, breathing, clicking a pen,
or typing on a keyboard. This type of sensitivity can
be a real problem. So today I am answering a
(00:49):
question from a woman who is struggling with others chewing
around her. Miss Aphonia is a disorder where people have
abnormally strong and negative reactions to the ordinary sounds that
humans make, such as chewing, breathing, tapping, which cause them
to feel intense anger, or anxiety, or even disgust. The
(01:16):
emotions can be extremely strong, even overpowering, to the point
where it might be hard to control what you do,
and people may avoid other people or even leave a
room to run away from the sound. This phenomenon can
affect people very differently. Some people have only one trigger
(01:40):
sound that causes this reaction, and some have Many people
can also have reactions that are more or less severe.
Often people can't control the emotions they feel, but can
control their responses to them, though can't control either, causing
(02:02):
them to react impulsively. In the most severe cases, one
may not be able to do certain things or be
in a specific environment because of their intolerance. Research shows
that missophonia can affect anyone, but seems to be more
common in women, with as much as fifty five to
(02:25):
eighty three percent of cases happening in women. Misophonia can
develop at any age, but research indicates it's most likely
to develop in the early teen years. There's limited information
and how often it really happens, but one study found
(02:46):
that it affects about twenty three percent of college undergraduates
that were examined. More research clearly needs to be done
to determine how common this really is. Items of mesophonia
revolve around how you react to the trigger sounds. The
(03:06):
reactions all basically fall under the natural fight or flight instinct.
It can be in any of three categories. Emotional, which
can be an intense or overwhelming emotion that can escalate
rapidly could be irritation or annoyance, but turn very quickly
(03:28):
to anger or even rage. Another area is the body
due to arousal of the sympathetic nervous system. As I
mentioned earlier, these are reactions that happen if you're, for example,
in a dangerous or frightening situation, but they're happening in
reaction to these sounds, and behavioral which is the action
(03:54):
that you do in reaction to the sound. These are
often unfortunately impul or instinct driven, meaning you might not
feel like you have control over it. So, for example,
in the emotional category, you might feel anger, anxiety, disgust, fear,
(04:14):
even or just irritation. The body symptoms can be an
increase in blood pressure, feelings of chest pressure or tightness,
getting goosebumps, having your heart rate increase, or sweating, and
the behaviors can include avoiding situations where the sound might happen,
(04:37):
leaving the area when you hear the sound, having a
verbal reaction like talking or yelling about the sound, having
some sort of action to stop the sound that is
either nonviolent or unfortunately violent, which really is rare, and
the severity of symptoms can vary when the symptom is
(05:00):
less severe, the emotional and body reactions may be all
you experience, but when it's more severe, the effect can
be so strong that you do have this behavioral response,
this feeling of I'm so uncomfortable, I've got to flee,
and in severe cases, I'm enraged, I'm in a panic,
(05:23):
I'm in a totally fearful state. Afterwards, it is common
for the person with misophonia to recognize and then regret
that what they did wasn't appropriate, but they may still
struggle in the similar situation with a similar reaction in
the future. Any sound can trigger miss aphonia, but some
(05:45):
sounds are much more likely to be triggers. While sounds
on the TV or the radio or some other electronic
device can typically trigger misophonia, the reaction is usually not
as intense as if it's a sound that it's actually
close to you in the room with you. So for example,
(06:05):
eating and drinking noises are very common, like smacking the
lips or chewing with your mouth open or crunching sounds,
slurping sounds, loud swallowing or gulping. Sometimes it's breathing noises.
This could be snoring or someone sniffing or blowing their nose,
(06:25):
just being a heavy breather near you. It could be
activity and movement noises like tapping their fingers, clicking a pen,
loud typing, or even the sound of utensils being used
to eat with. They might be mouth or throat noises
like throat clearing, coughing, and even loud kissing. Some people
(06:52):
describe having miss aphonia related to a clock or a watch,
the ticking sound, plumbing like a toilet flushing or water dripping,
ringing a bell or a phone, even animal sounds, and
the rustling of paper or plastic. Now, mesophonia is actually
(07:13):
more likely to happen in people with certain conditions, for example,
people who have attention deficit hyperactivity disorder, or autism spectrum
disorder or Tourette syndrome. And also it's more likely to
happen in people who have major depression, obsessive compulsive disorder,
post traumatic stress disorder, or borderline personality disorder. And it's
(07:38):
also more likely to happen in people who do not
have any of these psychiatric disorders, but instead have some
hearing loss or what's called tenetus, or a sound or
ringing in your ear. Or a condition called hyperacusis, an
over sensitivity to sound. It actually turns out that missiphonia
(07:59):
might be a condition that runs in families. There is
one known of genetic mutation that may play a role,
but more research is really necessary to determine if this
is even true. So with that, right after the break,
we'll get to my listener's question. Welcome back. Let's get
(08:31):
to my listener's question and see how can I help,
dear doctor Sols. My daughter, who is seventeen years old,
is a pretty typical teenager, delightful at times and not
so delightful at other times. But one thing I notice
is that she moves into well beyond not so delightful
(08:51):
territory when she is bothered by certain noises. I am
definitely not a fan of eating noises, but she's sort
of loses it and is downright nasty about it. Like
if she hears lipsmacking or chewing or god forbids, slurping,
she snaps immediately at the person and is so set
(09:12):
off she can't seem to stop being mad for a while.
Sometimes she has literally stormed off from the table. Besides
the fact that it has made our dinner times together unpleasant.
I'm worried about how she is going to handle this
out in the world, like with friends at school and
(09:33):
so on. Is there anything to help her with this issue.
Some people are more sensitive to sounds that the rest
of us find more innocuous. Eating noises actually are amongst
the sounds that bother more people, often because it is
associated with being rude, or it's associated with your mouth
(09:56):
or chewed food, or basically things that aren't especially attizing
when you're trying to eat. But for most people who
are bothered, the level of bother is simply yuck, which
they would close their mouths or not slur, but then
that thought kind of goes away and they don't feel
panic or rage. Your daughter sounds like she is feeling
(10:19):
instantly extremely angry or even panicky at the sounds, and
sometimes even needs to flee. This is a more extreme reaction,
and though she is an adolescent, an age group actually
known for more extreme reactions. That it is specific to
the sounds of eating make it more suspicious for what
(10:41):
is called misophonia. There is no way to actually test
for this problem. It's a clinical diagnosis based on what
bothers her, how much it bothers her and how much
it disrupts her life. It seems to bother her a lot,
and it is disrupting her ability to eat with her family.
(11:02):
If this is the case, it is unlikely to get
better on its own, But there are things that she
can do to help herself and have this bother her
less and be less disruptive. One thing that helps people
with misophonia is white noise, a steady stream of low
level noise that is playing for her to hear, so
(11:25):
that the eating noises sound much quieter or possibly not
heard at all. A fan in the room can provide
a white noise, a white noise machine, even an app
on her iPhone. She can experiment with this to find
something that helps and use that in the background during meals.
(11:47):
Some people even use headphones that allow her to hear
the white noise but at a lower left level that
she can still hear the conversation and participate. Also helpful
be a mental health evaluation and some therapy. The reasons
are twofold. Many people with misophonia also have either an
(12:09):
anxiety disorder or obsessive compulsive disorder, and finding out and
treating that will help her, but also because some therapists
can even treat missophonia with any one of several types
of therapy, from cognitive behavioral therapy to what's called dialectical
(12:30):
behavior therapy specific to misophonia. Check out the Misophonia Institute
online for therapists who specialize in this and who can
see her by zoom. Getting some affirmation that she is
not a bad person nor making this up will help
(12:50):
her to feel less ashamed and less likely to start
avoiding eating with anyone. On the other hand, she does
want to learn some coping mechanisms in therapy because just
experiencing it with nothing to do nothing to help, can
actually make it worse. It will also make life with
(13:11):
her more pleasant for you and the rest of the family.
I hope that was helpful. Various treatments have been proposed
for misophonia. These range from white noise devices all the
way up to hypnotherapy. There is something called tinatus retraining therapy.
(13:34):
Tinatus is a condition in which a person hears a
persistent ringing in their ears that can cause discomfort or
agitation and really interfere with their daily life. It's natural
that treatments for tenatus could possibly be extended to misophonia.
This tentatus retraining therapy involves learning to tolerate noise so
(13:57):
that it no longer causes the person as much discomfort.
Another treatment that has been applied to misophonia is cognitive
behavioral therapy. Through CBT, individuals learn to better understand their
reactions to the triggering sounds and to develop coping strategies
to manage the negative reaction they're having. It might involve
(14:20):
changing negative thinking patterns related to the triggering sounds. Another therapy,
dialectical behavioral therapy, involves learning to manage emotions through techniques
such as mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Finally,
(14:44):
some people with misophonia may benefit from relaxation techniques like
progressive muscle relaxation, which involves learning to trigger the relaxation
response by practicing alternating tensing and relaxing different parts of
the body. Some people respond really well to white noise
(15:05):
that masks the sound that the missiphonia is triggered by.
These can be ear level devices that play the sound
it might be like the sound of a waterfall or
a river, or room level devices like a fan or
a white noise machine. Some really high end white noise
(15:26):
machines can be obtained through an audiologist, which actually, while
normally being expensive, might be covered by your insurance. On
the other hand, a smartphone or ear pods headphones can
get the same effect using a sound app to play
white noise on your phone, which of course would cost less.
(15:50):
To make this most effective, the person with misophonia would
use the headphones that do not completely block outside sounds
so that they could still hear over the noise and
of course participate in the conversation going on. In general,
the goal of using these types of devices is to
add background sounds to your environment and avoid silence so
(16:14):
that triggering sounds are not as loud, or they blend
in with the white noise sounds which make them less intrusive.
These options might be best if you struggle to manage
your reactions by changing your thinking patterns alone. There are
no medications that are approved specifically for misophonia. There is
(16:36):
a paper that did follow the treatment of one patient
extremely successfully with the use of a beta blocker medication
called propranolog, but it's important to discuss medication with your
doctor to see if there might be an option that
could be helpful, and of course one patient does not
an actual study make Other forms of therapy have been
(17:00):
tried with misophonia, things like hypnotherapy, biofeedback, and neurofeedback. Sometimes
you need a combination of specialists to help you, an
audiologists who specializes in ear issues, a psychologist, and even
sometimes in odolaryngologist who is a type of physician who
(17:21):
deals with ear issues. You could also visit the Misophonia
Institute online to learn more about the condition and what
can be done to help it. This institute includes a
treatment provider directory that lists providers based on your location
and also their profession and their specialization. They can assess, manage,
(17:44):
and then select a training and treatment that can be
done remotely by phone or online. And importantly, they do
offer resources for children who sometimes do develop missophonia in
terms of comedy at school and also parenting coaches. So
if you're a parent struggling to find help for your
(18:06):
child living with missophonia, this could be a good option
for you. Do you have a problem I can help with?
If so, email me at how Can I Help at
senecawomen dot com. All centers remain anonymous and listen every Friday,
to how can I help with me Doctor Gail's Saltz
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