Misophonia is not a disease, but a disorder in which individual sounds are perceived as distinctly unpleasant and cause anger. The causes are not yet clearly understood, but the prospects for treatment are good.
What is misophonia?
Misophonia translates as “hatred of sounds.” Affected individuals react aggressively when they hear certain sounds. These may be eating sounds such as smacking, slurping, chewing, or other sounds such as sneezing, clearing the throat, or lifting the nose. Misophonia was first studied and named by the American neurophysiologists Pawel and Margaret Jastreboff. Today, selective noise intolerance is often used in this context. The selectivity consists in the fact that only certain noises are experienced as enervating. Sometimes the literature neglects the fact that extreme negative reactions occur especially when the sounds are produced by certain persons like the father or the partner. Lowered tolerance to certain sounds and the resulting anger should be distinguished from hyperacusis (general hypersensitivity to sounds that other people do not find loud and disturbing) and from phonophobia (fear of specific sounds).
Causes
Childhood experiences are thought to cause misophonia: If there was a problematic father-child relationship and the father slurped soup at lunch, then similar noises may cause anger in the current spouse. In addition, sexual abuse can also be responsible for a fellow spouse’s heavy breathing later being perceived as hateful. Every time the stimulus or the sound is perceived, the negative reaction sets in “as if by itself”. Those people who begin to suffer from misophonia often already have an obsessive-compulsive disorder. Perfectionists are particularly at risk because they also assume that there is a perfect way of eating, chewing, drinking, coughing, etc. that everyone else must follow. Selective Noise Intolerance is not caused by a hearing disorder. According to a study by brain researcher Sukhbinder Kumar of Newcastle University, it is due to a brain disorder. However, this theory is controversial.
Symptoms, complaints and signs
The literature cautions against pathologizing discomfort caused by sounds. This is appropriate in that many people have unpleasant childhood memories associated with noise, and all urban dwellers must live with a wide variety of noises. However, when reading the literature, one sometimes gets the impression that misophonia is trivialized. Those affected are not taken seriously and are labeled as “oversensitive. The decisive factor is the pressure of suffering, which can manifest itself in massive avoidance behavior: People are reported who have not eaten together with their families for many years. Others make violent scenes to their partners or do violence to them when they make them angry with their noises. The suffering can also be measured objectively: When they hear the noises, affected people react with altered skin conductivity, with increased pulse, with sweating and with muscle tension. Thus, nervousness, stress, panic arise.
Diagnosis and course of the disease
Diagnosis involves looking at how people respond to certain sounds: If they feel fear, phonophobia is suspected. If they become angry and the physical symptoms described above are evident, then it is a case of misophonia, which can be pronounced to varying degrees. One can speak of a pathological condition when life is comprehensively rearranged in order not to be at the mercy of any unpleasant situations and noises. Professional difficulties, relationship problems and social withdrawal are the consequences.
Complications
As a rule, misophonia leads to psychological complaints and limitations. In this case, the affected person perceives all sounds in the environment as disturbing and can no longer concentrate properly. Especially in children, this complaint can lead to developmental disorders or social discomfort that significantly reduces the quality of life.Not infrequently, treatment is delayed because those affected are not taken seriously and thus do not engage in proper treatment. Furthermore, the patient may also have an aggressive mood or become irritable, which has a very negative effect on health. Patients also suffer from headaches and sweating or tension in the muscles. Likewise, there is stress and severe nervousness. In some cases, the sufferers may also suffer from panic attacks. A direct and causal treatment of misophonia is not possible. Therefore, treatment always takes place symptomatically and aims at limiting the symptoms. However, this does not always result in a positive course of the disease. Sometimes, those affected are dependent on prolonged therapy so that misophonia can be treated.
When should one go to the doctor?
People who are particularly sensitive to certain environmental sounds should see a doctor. Although misophonia is not a disease in the medical sense, it is still advisable to clarify the symptoms so that organic causes can be ruled out. If there is inner restlessness, behavioral problems or irritability, a doctor is needed. If the auditory perceptions trigger feelings such as aggression, anger or strong despair, a visit to the doctor is advisable. Consultation with a medical professional is helpful if there is internal tension, decreased enjoyment of life, or a lowered sense of well-being. Stress, anxiety, states of panic or nervousness are signs of a present health irregularity. A comprehensive medical examination is needed to determine the cause and initiate countermeasures. Loud palpitations, an increase in pulse rate or other disturbances of the heart rhythm should be medically clarified. If people suffer from the sounds due to their sensitivity, a treatment plan is needed so that an improvement in the quality of life can be achieved. If the affected person shows a withdrawal from social life, hardly visits public places anymore or there are more conflicts as well as interpersonal disputes due to the disturbing noises, a visit to the doctor is recommended. In the event of the use of violence, medical assistance should be sought immediately.
Treatment and therapy
In the presence of misophonia, a behavioral therapy is offered, in the context of which an attempt is made to break the link between stimulus or noise and negative emotion. The method of “counterconditioning” is applied: Individuals suffering from misophonia are confronted with the sounds previously perceived as unpleasant in a new context – associated with positive associations – in order to displace the negative ones with positive reactions. In her treatment method, German acoustician Gabriele Lux relies on providing those affected with soothing sounds (the sound of the sea, etc.) via headphones or via sound generators to be worn behind the ear. The aim is to soften the sounds perceived as stressful and, ideally, to experience them in a new way. In most cases, it is helpful to deal with the specific noise experience that caused the discomfort. This can take place in the context of group or individual therapy with psychologists who specialize in this area. Despite all the measures taken, negative reactions will not be absent in the future, but those affected will be able to absorb the sounds more calmly in the future. Relaxation techniques (progressive muscle relaxation according to Jacobson, autogenic training or yoga) are a useful supplement.
Outlook and prognosis
The prognosis for misophonia is relatively good. The disorder and associated aggression can be treated with relaxation therapies, behavioral therapies, and psychological care. In the course of therapy, those affected also learn to accept the disorder and thus to live more calmly and openly. For patients, this often opens up the opportunity for social contacts and relationships. A prerequisite for a positive course is early treatment. It is imperative that sufferers have their sensitivity to noise treated therapeutically before further mental illnesses manifest themselves. The prolonged stress can also cause physical ailments such as high blood pressure or gastrointestinal complaints.If physical or psychological secondary complaints have already established themselves, this makes treatment of misophonia more difficult. Around 80 percent of all misophonia patients recover from the condition with appropriate therapy. Relapses rarely occur. The prognosis for misophonia is therefore comparatively positive and the prospect of a symptom-free life is given. Life expectancy is not reduced by misophonia. The prognosis is based on the cause and therapy of the misophonia. It is made by the neurologist in charge with the assistance of an ear, nose, and throat specialist.
Prevention
If the main cause of misophonia is concrete noise experiences, then prevention turns out to be difficult. The best prevention is to identify and eliminate the causes of the problem. One way of prevention is to talk to the person making the annoying noises soon and try to find a solution. This will lead to disagreements, but it is unavoidable. If pathological perfectionism or control compulsions are involved in creating the problem, it is necessary to treat these compulsive behaviors.
Aftercare
Since there is no independent cure for misophonia, aftercare focuses on a healthy and prudent lifestyle. If the effects of the disease have led to psychological upset or depression, therapy with a psychologist can be helpful in working through the symptoms and regaining a positive outlook on life. The further course of the disease usually depends very much on the exact cause, so that no general prediction can be made. The extent of aftercare also depends on this.
What you can do yourself
Those affected by misophonia should take their suffering seriously and not trivialize it. This is especially true if certain noises cause severe aggression or if the patient is already beginning to massively rearrange his or her lifestyle in order to escape the hated noises. As a rule, the family doctor can only serve as a first point of contact here. The diagnosis should be left to an expert who also carries out or at least monitors the therapy. Since the disease is rather rare, experienced doctors and therapists for this disorder are not easy to find. If the family doctor is unable to help, those affected can contact the medical association and their health insurance company. Some professional associations, such as the Deutsche Psychotherapeuten Vereinigung e.V. (German Psychotherapists Association), provide tools on the Internet that help in the search for a suitable therapist. In any case, those affected must be prepared for a lengthy behavioral therapy. The success of this therapy can often be promoted by learning relaxation techniques such as yoga or autogenic training. What further self-help measures sufferers can take depends on the sounds to which they react aggressively. However, earplugs from the pharmacy or an iPod that plays favorite music can shield against unpleasant noises in many situations.
