It's Sunday lunch, the whole family is at the table and someone is eating crisps. Every crunch runs down your spine. Your face gets hot, your shoulders tighten and a wave of anger rises from somewhere you can't place. You know perfectly well that this person isn't doing anything wrong, they're just eating, and still it takes everything you have to stay in your chair. If this happens to you a lot, you may have misophonia.
It has little to do with bad manners or with being a fussy person. It's a very strong reaction to specific sounds, almost always everyday ones, and it can make family life, work and even seeing friends much harder. In this article I'll explain what misophonia is, which sounds set it off, what we know about why it happens and how it's treated.
What is misophonia?
The word comes from Greek and literally means "hatred of sound". It was first used in the early 2000s by Pawel and Margaret Jastreboff, two researchers who worked with people with tinnitus and problems tolerating sound. For years it got little attention, until in 2022 an international group of experts published a consensus definition. According to that paper, misophonia is a disorder of decreased tolerance to specific sounds or to stimuli associated with those sounds.
Volume isn't the issue. A colleague chewing gum at the other end of the office can become unbearable, while the noise of a concert or of traffic doesn't set off the same reaction. What matters is which sound it is and, often, who is making it. For now, misophonia isn't listed as a diagnosis in its own right in the DSM-5, the main reference manual in mental health, as the Cleveland Clinic points out. That doesn't stop it from being assessed and treated.
The sounds that set it off
Everyone has their own triggers, but some come up again and again. According to the consensus definition, mouth sounds are among the most often reported, and nose sounds such as breathing or sniffing are very common too. The list usually includes:
- Chewing, especially crunchy food, slurping or lip smacking.
- Heavy breathing, sniffing or snoring.
- Throat clearing or coughing.
- Repetitive sounds, such as a pen clicking, fingers tapping, typing or a clock ticking.
Most of them are made by another person. And because they're part of daily life, they tend to come from the people you spend the most time with, such as your partner, your family or your colleagues. The same sound coming from the TV or a phone can also bother you, though usually less.
When misophonia comes in through the eyes: misokinesia
Some people with misophonia react in the same way to something they see, like a leg bouncing under the table or someone twirling a pen. This is called misokinesia. In three studies with more than 4,000 participants, roughly a third said that seeing other people's small, repetitive movements bothered them to some degree (Jaswal and colleagues, 2021).
Symptoms of misophonia
The reaction is fast, almost automatic, and it shows up on three levels that tend to arrive together.
The first is emotional. According to the expert group, the most common feelings are irritation, anger, disgust and anxiety, and some people feel something closer to rage.
The second is physical. Your muscles tense, your heart speeds up and you may sweat or feel pressure in your chest. It's the fight-or-flight response, the same one your body switches on when it senses a threat.
The third is what you do. Some people leave the room, some cover their ears and some snap at the other person to make the noise stop. Violent reactions are rare, but at home it's easy for things to end in an argument.
Many people know their reaction is out of proportion, which makes it easy to feel guilty once the moment has passed. Over time you also learn to see it coming. Your jaw is already tight before you sit down to eat, you pick the seat furthest from the loud eater or you stop going to work lunches. The team at Amsterdam's university hospital, one of the groups that has studied the condition most, explains that this avoidance ends up leading to isolation and real difficulties getting through daily life.
Why does misophonia happen?
The exact cause isn't known yet, but a few things are clear. The first is that it isn't a hearing problem. In a study of 575 patients diagnosed at the Amsterdam hospital, only 1% had hyperacusis and 2% tinnitus. Hearing tests were done on 109 of them, and only three had any hearing loss, in one ear. Neurological examinations and blood tests were normal as well (Jager and colleagues, 2020).
The second is that it usually starts early, in childhood or early adolescence, and that it may run in families.
What happens in the brain
A team at Newcastle University played trigger sounds to people with and without misophonia while scanning their brains with MRI (Kumar and colleagues, 2017). In people with misophonia, those sounds caused a much stronger response in the anterior insula, a brain area that helps decide what deserves attention and links body sensations with emotions. Their heart rate also went up more, and their skin sweated more. Put simply, the brain flags these sounds as very important, and the body gets ready as if they were a threat.
How common is it?
More common than you might think. In a sample representative of the UK population, a team at King's College London estimated that about 18% of people have misophonia symptoms that place a significant burden on their lives (Vitoratou and colleagues, 2023). The Cleveland Clinic puts it at roughly one in five people at some point in their lives.
Figures vary a lot depending on how it's measured, and the 2022 expert group chose not to settle on one. More women than men reach specialist services. In the large Amsterdam study, 69% were women, with an average age of 34.
Misophonia, hyperacusis and other look-alikes
Several sound-related problems can be mistaken for misophonia, and the expert group stresses that the first step is to tell it apart from hyperacusis. With hyperacusis, sounds feel too loud, even painful, and the louder they are, the worse it gets. With misophonia, what matters is the kind of sound, however quiet, and the reaction is mainly emotional.
It isn't the same as phonophobia either, which is fear of a particular sound, like a fear of fireworks. Misophonia can come with anxiety, but irritation, anger and disgust are what dominate.
In autism, a broader sensory sensitivity is common, where lots of stimuli at once become overwhelming. That's a different thing, although misophonia can also appear alongside autism or ADHD. Something similar happens with highly sensitive people, who may notice noise a lot and tire quickly in busy places. High sensitivity, though, is a temperament trait, not an angry reaction tied to specific sounds, and you can have both.
If, on top of your triggers, all loud sounds bother you, your ears hurt or you hear ringing, see an ear, nose and throat specialist or an audiologist first.
What it often comes with
In the large Amsterdam study, one in four people with misophonia had obsessive-compulsive personality traits, such as a strong need for order and control. Ten per cent had a mood disorder, 5% had ADHD and 3% autism, and almost all of them scored high on perfectionism (Jager and colleagues, 2020). The Cleveland Clinic also lists obsessive-compulsive disorder, PTSD and depression among the conditions that can occur alongside it.
Appearing together doesn't mean one explains the other. The consensus definition makes clear that, to speak of misophonia, the symptoms shouldn't be better explained by another disorder. But if other problems are there, they need to be taken into account in treatment too.
How is misophonia diagnosed?
Because it isn't yet an official diagnosis in the manuals, there's no test that confirms it. A professional identifies it through an interview that covers which sounds bother you, what you feel, how you react, how long it's been going on and how much it limits you. Research uses specific questionnaires, such as the Amsterdam scale (AMISOS-R) or the S-Five, which help to measure how severe it is and to track how it changes.
A good assessment also rules out what isn't misophonia, such as hyperacusis or a hearing problem, and looks at whether there's anxiety, low mood or obsessive traits that need treating at the same time.
Misophonia treatment: what works
There's no pill or trick that makes it disappear overnight. The treatment with the most support is cognitive behavioural therapy (CBT). In 2021 the Amsterdam team published the first randomised clinical trial on misophonia treatment, with 54 patients. Some had weekly group therapy for three months and the others went on a waiting list. By the end, 37% of the people treated had improved to a clinically meaningful degree, compared with 0% of the waiting-list group, and the improvement was still there a year later.
That therapy combined several tools:
- Training attention so it doesn't get stuck on the sound and goes back to what you're doing.
- Learning to bring your body's arousal down.
- Linking trigger sounds to kinder emotions instead of anger.
- Working with the sound itself in a controlled way and changing it, to regain some sense of control.
In practice, treatment is tailored to each person. It often includes work on anger management, looking at the thoughts the sound sparks ("they're doing it on purpose", "I can't stand it") and undoing avoidance step by step, without throwing you straight into the sounds you find hardest. If there's anxiety, low mood or obsessive traits, those are worked on at the same time.
Medication, for now, has no solid studies behind it for misophonia. If there's anxiety or depression as well, it's for a doctor to decide whether it's needed.
Headphones and misophonia: friend or trap?
Noise-cancelling headphones, earplugs or background noise such as white noise can help at specific moments, like in the office or on a long journey, and the Cleveland Clinic includes them among the tools for living with misophonia. The problem comes when they're used so that you never have to be around anyone. If you avoid more and more places and people, your life keeps shrinking, and that's also part of what therapy works on.
What you can do starting today
- Make a list of your triggers and rate each one from 0 to 10. Knowing which are the worst helps you prepare.
- Plan for the moments you can see coming. Some background music at dinner or swapping seats at the table can take a lot of the tension out.
- Stop before you snap. When you feel your body ramping up, step out for a moment, breathe slowly, loosen your jaw and shoulders, and come back once your body has settled.
- Talk about it when things are calm, not in the middle of the sound. "It's not you, it's the sound" lands much better in a conversation than shouted across the table.
- Agree on a signal with the people you live with, like a gesture that means "I need to step out for a minute", so nobody takes it as an attack.
- Use headphones wisely, for specific moments rather than all day.
These ideas take the edge off, but if misophonia is already shaping your life, the most useful thing is to work on it with a professional.
Misophonia in children and teenagers
Because it tends to start between childhood and adolescence, many parents first notice it at the dinner table. Suddenly your child can't bear to hear their brother or sister eat, gets up angry or asks to have dinner in their room. It's easy to read this as a whim or a lack of respect and to answer with "you'll get used to it" or by making them stay.
If you suspect your son or daughter has misophonia, these things help more:
- Believe what they tell you. The reaction is real, even if the sound seems trivial.
- Look for arrangements that make life easier for everyone, like background music at meals or a different seat, without reorganising the whole house around the problem.
- Don't force them to "put up with it" or make fun of it, as that only adds shame.
- Talk to the school if they struggle to concentrate in class or avoid the canteen.
If living together is getting hard or you see them withdrawing, talk to a professional. The parents' guide to teen mental health covers other signs worth paying attention to.
When to ask for help
It's worth seeing someone if:
- You avoid meals, plans or places because of sounds.
- You often argue at home or at work because of it.
- You find it hard to control your reaction and feel bad afterwards.
- More and more sounds are starting to bother you.
- You notice it affecting your mood, your work, your studies or your relationship.
In the large Amsterdam study, the more severe the misophonia, the worse people's quality of life. The Cleveland Clinic also warns that in severe cases the risk of self-harm or suicidal thoughts may be higher. If at any point you think about hurting yourself or ending your life, call 024 (Spain's suicide helpline), which is free and open 24 hours a day, or 112 in an emergency.
Therapy for misophonia in Igualada and online
At my practice in Igualada and online, I work from a cognitive behavioural approach, which is the one with the most evidence for misophonia. First we take a calm look at what's happening to you: which sounds, at what moments, how you react and what you've tried so far. From there we work on attention, your body's arousal, anger and avoidance. If it helps, we have a session with your partner or family so they understand what's going on and you can agree on changes at home. I work in Spanish and Catalan, as a health psychologist. If distance suits you better, here's how online therapy works.
If you recognise yourself in what you've read, there's no need to wait until it gets worse. Get in touch and, in a first conversation with no commitment, we'll look at how I can help.