Misophonia: what it is, symptoms and treatment

Oxford Health NHS Foundation Trust, in the information from its specialist psychology service OHSPIC, describes misophonia as an extreme emotional reaction to certain everyday sounds that most people would find relatively easy to ignore. Many people find noises annoying, but people with misophonia describe an intense feeling of disgust, anger, distress or panic that escalates while the sound is still present, even when it is at a very low volume.

Misophonia means "extreme dislike of sound". Misophonia UK, a charity, notes that the term was coined by the US scientists Pawel and Margaret Jastreboff in 2001. A UK case-series paper by Oxford Health and South London and Maudsley clinicians describes it as a disorder characterised by a decreased tolerance to certain sounds, typically repetitive, everyday sounds that most people would find neutral or mildly aversive.

Oxford Health says the three main types of sound that disturb people with misophonia are eating sounds, nose and throat sounds, and repetitive environmental sounds such as keyboard tapping and rustling paper. Many people also report reacting to repetitive movements (misokinesia), such as leg shaking, fidgeting or blinking lights.

The reaction is both emotional and physical, with sensations similar to a flight or fight response.

• Intense disgust, anger, distress or panic that escalates while the sound continues.

• Racing heart, shortness of breath, tension and feeling hot.

• Feeling trapped, helpless and out of control when you cannot get away from the sound.

• Anxious anticipation of sounds before they happen, and replaying them afterwards.

• Guilt or embarrassment about your own reactions, and verbal outbursts.

• Avoiding things you would otherwise like to do for fear of meeting trigger sounds.

There is no single established treatment. Oxford Health says there is some evidence that cognitive behavioural therapy (CBT) can help, and is likely to be especially helpful for those with more severe misophonia that significantly disrupts daily living or causes distress on most days. It suggests therapy may help if the impact of the sound exists even when the sound is not present, for example taking a long time to wind down, worrying about sounds in advance, or lasting impacts on work or relationships.

The Oxford service says there is not one set protocol, because misophonia is influenced by a person's past experiences, current circumstances, beliefs and personality. Its CBT includes setting goals, testing ideas through experiments, identifying and understanding emotions, using imagery to reduce reaction intensity, processing anger, developing ways to communicate with important people to gain support, and working out suitable accommodations.

A UK service evaluation published in 2023 looked at 19 patients treated with one-to-one formulation-driven CBT in an NHS specialist psychology service. Patients completed an average of 13 hours of therapy, and scores improved significantly on both misophonia measures used. It was a small retrospective evaluation, so the findings are preliminary. The paper also notes there is currently no consensus on the best treatment approach.

Misophonia UK reports that tinnitus retraining therapy, CBT and psychotherapeutic hypnotherapy have been reported as beneficial to some people, but says long-term effectiveness needs confirming with properly funded research.

The cause is not established. Oxford Health says it thinks that at the core of misophonia is a variation in sensory processing, including heightened attention to certain sounds that could signal potential contamination or a potential predator. It notes that this aspect of sensory processing might not be directly changed by therapy.

It also says individual differences are large: some people react more strongly to sounds made by those close to them, others to strangers; some have been bothered for as long as they can remember, while others recall reactions getting much worse at a particular time or after a particular event.

There is no blood test or scan. Oxford Health says its assessment uses standardised questionnaires to assess the severity of the problem, its impact on daily life, associated thoughts and beliefs, and other difficulties. It says an individual may be considered to have clinically significant misophonia when it causes frequent distress and affects daily living, work, study and/or relationships.

Misophonia UK advises going to your family doctor first, who can refer you to an appropriate specialist if necessary, and notes that many family doctors have not heard of the condition. It suggests asking for referral to an audiological physician or an ear, nose and throat consultant, or to psychology services.

Oxford Health says people might report low mood, anxiety, sleep problems, family tensions, inability to relax in the home and trouble focusing. At the more severe level, people may be unable to work or attend school, have trouble maintaining relationships, feel near constant distress, and may contemplate ending their life.

If you are having thoughts of ending your life, contact your GP or NHS 111 urgently, or call 999 if you are in immediate danger.

Misophonia UK says the age of onset is often around 10 to 12 and that it can affect children and adults. Oxford Health notes that some people have been bothered by sounds for as long as they can remember.

If a child is distressed by sounds, struggling to eat with the family or avoiding school, speak to their GP or school nurse, and write down which sounds and situations cause the problem so that a professional can see the pattern.

Oxford Health stresses there is no one protocol. Misophonia UK says that while many treatments do not cure misophonia they can help mask the offending sounds, and that coping skills can help people and those around them.

Elements of the Oxford CBT programme give a sense of what practical coping looks like: developing ways of communicating with important people to gain appropriate support for sound sensitivities, reclaiming time when there are no sounds present, and working out suitable accommodations that minimise the impact of sounds. These are not a substitute for professional assessment if misophonia is affecting your work, school or relationships.

On the NHS, you would usually begin with a GP, who may refer you to psychological therapies, audiology or ENT. Some NHS trusts, such as Oxford Health NHS Foundation Trust through OHSPIC, have specialist psychology services that treat misophonia, but access depends on local commissioning and referral routes.

Private psychologists and audiologists also see people with misophonia. Check the practitioner is registered with a professional body such as the HCPC, ask what approach they use and how progress will be measured, and be cautious of any service that promises a cure.