Cognitive Behavior Therapy (CBT)
Cognitive behavior therapy (cognitive therapy, or CBT) is used commonly in psychiatric practice to help individuals change the way they think (called "cognitive restructuring") and behave in certain situations. Cognitive behavior therapy is a widely accepted therapy that can be used to treat any uncomfortable or destructive habit or practice. It is commonly used to treat addictions, eating disorders, mood swings, stress, relationship difficulties, insomnia, anger, and other conditions.
What is misophonia?
Misophonia, which literally means "hatred of sounds," while not yet officially recognized as a distinct psychiatric disorder in medical literature, is a source of great distress and sometimes debilitation in its sufferers. The definition of misophonia, which is often classified as a form of decreased sound tolerance, is severely negative reactions to sounds that have a specific pattern, meaning, and context to the sufferer based on previous experiences. This condition usually entails a number of negative reactions, like anger, agitation, and hatred of particular sounds and is different from hyperacusis, another form of decreased sound tolerance, which is defined as a negative reaction to sound due to particular physical characteristics, like volume, type, and intensity. Misophonia should also be distinguished from phonophobia, which refers to a fear of specific sounds. Similarity in spelling is where the commonality of misophonia and misophobia ends, the latter referring to an irrational fear of being contaminated, dirty, or germy.
While there are few specific statistics regarding how often misophonia occurs in the general population, this form of extreme noise sensitivity has been found to occur in up to 60% of people who suffer from tinnitus, also called ringing in the ears. A sample of college students revealed that this condition may be quite common, as it was found in 20% of that sample.
What are causes and risk factors for misophonia?
While there is no known single cause for misophonia, it is thought to be associated with the way the central nervous system (brain and spinal cord) works rather than any change in its structure/anatomy. Specifically, this disorder is thought to be related to an increase in the hearing (auditory) pathways in the central nervous system, as well as heightened anxiety and other emotional reactions to sounds. People with one hearing disorder may be at risk for another. For example, people with hyperacusis are at a higher risk for tinnitus, hearing loss, and phonophobia.
Behavioral theories about the development of this disorder usually center around becoming conditioned to having an extreme reaction to normal noises in the environment. In other words, it is thought that this illness develops at least partly as the result of the sufferer developing an emotional association between a normal, potentially irritating noise to an aversive physical reaction. The individual may consider this disorder to be caused by what they perceive to be the trauma of hearing normal environmental sounds.
Misophonia tends to co-occur with mental disorders like obsessive compulsive disorder, obsessive compulsive personality disorder, Tourette's disorder, and eating disorders. Girls of prepubescent age have been found to be at higher risk of developing misophonia compared to males and to people of other age groups.
What are misophonia symptoms, signs, and common triggers?
There are numerous potential triggers for misophonia, including everything from:
- nose whistling and sniffling,
- to chewing with one's mouth open,
- talking with food in one's mouth,
- teeth grinding,
- loud throat clearing, and
For example, the person with misophonia may react with fear, irritation, or rage at what they may consider to be annoying popping of gum or loud chewing. He or she may try to distance himself or herself from the trigger or engage in acting out at the source of the sound, as by yelling at or hitting that person. A key aspect of this disorder is that once the sufferer is exposed to what they deem to be an offensive stimulus, the reaction usually begins with irritability or disgust then quickly escalates to an extreme level that is clearly out of proportion to the trigger in terms of anger, hate, and/or disgust. The misophonia sufferer usually believes their response is uncontrollable.
What tests do health care professionals use to diagnose misophonia?
Many health-care professionals, including psychiatrists, primary-care providers, audiologists, speech and language therapists, psychologists, psychiatric nurses, physicians' assistants, and social workers may help make the diagnosis of misophonia. One of these professionals will likely conduct or refer the patient for an extensive medical interview and physical examination as part of the assessment. One of the key aspects of establishing the diagnosis of misophonia includes ruling out other hearing disorders, including age-related hearing loss, tinnitus (perception of sound due to abnormal hearing perception), hyperacusis (decreased tolerance to ordinary sounds in the environment), and auditory hallucinations (hearing things, often voices, that have no basis for perception).
This illness is sometimes associated with a number of other mental-health problems, like depression, bipolar disorder, obsessive compulsive disorder and other anxiety disorders, obsessive compulsive personality disorder, the condition that used to be called Asperger's syndrome, as well as other autism-spectrum disorders. The distractibility that may be exhibited by misophonia sufferers may be misdiagnosed as, or co-occur with, attention deficit hyperactivity disorder (ADHD). Therefore, the evaluator will likely screen for signs of depression, manic depression, anxiety, behavioral disturbances, and other mental-health symptoms. The symptoms of misophonia may also be the result of a number of medical conditions or can be a side effect of various medications. For this reason, health-care professionals often perform routine laboratory tests during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help disqualify other diagnoses.
What is the treatment for misophonia? Is there a cure?
While there is no known specific cure for misophonia and little rigorous (controlled studies) research regarding effective treatments, there are a number of approaches that tend to be used with some apparent success. Tinnitus retraining therapy (TRT) entails teaching people with misophonia how to improve their ability to tolerate certain noises. Cognitive behavioral therapy involves changing the negative thoughts that may contribute to the patient's suffering. Another treatment involves adding background noise to the person's environment in an effort to help them ignore their triggers for negative reactions. Fans and "white noise" machines along with behind the ear noise generators are some such sources of increasing background noise. Since it is thought that this illness develops at least partly as the result of the misophonia sufferer developing a conditioned response to certain noises, an approach that has had some success is the process of deconditioning people with this disorder. Specifically, this form of treatment involves pairing a positive experience with the misophonia trigger.
A variety of medications have been tried to treat misophonia, including those that treat depression and anxiety (like fluoxetine [Prozac], sertraline [Zoloft], or escitalopram [Lexapro]), attention deficit hyperactivity disorder (for example, amphetamine and dextroamphetamine [Adderall], methylphenidate [Concerta and Ritalin]), and bipolar disorder (for example, lamotrigine [Lamictal] and divalproex sodium [Depakote]), as well as dietary supplements like vitamins, minerals, and fish oil. However, medication is not usually used to treat this condition.
What is the prognosis of misophonia? What are misophonia complications?
Complications of misophonia include that the sufferer may become defensive against certain situations, changing their life to avoid experiences that may trigger symptoms. That can result in avoiding socializing with friends or family members, even avoiding sleeping in the same room as a spouse. Those issues can eventually result in problems succeeding in relationships, school, or employment. Fortunately, research indicates that more than 80% of misophonia sufferers can experience significant relief from symptoms if treated.
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Is it possible to prevent misophonia?
Since most of the theories about risk factors for misophonia seem to be biologically based, prevention usually focuses on trying to prevent complications of this disorder rather than the disorder itself.
Peter O’Connor, M.D.
American Board of Otolaryngology with subspecialty in Sleep Medicine
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