Can you please chew more quietly?

Hearing loss and calls for the funding of hearing aids has been in the news lately,  but there's a condition that affects people who almost hear too well, for whom certain sounds not only drive them to distraction but seriously impact their quality of life.

Most, if not all of us, dislike certain sounds more than others: the open mouth chew, the phlegmy throat clear, the sniff, the keyboard tap-tap-tap, the clicking of a pen, the dripping tap, the ticking clock and so on. But for upward of 10 percent of the population, hearing these types of sounds create extremely strong negative emotional reactions: hate, anger, disgust, rage.

This hatred of sounds, usually human-made sounds and sometimes the sounds created by specific people, is called misophonia. Misophonia is a disorder of decreased tolerance to specific sounds or stimuli known as ‘triggers’. Like many sensory disorders, misophonia exists on a continuum from slight annoyance to reactions so strong that they interfere with a person’s ability to live life normally.

A person with misophonia may not be able to visit a café or sit and have dinner with the family because of hearing, seeing, chewing, and slurping. Misophonia may impair concentration at work or school. Some people will even have violent reactions to trigger sounds. Self-generated sounds (one’s own heavy breathing, one’s own noisy chewing) don’t typically evoke the same reactions to those made by other people.

Selective sensitivity to triggers was first given the name misophonia in the early 2000s by doctors Pawell and Margaret Jastreboff. In the intervening 20 years there has been a huge growth in research, recently aided by philanthropic funding by organisations such as the USA-based Misophonia Research Fund. What do we know about this condition? We do know misophonia usually first appears in adolescence and that brain networks associated with salience, attention and emotion are overactive and highly connected. People with misophonia find it extremely difficult to ‘switch off’ from trigger sounds.

Misophonia is diagnosed by clinical interview and questionnaires. The assessment tries to identify the sounds causing problems and why people have such strong reactions to certain sounds.

There is no single gold standard treatment for misophonia. Medications, such as anti-anxiolytics, try to reduce reactions, not the cause. Wearing earplugs seems an obvious solution, but this can create even greater sensitivity to the sounds people are trying to block out. Understanding what specific triggers are and how they can be reduced can help – such as choosing seats in a restaurant away from where most activity is or sitting outside where it’s less noisy.

Relaxation or mindfulness strategies can help when exposed to a trigger that can’t be avoided. People, or families, coping with misophonia need to be open to explaining the condition to others so that they can be considerate in interactions and understanding that some sounds create anger.

If you’re having difficulty coping with the sounds of other people and need strategies to manage its affects you could visit a psychologist. However, most current therapies focus on the reaction to triggers not the cause.