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Misophonia treatment should be explored within a neurodiversity paradigm.
Misophonia, or ‘hatred of sound’, is a neurological condition characterized by an intense emotional reaction to everyday sounds such as the sound of eating, typing on a keyboard or coughing. People with misophonia experience strong negative emotions when they hear these sounds; these reactions can range from mild annoyance to intense rage or fear and panic. Those who suffer from this condition often experience social isolation due to their inability to cope in settings with loud noises or conversations.
Unlike other forms of ‘hearing difficulties’, people who has misophonia do not have difficulty hearing sounds; if anything they hear sound more intensely. It is likely a neurological condition, but their reaction to sounds occurs on an emotional level.
An approach that honours neurodiversity seeks to understand misophonia within the context of neurological differences rather than mental illness. Through this lens, you can exploe not just traditional medical care but also alternative therapies including sound therapy and mindfulness-based interventions. Neurodiversity-informed misophonia treatment can be potentiallyy beneficial for reducing symptoms of misophonia and improving quality of life.
Growing up with misophonia
Was quite a difficult sensation,
Sounds that would fill me with rage
Set off angry feelings on my page.
It felt like the world was so loud,
Making it difficult to stay proud,
People looking in don’t understand,
What it’s like living with such a demand.
Triggers take me by surprise,
I’ve had to develop strategies to survive.
But now I know how best to cope
With this condition I cannot elope.
Misophonia test: Might you have Misophonia?
Here is an inofficial Misophonia test; please note that this is for informational purpose only, NOT a diagnostic tool.
– My life is affected by my problems with sounds in the world.
– My difficulty tolerating certain noises makes me not want to leave the house.
– I am bothered by the sounds of people eating or chewing.
– When I sit next to my intimate partner, the sounds they make – breathing, fidgeting, coughing – bother me.
– I hate it when people clear their throats or snort; I get fixated on it and can not relax.
– I hate seeing repetitive movements in people. For example, when they click a pen, tap their finger, or wiggle their legs .
– I can only work in silence. Even the sound of a fan or refrigerator disturbs me .
– Even sounds from nature, such as barking, wind, leaves and trees, disturb me.
– It is difficult to live with someone because everyday noises, such as walking or typing on a computer, bother me and I cannot concentrate.
– I am annoyed when people speak with a particular intonation.
– I have to have a silent clock; I can not be in the same room with a clicking clock.
– I feel like no one really understands that I have a problem with noise and they think I am being dramatic.
– I panic when I know I am going to be in a room with sounds I hate.
– I have a hard time working in an open office because of my sensitivity.
– I am afraid that there is something wrong with me.
– I alienate myself socially to find more peace of mind.
– I feel guilty because I get annoyed by the sounds my friends and housemates make, even I do like them as people.
– I feel enraged just thinking how selfish some people are as they are not aware of the noise they make.
– I feel compelled to ask people to stop making certain sounds (e.g. clicking a pen) but I don’t feel assertive enough to do so.
– I feel extremely alone in the world because no one understands what I am struggling with.
– I have tried everything from earplugs to noise-canceling headphones, but with little success.
– Sometimes I wonder if I really love my partner because sometimes I do not want to be in close proximity with them.
– I have tried to seek help, but the conventional doctors do not understand my struggles.
– I feel defective as a person and I worry my issues are not legitimately medical.
If you identify with more than 6-8 items above, it is worth looking into an official misophonia test or assessment, to see if you can get a diagnosis.
If you want to do other validated tests, online and offline, here is a link to some rather thorough resources.
Hyper-sensitivity and Misophonia
Misophonia is a neuro-otological diagnosis in which certain auditory stimuli are being interpreted by the brain as threats. The condition was established in 2001 by American otolaryngologists Pawel and Margaret Jastreboff. They observed that some people reacted to sounds such as chewing, keyboard typing, and coughing, with high levels of irritability, elevated heartbeat, muscle tension and sweating, along with other stress responses and strong negative emotions.
Although the exact cause of misophonia is not yet known, there are several theories about it. Some suggest that it may be related to hypersensitivity of the central nervous system or overactivation of certain brain regions in response to auditory stimuli.
‘Hypermirroring’ and Misophonia?
Interestingly, some recent research has found a link between having a hyper-sensitive and highly activated mirror neuron system and misophonia (Kumar et al., 2021; The motor basis for misophonia). The mirror neuron system (MNS) is a neurological system that consists of neurons that are believed to enable the ability for humans and other animals to recognize, understand, and empathize with the actions of others. This is also the mechanism behind emotional empathy. It makes sense, therefore, to draw a potential link between hyper-empathy as a trait and misophonia.
Many people with Borderline Personality Disorder has been found to have a highly active mirror-neurons system (Z Sosic-Vasic, 2019), which makes them more prone to emotional contagion and be affected by other people’s feelings, especially negative ones.
It wouldn’t be surprising, therefore, to say people misophonia is common in highly sensitive people, in the gifted,and in people who are hyperempathic. People who are diagnosed by Borderline Personality Disorder may also be more prone to suffering from misophonia.
Other theories suggest that psychological factors such as negative experiences with noise in childhood, trauma, or even a genetic predisposition may be the cause.
Understanding this etiology may also inform how we plan misophonia treatment for ourselves.
Misophonia Treatment: From Conventional to Alternative
When it comes to finding the right misophonia treatment, there is no magic formula. One of the most common forms of treatment that doctors prescribe for misophonia is cognitive behavioral therapy (CBT). Cognitive behavioral therapy helps sufferers understand their reactions to certain sounds and learns how to better manage those reactions. In addition, medications may be used to reduce anxiety symptoms associated with misophonia. Other therapies include sound therapy, music therapy, and lifestyle changes such as avoiding trigger sounds or using noise-canceling earplugs or headphones, if needed.
Another alternative treatment is tinnitus retraining therapy (TRT).
Tinnitus Retraining Therapy (TRT) was developed in the 1990s to address a common problem associated with misophonia – tinnitus. Tinnitus is a hearing disorder characterized by persistent ringing or other sounds in the ears. TRT works with a combination of cognitive behavioral therapy and sound therapy to reduce the emotional response to the tinnitus, improving the patient’s ability to cope with their symptoms. TRT combines counseling and sound therapy to retrain the brain so that the person can better cope with their condition. The steps of this treatment are simple, but they require consistency and commitment to be successful.
Another option for treating misophonia symptoms is mindfulness and meditation techniques such as mindfulness-based stress reduction (MBSR).
Misophonia Treatment vs Hyperacusis Treatment
Hyperacusis is a condition that comes from a difficulty in the way the brain’s central auditory processing centre perceives noises.
Individuals with hyperacusis have difficulty tolerating sounds that do not seem loud to others, such as the noise from the dishwasher, fan on the refrigerator, or shuffling papers. Such sensitivity to the most ambient noise can have a huge impact on the person’s day to day activities. Hyperacusis may be a result of injury or trauma and can develop gradually over time. Conditions associated with hyperacusis include: Post-traumatic stress disorder, Chronic fatigue syndrome, Epilepsy, Tinnitus, Migraine headaches and Depression. Currently, there are no specific corrective surgical or medical treatments for hyperacusis. However, sound therapy may retrain the audditory processing centre of the brain to accept everyday sounds. This works on the basis of neuroplasticity (Brout, 2018).
Hyperacusis and misophonia are different conditions. Unlike people with hyperacusis, individuals with misophonia respond particularly strongly to repetitive and pattern-based sounds. In hyperacusis, the response to the sound was felt as physical pain in the ear canal. In misophonia, the reactions were more emotional, involving fear, panic and irritability, and go alongside other physical stress reactions such as racing heart and tight chest, but dissipate when the noise goes away. In hyperacusis, the louder the noise, the greater the pain, while in misophonia, it was not the loudness that constitute the reactions; Regardless of the sound’s loudness and frequency, the emotional response and whole-body contraction are instantaneous.
However, the treatment propocal for misophonia and hyperacusis often overlap.
Misophonia Treatment and Understanding Within a Neurodiversity Paradigm
The neurodiversity paradigm may help to explain misophonia. People’s brains differ. Some people are born with a biochemical or neurological makeup that makes them more emotionally or intellectually intense, sensitive, and susceptible to external stimuli than the general population.
Neurodiversity is a biological reality; the term refers to the infinite variation in our human functions. The notion that there is a single “normal” or “healthy” way of perceiving and being in the world is, in fact, a cultural construct (Foucault).
Many people feel as if they are shooting in the dark when it comes to seeking misophonia treatment because conventional doctors misunderstand them or conventional medicine does not help them. Understanding of mental health and health is frequently limited to categorizing people based on a disorder or diagnosis. While obtaining a formal diagnosis has tremendous value (accessing the right treatment, feeling validated for the difficulties, realizing one is not alone, research), such a ‘one size fits all’ mentality has its limitations.
A part of an effective misophonia treatment protocol would include reframing the meaning of having misophonia. The neurodiversity paradigm proposes that the diversity embedded within us, while difficult to navigate at times, makes us stronger as a species, as communities, and as individuals. Having a group of people who function more intensely in the world is not only a natural form of human diversity, but it is also an important factor in our evolution and the advancement of our collective consciousness. This viewpoint contradicts the medical model, which holds that there is a ‘normal’ and desirable way of functioning and that the rest are disorders. Understanding individual differences within a neurodiversity paradigm can be invaluable in that they can help you make sense of your life history.
Taking a strength-based, postmodernist misophonia treatment approach encourages you to look at your condition from a new perspective and view it as an opportunity for personal growth instead of a hindrance.This may include practically understanding more about what misophonia is and how it affects day-to-day life. Practicing self-compassion may also help you move beyond feelings of helplessness or frustration when encountering triggering noises.
Thin Skin vs Thick Skin
Thin Skin vs Thick Skin: People with ‘thin skin’, or ‘thin boundaries’ are more sensitive than those with thick skin or thick boundaries. Their bodies and brains absorb and feel more signals from their surroundings. They react strongly to sensory stimuli and can become irritated by things like bright lights, loud sounds, particular aromas, tastes or textures.
Understanding the concept of ‘having thin skin’ may helps us understand misophonia.
Thin Skin vs Thick Skin comes from the Boundaries in the Mind concept, developed by Ernest Hartmann. Boundaries in the Mind is a concept that characterises the way a person operates in the world, particularly how that person handles energies and feels the tone of his or her surroundings: To what extent are stimuli “let in” or “kept out”? How are a person’s feelings processed internally?
“There are people who strike us as very solid and well organized; they keep everything in its place. They are well defended. They seem rigid, even armoured; we sometimes speak of them as “thick-skinned.
At the other extreme are people who are especially sensitive, open, or vulnerable. In their minds, things are relatively fluid… such people have particularly thin boundaries.”
The colloquial term ‘having thin skin’ may have a scientific basis. Since its discovery in the 1980s, at least 5,000 people have taken Hartmann’s Boundary Questionnaire (BQ) and more than 100 published papers have referenced it. Research is mounting to build a picture of issues and symptoms that are associated with the ‘thickness’ of mind-boundaries.
Having thin skin, or having thin boundaries not only means you may have misophonia, but it also means that globally, you are highly sensitive and may demonstrate the following from an early age:
- Reacting more strongly to sensory stimuli and becoming agitated due to bright lights, loud sounds, particular aromas, tastes or textures.
- Responding more strongly to physical and emotional pain in themselves as well as in others.
- Becoming stressed or fatigued due to an overload of sensory or emotional input.
- Be more allergic and have immune systems that are more reactive.
- Be more deeply affected by events during childhood.
People with thick skin, in contrast, may have the tendency to:
- Brush aside upsetting emotions, in order to solve the problem at hand or to get practical matters in order.
- Have less apparent mood swings, are slower to recognise how and what they are feeling.
- Less sensitive to subtle changes or nuances in their environment.
- May experience an ongoing sense of detachment and sometimes emptiness.
- It is worth pointing out that people with thick boundaries are affected by feelings as much as people with thin boundaries. In experiments, this was indicated by bodily signals such as heart rates, blood pressure, hand temperature and tension.
Interestingly, significantly thinner boundaries were found in the following population:
– art students (Beal, 1989, Hartmann, 1991)
– music students
– mixed groups of creative persons (Beal, 1989)
– frequent dream recallers (Hartmann, 1991, Hartmann Elkin, & Garg 1991)
– adults and adolescents with nightmares (Hartmann, 1991, Levin, Galin, & Zywiak 1991; Galvin, 1993)
– male and female fashion models (Ryan 2000)
– persons with unusual mystical experiences (Krippner,, Wickramasekera, Wickramasekera, & Winstead, 1998),
– persons with a diagnosis of Borderline Personality Disorder, Schizoid Personality Disorder or Schizotypal Personality Disorder (Hartmann, 1991).
On the other hand, groups that score significantly “thicker” on the inventories include:
– naval officers
– persons with a diagnosis of Obsessive-compulsive Personality Disorder
– persons suffering from “Alexythymia” (Hartmann, 1991)
– patients with a diagnosis of Sleep Apnea (Hartmann, 1992).
Having thin skin may have implications beyond psychology. The concept of mind-boundaries is unique in that it also ties in with an impact on physical health— which is when misophonia might come in. It was found that thick boundary people are more prone to hypertension, chronic fatigue syndrome, and ulcers; whereas thin boundary people are more susceptible to migraine, irritable bowel syndrome, and allergies. There also appears to be a relationship between thin boundaries and multiple chemical sensitivities (Jawer, 2001).
In their work ‘Your Emotional Type’, Dr. M. Jawer and M. Micozzi pointed out that being aware of your emotional type (where you are on the mind-boundary spectrum) would allow you to access the kind of support that is more likely to benefit you. This applies too, when you are seeking misophonia treatment that is right for you.
Although physiological responses are induced as a result of triggering noises, misophonia is neurological in nature and is not a psychiatric disorder. Therefore, some people also argue that psychological interventions such as ‘Exposure Therapy’ actually make the condition worse rather than better.
Interestingly, a survey suggests that people with thin boundaries are more likely to value psychotherapy, to have been involved in psychotherapy, and to have benefited from psychotherapy (Hartmann, 1996). In other words, people with thin boundaries likely make up the majority of therapy clients. Despite its limitations (lack of quantitative data, inevitable generalisations), the idea of mind-boundaries offer a unique framework that can enhance therapy effectiveness by valuing individual differences. It also means that you might benefit from the right kind of psychotherapy as a part of your misophonia treatment plan, especially when it comes to dealing with the feelings of shame and guilt that comes with being wired differently.
Do You Have Thin Skin or Thick Skin?
For a quick reference, here are a few items listed on the boundary inventory. For further information please refer to ‘The Emotional Type’ developed by Dr. M. Jawer and M. Micozzi :
- My feelings blend into one another.
- I am easily hurt.
- I spend a lot of time daydreaming, fantasizing or in reverie.
- Sometimes it’s scary when one gets too involved with another person.
- A good parent has to be a bit of a child, too.
- I can easily imagine myself as an animal or what it might be like to be an animal.
- When something happens to someone close to me, it is almost as if it happened to me.
- In my dreams, people merge into each other or become other people.
- There are no sharp dividing lines between normal people, people with problems and people who are considered psychotic or crazy.
- I am far from a down-to-earth, no-nonsense kind of person.
- I have had the experience of someone calling me or speaking my name and not being sure whether it was really happening or whether I was imagining it.
To read more, here is an interview I did with Michael Jawer, a writer and researcher whose works explore the idea of thin skin vs thick skin. In this episode, we discussed:
— The concept of energetic boundaries; What it means to have thick/ thin skin
— What is Alexithymia— when people can’t name their feelings
— How having thick/ thin skin affects your physical symptoms; e.g migraines, allergies
— The relationship between boundaries and MBTI Personality types
— Who are the orchids and the dandelions
“I’ve never gotten thick skin. If you close yourself off and you get this protective armour, there is a price you pay with that – of not feeling. And the feeling is important when you are a songwriter.” – Taylor Swift
Misophonia Treatment: Healing Thin Energetic Boundaries
In their seminal work ‘Healing Developmental Trauma’, Heller and LaPierre (2012) discuss the idea of ‘energetic boundaries’ and how these boundaries can be compromised. People with misophonia are also more likely to have thinner energetic boundaries. So a misophonia treatment protocal can also be informed by how we can heal and resume more intact boundaries.
Our energetic boundaries constitute the three-dimensional space that is above us, below us, and around us. It buffers us and regulates our interaction with other people and the environment. We are all to some degree aware of the impact of a compromised physical body— try imagining someone standing too close to you in public transport. However, unlike physical boundaries, energetic boundaries are invisible. Thus, the experience of a boundary rupture can be puzzling and distressing. For instance, you may not be able to recognise clearly when and how your energetic boundaries are being violated.
People with intact energetic boundaries are able to have an internalised sense of safety, and a capacity to set appropriate limits with others and the world around them. However, where there is a chronic early threat, you may struggle to fully develop these energetic boundaries. If you were born sensitive, with thin skin, trauma will further weaken your energetic boundaries.
With thin skin and ultra-thin energetic boundaries, you will physically become extremely sensitive to your surroundings. This phenomenon is also experienced by those who identify as empaths. Sometimes, you can appear ‘psychic’ and be able to energetically attuned to others and the environment. On the flip side, you can feel swamped or invaded by other people’s energies and emotions. Having thin skin or thin energetic boundaries can also lead to the feeling of “spilling out” into the environment, not knowing the difference between self and other, inner from outer experiences.
Environmental sensitivity is another telling sign of having compromised energetic boundaries. Because intact energetic boundaries are needed to function to filter environmental stimuli, without it, you may feel extremely raw, as if you are ‘walking around with no skin’. With very thin skin, you may feel constantly flooded by environmental stimuli, including ‘human contact, sounds, light, touch, toxins, allergens, smells, and even electromagnetic activity’ (Heller and LaPierre, 2012, p. 157).
The inability to filter external stimuli makes the world seem continuously threatening, leading to a constant state of tension and hypervigilance. As a result, you may feel the need to isolate yourself. As you don’t have an adequate internal sense of safety and energetic boundaries to count on, you may have defaulted to using minimising contact with other human beings in order to feel safe.
Here are some of the questions drawn from a Checklist developed by Heller and LaPierre (2012) on symptoms that may indicate difficulty with the connection (with self and others) due to early trauma.
• Do you suffer from environmental sensitivities or multiple allergies?
- Do you have migraines, chronic fatigue syndrome, irritable bowel syndrome, or fibromyalgia?
- Did you experience prenatal trauma such as intrauterine surgeries, prematurity with incubation, or traumatic events during gestation?
- Were there complications at your birth?
- Have you had problems maintaining relationships?
- Do you have difficulty knowing what you are feeling?
- Are you particularly sensitive to cold?
- Do you often have the feeling that life is overwhelming and you don’t have the energy to deal with it?
- Are you troubled by the persistent feeling that you don’t belong?
- Are you always looking for the why of things?
- Are you uncomfortable in groups or social situations?
- Does the world seem like a dangerous place for you?
Many people with compromised energetic boundaries can also have misophonia. Neuroscientists have long been investigating the different ways in which our nervous system reacts to sounds, and have found that certain people are more auditory sensitive than others; their auditory systems are described as being ‘over-responsive’ to stimuli (Auditory over-responsiveness), which is associated with misophonia.
Misophonia Treatment- DIY Resources
According to the Misophonia Management Protocol (MMP), one management approach is to add background noise to your day to day life, combined with some form of cognitive therapy. Here are some products that you may find helpful:
The sound of rushing air (white noise) is produced in 10 unique variations. It is one of the more powerful models and is loud enough to cover day-to-day noises. Generally widely recommended by reviewers. This is an international model and would require an adapter.
DOHM is slightly different to the Lectro Fan. The sound is not electronically generated. I personally prefer Dohm as it feels more ‘natural’- it is literally just ‘a fan in a box’. It is much quieter, though. It comes with two speeds and adjustments for volume and pitch.
Misophonia Treatment- What to do From Here
Misophonia is a kind of invisible disability.
Having an invisible disability can be incredibly lonely. People with an invisible disability have no physical signs of the illness or impairment to alert those around them to what they are going through. It is often difficult for other people to understand, leaving those affected feeling isolated and lonely.
Social interactions become challenging when you have misophonia. The feeling of being excluded from society can be exacerbated if you do not have access to support systems that would allow you to cope better and interact more confidently in a social setting.
With misophonia, you may also experience stigma from your family members or peers who may think you are exaggerating your symptoms or using them as an excuse.
Accepting any ‘disability’ or ‘condition’ can be incredibly difficult and emotionally overwhelming. Yet it can be liberating to have a name for what you have suffered from all your life and to know that you are not alone.
It’s important to try to accept the condition without fighting it. That way, we can move forward with an action plan that maximizes our chances for better wellbeing and a good life.
Being organized and prepared for triggers is of the utmost importance. This includes changing your environment, such as using noise-canceling headphones or reducing the amount of time you spend in noisy environments. Make sure you are always prepared – take earplugs and headphones with you when you go out, and take it as seriously as a diabetic needs insulin. (Personally, I have found noise-canceling headphones to be very useful. My favorite brand is Bose. In the noisiest environments, I pair them with a white noise app or a white noise video on YouTube to help me cope with the noise.)
Misophonia is a condition that can be difficult to explain and understand. Your family may not fully understand misophonia, but it is worth talking to them and showing them official documents or sources that show what you are going through. Even if they can not do anything to help you directly, their understanding can make you feel more supported. As much as possible, let them know that this is a neurological condition and not a conscious decision. You are not intentionally trying to be difficult!
As it is not a choice, there is also no need to feel guilty or ashmed for honouring your needs. If you need a quiet space to work, or downtime to recuperate from the noise of the world, it is within your right to do that. You are not hurting anyone.
You may find that you cannot help but feel that ‘there is something wrong with me.’ One of the best ways to cope with shame is through self-compassion. Taking time for yourself, speaking kindly to yourself, and being mindful of your feelings can help you stay connected with your emotions without getting overwhelmed by them. Would you judge your own child or a friend harshly for their disability? Probably not. Can you extend that kindness to yourself? Another important way to handle shame attacks is through connection and communication with those around you. Talking openly about what makes us feel ashamed can counter-intuitively takes away some of the power that shame has over us.
It can be incredibly difficult for people with misophonia to work in an environment where they are constantly surrounded by noises that trigger negative reactions. Having an open conversation with yor boss about misophonia can be beneficial for both sides. They will have a better understanding of your needs and what accommodations may need to be made in order to ensure a productive workplace. You may feel more comfortable discussing strategies that can help and wouldn’t affect others, such as noise-canceling headphones or moving desks away from noisy areas in the office. Even if your boss does not really understand what misophonia is, that doesn’t mean they cannot make reasonable adaptations for you. When necessary, you can also speak to Human Resources about your right to reasonable adaptations.
Each person is different. You may have to experiment with different things to find what works best for you.
Most importantly, please remember that just because you have misophonia does not mean there is something inherently wrong with you. Having certain sensitivities or needs makes you unique and may even help you be a stronger, more assertive person who stands up for their rights. No one should ever feel ashamed or embarrassed because their needs differ from others around them – instead, recognize yourself for all of your qualities, even when some of them are a little more inconvenient.
Written by Imi Lo.
Imi Lo is a consultant and published author with extensive and international experience in mental health and psychotherapy. Her books Emotional Sensitivity and Intensity and The Gift of Intensity are available worldwide and in multiple languages. Imi has two Master’s degrees; one in Mental Health and one in Buddhist Studies. She works holistically, combining psychological insights with Eastern and Western philosophies such as Buddhism and Stoicism.