Coping Strategies And Mental Health Support For People With Misophonia Symptoms

It can be common for some sounds—like nails on a chalkboard, for instance—to lead to annoyance or discomfort. However, when reactions to certain sounds become overwhelming, persistent, or seemingly uncontrollable, they can be a sign of misophonia. Misophonia (sometimes called selective sound sensitivity syndrome) is when an individual experiences strong adverse emotional, physiological, and behavioral reactions to certain sounds. This article looks closer at misophonia, its characteristics, and the mechanisms behind the condition. It also offers tips on how to cope with misophonia symptoms so they don’t interfere with daily life.

Misophonia can lead to significant distress in daily life

Receive support in online therapy

Misophonia epidemiology

While prevalence rates are still uncertain, a recent large-scale US study from the Misophonia Research Fund found that 4.6% of participants reported having misophonia, while 78.5% said they were sometimes bothered by sounds. Other findings from the Misophonia Research Fund study include the following:

• Females generally experienced significantly more intense misophonia symptoms compared to their male counterparts.
• People aged 18-54 typically experienced more misophonia symptoms than those aged 55 and older. 
• Most study participants reported their first misophonia symptoms occurred in childhood or adolescence.
• Nearly half of the participants reported the first sound that led to misophonia symptoms was the sound of someone eating.
• Roughly 28% of the study participants had at least one family member who also experienced misophonia symptoms.

Is misophonia a mental disorder?

While not formally classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), misophonia is recognized by experts as a condition that can lead to significant distress and interfere with daily life. Some researchers propose that misophonia may warrant future inclusion in the DSM, potentially within the category of obsessive-compulsive and related disorders.

Obsessive-compulsive disorder (OCD) and other conditions associated with misophonia

Misophonia, sometimes called sound sensitivity disorder, is often associated with a range of mental health conditions, including obsessive-compulsive disorder. For example, studies have shown that a significant percentage of individuals with misophonia also exhibit obsessive-compulsive traits and anxiety symptoms. Research also links misophonia to several other conditions:

• Misophonia may have genetic links to anxiety, depression, and PTSD.
• Misophonia tends to be more prevalent in individuals with autism spectrum disorder (ASD), likely due to sensory sensitivities and difficulties with emotional regulation.
• Research suggests a positive correlation between misophonia and attention-deficit/hyperactivity disorder (ADHD).
• Some studies have found a link between misophonia and the severity of borderline personality disorder (BPD) symptoms.

The etiology and mechanisms behind misophonia

Research points to a combination of neurobiological factors and psychological mechanisms as potential causes of misophonia. For example, people with misophonia seem to have increased activity in the anterior insular cortex (AIC), which is key in processing sensory stimuli and assigning emotional meaning to stimuli. Increased activity in the anterior cingulate cortex (ACC), which plays a role in emotional processing and regulating autonomic responses, has also been identified in people with misophonia. Increased ACC activity may explain why some people with misophonia experience exaggerated anger, irritation, or distress when exposed to certain sounds.

Psychological mechanisms like classical conditioning, where a neutral stimulus becomes associated with an unpleasant experience, may play a role in misophonia. Individuals with misophonia may be hypervigilant to specific sounds, constantly anticipating and becoming more sensitive to them. Additionally, some studies suggest a genetic link to misophonia, with research identifying specific genes associated with the condition. 

Recognizing symptoms of misophonia

Emotional, physical, and behavioral misophonia symptoms typically manifest on a spectrum of severity. Strong emotional reactions, like anger, irritability, disgust, or anxiety when hearing specific sounds, are common. Some people have physical reactions like increased heart rate, blood pressure, and body temperature, as well as sweating, muscle tension, tightness in the chest, goosebumps, and a fight-or-flight response. 

Behavioral responses to misophonia can include avoiding situations where sounds that provoke a reaction are likely, leaving a place when a specific sound is heard, or verbally reacting to the sound. Some people may also react to visual stimuli associated with certain sounds. Visual stimuli that can lead to misophonia symptoms may include seeing someone eating or seeing people engage in repetitive movements, like leg shaking or finger tapping. 

Sounds frequently associated with misophonia symptoms

While any sound can prompt symptoms of misophonia, some appear to be more common than others. These include eating sounds (chewing, slurping, crunching) and nasal sounds (breathing, sniffing, sneezing). Repetitive and pattern-based sounds, like tapping or clicking, also frequently lead to reactions in individuals with misophonia. 

How unmanaged misophonia can affect mental health 

Additionally, studies have shown a correlation between misophonia and higher rates of self-harm and suicidal ideation, as well as poorer overall well-being. Some people may experience feelings of shame and guilt if their reactions are extreme or cause distress to others. Guilt, shame, and avoidance of situations where upsetting sounds are common may lead individuals with misophonia to isolate themselves or withdraw from social situations.

How symptoms of misophonia can impact daily life

Strong reactions to certain sounds can strain relationships with family, friends, and colleagues. Symptoms of misophonia may make concentrating difficult, and an inability to tolerate specific sounds can interfere with studying, working, and performing daily tasks. Individuals may actively avoid certain places, people, or activities to minimize distress, potentially limiting their daily routines. While avoidance may provide temporary relief, it can limit participation in life.

Preparing for the Fourth of July: Steps to mitigate noise exposure

The loud, sudden, and unpredictable nature of fireworks may be challenging for individuals with misophonia. To start preparing, let friends and family know about your experiences with misophonia and explain the need for accommodations during the celebration. When overwhelming emotions arise, try to engage in mental distractions like counting backward or reciting lyrics to redirect your attention. Deep breathing exercises, meditation, or focusing on something calming can also help individuals manage their emotional responses to distressing sounds.

Practical coping strategies for people with misophonia

Understanding which sounds associated with fireworks (like whistles, bangs, or pops) are most bothersome can help you plan accordingly. If possible, choose a viewing location that is further away from the main firework display or where you have some control over your environment, like a quieter area of a park or indoors. If you'll be indoors, create a "quiet zone" where you can retreat if needed. Close windows and doors to minimize noise, and consider using soundproofing materials or arranging furniture to reduce sound transmission.

If the noise is unbearable, consider wearing noise-canceling headphones or earplugs to block out or dampen the sound of fireworks. You might also listen to calming sounds, music, white noise, or background noise from the TV to distract from the distressing sounds and make them less intense.

Coping strategies for symptoms of misophonia

Experiences of misophonia differ between people, and symptoms often vary in nature and intensity. Some people may have more intense emotional symptoms, while others have more intense physical symptoms. Coping with misophonia frequently involves a multi-pronged approach using strategies that manage the physical and emotional responses to upsetting sounds. 

Caring for your physical health

Like many mental health challenges, misophonia can be addressed from a holistic perspective that includes caring for the body to help heal the mind. For example, regular exercise can reduce stress and anxiety, potentially reducing misophonia reactivity. Reducing or eliminating caffeine and alcohol and maintaining nutritious eating habits can promote overall physical and mental health. Finally, getting sufficient high-quality sleep and practicing good sleep hygiene may make it easier to manage emotions.

While they can help you manage symptoms, exercise, eating habits, and sleep should be considered along with therapy and other interventions as part of a broader management strategy for misophonia. If misophonia significantly impacts your sleep quality or eating patterns, reach out to a healthcare professional or therapist for guidance. 

Caring for your mental health

Self-care practices that target stress and anxiety can play a key role in managing misophonia symptoms. For example, alternately tensing and relaxing different muscle groups (a practice called progressive muscle relaxation) can induce relaxation and offer a distraction from misophonia symptoms. 

Additionally, studies suggest that mindfulness techniques can mitigate the impact of misophonia on daily life and reduce relationship problems related to misophonia symptoms. Meditation, yoga, tai chi, and breathing exercises are examples of mindfulness-based stress reduction activities.

You can also cultivate better mental health by engaging in activities that nourish and bring you joy. Participate in a favorite hobby, work on a creative project, or do things that promote self-growth, like learning a new skill or taking a class. Spend quality time with friends and loved ones, and consider reaching out to a local or online support group for emotional support.

Environmental coping strategies

Adjust your living and working spaces to minimize exposure to distressing sounds if necessary. You may also find relief in the moment by engaging in activities or thoughts that divert attention away from these sounds, such as counting objects or practicing grounding techniques. If symptoms become overwhelming, consider physically removing yourself from situations where upsetting sounds are present. Sound therapy and earplugs or noise-canceling headphones can help block out distressing sounds.

Therapy and treatment options for people with misophonia symptoms

While they can be beneficial, self-help coping strategies aren’t a substitute for therapy. Instead, they’re typically used to complement clinical treatment. There are several evidence-based therapies available to treat misophonia. Mental health professionals usually tailor treatment programs to meet the unique needs of their clients. Standard therapeutic methods for treating misophonia include (but aren’t limited to) the following: 

• Cognitive behavioral therapy (CBT) generally focuses on identifying and changing negative thought patterns and behaviors associated with distressing sounds. This can help individuals develop coping mechanisms and reduce the emotional intensity of their reactions. 
• Exposure therapy can gradually expose individuals to sounds that lead to an emotional response in a controlled environment, helping them reduce reactivity over time. 
• Neural repatterning technique (NRT) pairs sounds that lead to a low level of distress with a pleasant stimulus to reduce the individual’s physical response to the sound.

Misophonia can lead to significant distress in daily life

Receive support in online therapy

Addressing treatment barriers

Although therapy can be highly effective in helping people with misophonia, not everyone seeks treatment. Some avoid therapy because they don’t think it will work, or they don’t believe they can afford it. Accessibility and convenience may be concerns for people who live in remote areas or have hectic schedules. 

Online therapy—particularly internet-delivered CBT (iCBT)—can be a highly effective alternative to traditional treatment for people with misophonia. Platforms like BetterHelp offer individuals the opportunity to speak with licensed, experienced therapists from the comfort of their homes on a schedule that fits their needs. Additionally, online therapy is often more affordable than in-person treatment without insurance coverage. 

Research shows promising results in managing misophonia symptoms using online CBT, including group-based and individual approaches. In one study published in the Iranian Journal of Psychiatry and Behavioral Sciences, participants experienced significant reductions in misophonia, depression, and anxiety symptoms upon completion of an online group treatment program.