Misophonia: When Life Sounds Like Nails on a Chalkboard

At one time or another, most people are annoyed by certain sounds — whether it’s a co-worker’s pen clicking or someone’s chewing at the table. But, for some people, these everyday sounds can trigger an intense response that makes it impossible to concentrate, work, or interact with other people. In these cases, everyday life sounds like nails on a chalkboard.

If this experience rings true for you, you might have misophonia (selective sound sensitivity syndrome). Misophonia is a neurologic condition that can derail your everyday life. But there’s a lot you can do to manage your symptoms and regain control. 

What causes misophonia? 

Experts don’t exactly know why some people develop misophonia. But studies show that for people with misophonia, the brain responds differently to certain sounds. Normally, only certain parts of the brain are activated when you hear something. But if you have misophonia, hearing sounds can trigger the parts of your brain that control emotions and your fight-or-flight response.

When people with misophonia hear certain sounds, they have a reflex response that makes them feel strong emotions, not just annoyance. They can also experience changes in their heart rate and blood pressure. Because it’s a reflex, people can’t control their response. And if they try to suppress their reaction, it usually makes things worse. 

Because they can’t control their response, people with misophonia often have no other choice but to avoid situations where they might hear triggering sounds. This might mean avoiding school and work or skipping social events. Over time, this can lead to isolation and harm people’s emotional and mental well-being. 

Is misophonia a type of autism?

Misophonia is not a type of autism. Both neurotypical and neurodivergent people may experience misophonia. 

People on the autism spectrum can also experience sensitivity to sounds, related to loudness or quality of the sound. This is not the same thing as misophonia. 

Does trauma cause misophonia?

There’s no evidence that trauma causes misophonia. But people who experience post-traumatic stress disorder (PTSD) often develop reflexes to sounds. This can include misophonia. They may also respond more forcefully to loud noises and experience typical sounds as being louder. 

Is misophonia a type of obsessive compulsive disorder?

People with obsessive compulsive disorder (OCD) sometimes experience misophonia. But it’s not a type of OCD. There’s also some research showing that many people who experience misophonia also have other symptoms of OCD. 

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Is misophonia linked to ADHD?

Misophonia is linked to attention-deficit hyperactivity disorder (ADHD). Several studies have looked at the link between ADHD and misophonia and found that many people who experience misophonia have ADHD, and vice versa.

Is misophonia linked to a vitamin deficiency? 

So far there’s no evidence that people who experience misophonia have any type of vitamin deficiencies.

What are the symptoms of misophonia?

Misophonia symptoms can vary from person to person. But everyone with misophonia experiences:

• Intense emotional responses to trigger sounds: This can include anger (from irritation to rage), aggression, fear, anxiety, disgust, and distress.

• Physical symptoms in response to trigger sounds: This can include a fast heart rate, high blood pressure, sweating, increased body temperature, tinnitus, chest tightness, and muscle tension.

• Impaired daily functioning: Over time, symptoms tend to get worse. People start to avoid social functions, work, and school. This can lead to other issues, like isolation, anxiety, depression, as well as job loss and poor school performance.

What triggers misophonia?

Not every sound triggers a misophonia reflex, but most people have multiple triggers. And while triggers vary from person to person, common triggers include: 

• Chewing and eating sounds

• Nasal/breathing sounds 

• Mouth/throat sounds (coughing, throat clearing, lip smacking)

• Repetitive tapping (pen tapping and clicking, foot tapping)

• Rustling sounds 

• Repetitive movements (leg jiggling)

How do you diagnose misophonia?

There’s no blood test or imaging study that can diagnose misophonia yet. For now, the diagnosis depends on what you’ve been experiencing. Your healthcare provider will ask you about your experiences with sounds and how they affect your daily life. They’ll also ask how long you’ve had these experiences, since misophonia usually starts in childhood. 

Your provider may ask you to complete a hearing test and diagnostic questionnaires, like:

• Misophonia Activation Scale

• Amsterdam Misophonia Scale

• Misophonia Response Scale

• Berlin Misophonia Questionnaire Revised

Not all of these questionnaires are validated. That means they might not give reliable results for everyone. 

What are the treatment options for misophonia?

New research is looking for the best treatment options for people experiencing misophonia. There are several options available, though you may need to try one or more before finding something that works for you: 

• Therapy: Cognitive behavioral therapy (CBT) can be helpful for people experiencing misophonia. Studies show that CBT provides both short- and long-term relief for people experiencing misophonia. For people who experience ear ringing as part of misophonia, tinnitus retraining therapy is another popular option. 

• Adaptation maneuvers: Adaptation skills can help you manage misophonia and sometimes form part of CBT. This can include noise avoidance through the use of music or noise-canceling headphones. Meditation and mindfulness exercises can also help.

• Eye movement desensitization and reprocessing (EMDR): EMDR therapy is a type of psychotherapy that works more quickly. Small studies suggest it can be helpful for people who don’t respond well to CBT.  

Keep in mind, some of these treatments take time to show effect, so don’t be discouraged if you don’t see results right away.

Why trust our experts?

Written by:

Jennifer Sample, MD

After a fellowship, Dr. Sample worked as the medical director at the University of Kansas Hospital Poison Center (The University Of Kansas Health System Poison Control Center), which served the state of Kansas for poison exposures. In 2007, she returned to Children’s Mercy Hospital in Kansas City, Missouri, as a consultant in clinical pharmacology and medical toxicology.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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