Misophonia, Phonophobia, and Hyperacusis: Auditory Sensitivity and Mental Health

There are at least three different types of sound sensitivities, and this matters because sound sensitivities sometimes co-occur with other mental health conditions like OCD, Autism, Anxiety, Trauma and Sensory Processing Disorders. If you get really angry about certain noises, that’s misophonia, if you get really anxious or scared around certain sounds, that’s phonophobia, and if everyday normal sounds are painfully loud, that’s hyperacusis.
So let’s start with hyperacusis. Hyperacusis is when you perceive sounds as being louder than they objectively are. Everyday sounds seem louder than they should. 47% of people with hyperacusis also have anxiety.
Auditory sensitivity can occur on a spectrum, where hyperacuity may be on the more severe end of the spectrum, and a dislike of loud noises can be on the less severe side of the spectrum. Auditory sensitivity can also be associated with sensory differences with autism, and it can stand alone- it can just be that you have really sensitive ears.
Now, let’s talk about Misophonia, misophonia is when specific sounds trigger an intense reaction- usually anger but it can also be irritation, rage, anxiety and disgust. The most common triggers are repetitive sounds like chewing, breathing, lip smacking or tapping.
Like hyperacusis, Misophonia is not a recognized disorder in the DSM 5, and research is just beginning to understand the causes and treatment. There are some early studies indicating that there are brain differences in people with misophonia and there’s heightened response to sounds in the brain. Misophonia commonly occurs with other disorders including Anxiety, OCPD, ASD, and Sensory Processing Disorder.
Phonophobia is an intense fear reaction to certain sounds. Like other phobias, it can be connected to anxiety disorders or a history of trauma, but it can also stand alone.

00:00 - Intro to sound sensitivity and noise sensitivity
2:27 - Hyperacusis
3:49 - Misophonia
5:01 - Phonophobia
6:43 - Treatment options

Therapy in a Nutshell and the information provided by Emma McAdam are solely intended for informational and entertainment purposes and are not a substitute for advice, diagnosis, or treatment regarding medical or mental health conditions. Although Emma McAdam is a licensed marriage and family therapist, the views expressed on this site or any related content should not be taken for medical or psychiatric advice. Always consult your physician before making any decisions related to your physical or mental health.
In therapy I use a combination of Acceptance and Commitment Therapy, Systems Theory, positive psychology, and a bio-psycho-social approach to treating mental illness and other challenges we all face in life. The ideas from my videos are frequently adapted from multiple sources. Many of them come from Acceptance and Commitment Therapy, especially the work of Steven Hayes, Jason Luoma, and Russ Harris. The sections on stress and the mind-body connection derive from the work of Stephen Porges (the Polyvagal theory), Peter Levine (Somatic Experiencing) Francine Shapiro (EMDR), and Bessel Van Der Kolk. I also rely heavily on the work of the Arbinger institute for my overall understanding of our ability to choose our life's direction.

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[MariannaV]

It is so calming to find that others have the same dislike to noise as I do. It already makes me feel better that I am not alone.

[mentalwealth]

I’ve discovered I have misophonia. I live with a family that slams doors, cabinets, yells, smacks their food, and walks very heavy. Hearing these things make me VERY angry. I attempted to block it out with headphones, but it does make it worse. The anxiety and rage is so exhausting, it’s stressing me out. Until I move out, I’ll practice these things going forward. It will help in life in general. Thank you. 🤗

[riffmagos]

Misophonia with depression, anxiety, and PTSD is its own hell.

[AVToth]

I've had misophonia for as long as I can remember. Every morning, before school, having to listen to my sister chewing cereal, toast or anything just filled me with rage. My mother always accused me of just being hateful. It isn't bad when there is a group, like the family around the table. When my kids were, well, kids and my grandchildren were around 6, I had to explain that they were doing nothing wrong. If I got up and left the room quickly while they were eating, everything was ok, even when I had a mad look on my face. Anytime they needed reassurance that I wasn't mad at them, we talked as much as they needed. I also reinforced over and over that even though things like apples, carrots, strawberries, anything crunchy flipped a switch in my brain and made me feel furious, I didn't feel furious at them or anyone and I wanted them to eat healthy crunchy things no matter what. As they got older I would be more detailed but mostly I wanted them to understand that it wasn't a problem with their behaviour, it was just a little bad wiring in my brain. Turned out that my son has this also. Any oral sounds, phlegmy sounds, repetitive sounds like something loose and vibrating. I couldn't carry a tune in a bucket even if you put a lid on it BUT while I can't reproduce the sound, if someone is singing and the sound is even a tiny bit off, flat or sharp, I have to grit my teeth.

These sounds have never caused anxiety. I can be happy, laughing or completely relaxed but as soon as I hear the sound it is as fast as a light switch. Rage, sometimes I am desperate to flee only because I can feel the rage growing and my control slipping. As soon as the sound stops, I'm calm. Again, like flipping a switch. There's a little adrenaline residue and while I feel the effects of it, I find I don't always notice it.

It has always sort of amazed me simply because with no necessarily emotional stimulus, merely an innocuous, everyday sound can cause such rapid and extreme emotion. I would love to see this on fMRI.

[Charlotte-Willow]

Low, bumping bass from car stereos makes me instantly angry and feeling like my heart is going to explode…and it rattles my home :(

[annanimity]

It made me cry when this video started because it hits home and I can truly empathize with those who are afflicted by this. It can be debilitating for many and that needs to be recognized. I’ve had misophonia and hyperacusis since as far back as I can remember. My mom recalls my emotional breakdowns around the age of 5 when eating with my family. I would hide in a bedroom and eat alone there when everyone else was eating because I couldn’t cope with the sounds. This was early 80’s and my mom had no clue about anything relative to sound issues, mental health or the like. The gambit is vast for me and includes visual triggers as well like watching someone shake their leg or seeing someone chewing.

I came across a local audiologist who has dedicated much of her practice to helping those with these disorders. She helped me feel, for the first time in my life, like I wasn’t a complete loon because that’s been the response I’ve been met with until now.

I am in the midst of my treatment currently and it’s a slow process but there has definitely been progress. I use hearing aids during waking hours, that play a customized type of “white noise” all day. It plays at a low enough volume so I can still hear and engage in conversation. I can control the volume as well for times that I’m struggling and need my brain to be refocused away from my triggers. I do daily deep breathing exercises and daily note taking of triggers and severity.

Thank you so much for bringing awareness to these issues, validating them and sharing your knowledge!!

Best of luck to those afflicted, you aren’t alone and there is treatment 💜

[roweme]

Have literally just escaped to my room from a family dinner to have a cry and self regulate (after feeling totally overwhelmed by everyone having conversations all at once) and saw on my phone this had been recommended 😢❤ Thank you.

[emmelinesprig]

I’ve had chewing misophonia since I was a child. It used to make me feel angry, but now it’s more anxious frustration. Like feeling trapped.

Sound can feel very invasive. You can’t close your ears the way you can close your eyes.

[BoomRoomFive]

Incessant dogs barking, eating or animal licking sounds, loud exhaust systems, the police helicopter, but most of all, near constant sirens drive me completely nuts. It's not just the sound, but the psychological awareness that there is always calamity within earshot.

[economicist]

One of my misophonia triggers is the music played in almost all retail and foodservice settings. Took a couple years of avoiding both over the pandemic to really isolate it. Even if it's a genre of music I love, I find it really imposing when I'm trying to shop or eat.

[victoriasalexa]

i have misophonia and it’s quite miserable at times. i get so extremely enraged or disgusted at any repetitive noises that i sometimes have to excuse myself from wherever it’s stemming from to calm myself down.

[TheLiberaceTheory]

Thanks for this-- I could have written that email myself. I am dx with autism, OCD, anxiety, PTSD, and sensory processing disorder. I have lived in rental housing the last 12 years... a different place nearly every year. Every time I get settled into a location, something happens, some person starts making a sound, and I can't tolerate it and have to leave. I lived in an apartment below a lady with a constantly barking dog; moved to a house on a hill that overlooked a freeway that got busier and busier the longer the year went on; moved to a tiny apartment surrounded by barking dogs, moved to a big house with a big yard... then neighbors on *both* sides of me got dogs and let them bark. Moved downtown... barking dog in the house diagonal to me. Moved uptown, barking dog in the unit below me, round the clock. I kindly asked that neighbor if he could please quiet his dog, 3 times, and I got a gun pulled on me.

Finally gave up and moved out of state to a tiny house in the woods... within a week, some houseless folks set up a chop shop for stolen vehicles right across the street from me. Midnight, 2am, whirring metal saws amplified by the shipping container they were hiding the op in. I moved again, to my current place, and had about 3 months of quiet... then last week, I got a new upstairs neighbor. With a Rottweiler. It sounds like I'm living under a circus explosion.

I've been BEGGING for an end to the endless noise my whole life. I wear earplugs 24/7 to the point the skin has sloughed off the insides of my ear canals. I switched to noise cancelling headphones, and it got my ear infected.

I wish the world were more mindful of noise and the concept of the "captive audience". If you're making a sound, and the people around you perceiving it do not have the opportunity to escape that sound, they are a "captive audience", and it's important to limit your effects on your neighbors. I try to be as quiet as a mouse 24/7. Most people don't even know I'm here. But it seems like no one else is paying attention in the slightest to the effect they have on others...

[tracyzimmerman]

There's one thing to say about noise. We didn't evolve to take in all this noise. We didn't evolve to to have so much stimulation all the time visually or auditory. I know loud sounds are jarring to my system. I don't like people having conversations all at once. My thoughts on why this is is because my brain can't process it. There's no focal point. It's a muddle of sound. I know part of the reason for my sound sensitivity is due to my traumatic childhood. If you yell at me I will completely shut down. Also I can't drown out other people's conversations. I ended up eavesdropping. I don't know which ones of these I have. I just know I'm sensitive to noise.

[emmelinesprig]

Thank you Emma for acknowledging that some therapists harm a patient’s recovery with inappropriate advice. I rarely see people in the psychology field admit this, or even talk about therapist specialities.

[USER-cnuo]

The day I was diagnosed with misophonia was a relief. Until then I thought I was crazy or cranky or just mean. I also am driven to a range by repetition (someone repeating themselves over and over) or repeated sounds. Sometimes while listening to NPR in the morning during morning edition, they play snipets of music as they go to break. Sometimes those songs are repetitive notes and I have to change the channel to avoid the rage

[KelBel]

I don't remember the last time I clicked on a video so fast after seeing the thumbnail. I self-diagnosed myself with misophonia about ten years ago when I shared an office with a coworker who would clear her throat every minute or so. I eventually asked my doctor for a note so I could wear headphones at work and drown it out. It's caused relationship strains (people don't like when I ask them to stop making certain noises), and my ex-boyfriend's open mouth chewing was a significant factor in why I ended things.

I definitely think my tinnitus has something to do with the onset of misophonia. I guess it makes sense that my brain does not want to deal with any additional annoying sounds since I'm subjected to a high-pitched ringing in my ears 24/7.

[aussiescorpio]

I have had misophonia since I can remember and it has been a lot of learning and tolerance. I used to have almost tantrums as a teen, explosive outbursts, I self medicated to tune out. I now live alone and that helps and I love my life. Relationships have always been hard because of this horrible condition. Eventually you preempt these noises and you get mad and resentful. Eating, slurping, sniffing, breathing whistles... I really hope one day there is some sort of treatment for this that everyone can afford.

[maisieliberty]

In my experience real sound sensitivity isn't only anxiety which has tolerance which can grow. It's painful. It's overload. Headphones, sound softener helps. Maybe if it is only anxiety based. But from people online who have similar experiences it doesn't get better from exposure. I find it much better to find coping strategies because then I can go places and do stuff more. People can be involved in situations with noise because it's not painful as much or overload as much. I see people who experience more often say tolerance can't grow and they finally could be thriving and included when they found ways to manage instead of pushing sound tolerance. People without sound sensitivity seem to think tolerance building is easy and the way to go, but it's not for the majority in my experience.

[OP-]

Music through a wall where you can only hear the bass sounds. Music from a party where you can only hear the bass sounds. Cars with loud music where you can only hear bass sounds. People humming. These are the banes of my life.

[alixnorman]

I have really strong synaesthesia, so sounds set off an explosion of colours, textures, words, numbers, emotions, and sensations. It's very overwhelming for a trauma survivor. But understanding how my nervous system works, how my brain processes information, and how to normalise trigger reactions (e.g. somatic tracking) has really helped.