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By Samantha Cooper

July 2025

Have you ever gotten irrationally angry at the dinner table because somebody was smacking their lips? Do you get upset when you hear the clacking of a keyboard? Can you not stand it when somebody constantly bounces their leg up and down?

You might have misophonia.

While the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR™) does not yet recognize misophonia as an official disorder, experts in audiology and psychology do believe it can be defined and diagnosed. Misophonia is a disorder characterized by a decreased tolerance to specific sounds or stimuli associated with sounds, explained M. Zachary Rosenthal, PhD, director of the Duke Center for Misophonia and Emotional Regulation, in an �ֲ���ýwebinar.

These sounds can vary depending on the person, but common triggers include chewing, lip smacking, pen clicking, keyboard tapping and sniffling. It’s not about the volume of the sound, Rosenthal said, but rather about the specific patterns of the sound.

The triggers elicit strong negative emotions in people, he added. “These sounds can cause significant distress to the point of interfering with daily life and contributing to mental health problems. It’s more than just being bothered.”

According to Jennifer Jo Brout, PsyD, LPC, who cofounded the sensory processing and emotion regulation program at Duke University, misophonia differs from other audiological disorders because it has neurophysiological components. When a person with misophonia hears a trigger sound, the person’s brain misinterprets the noise as being threatening or toxic. Some people are only mildly affected, while others are more severely affected.

“For people for whom it’s mild, it will affect one’s life,” Brout says. “But coping skills and environmental 2025 accommodations are enough so that the person isn’t inhibited from going anywhere or being with certain people.”

However, people who suffer from moderate misophonia might avoid certain activities or people, including spending time with loved ones. They cannot live their life as freely as they want to, Brout says.

In severe cases, when a person has many triggers, or their triggers are so common as to be unavoidable, they might isolate themselves to avoid sound in general, which can harm their socialization and mental health.

According to the Cleveland Clinic, reactions can include negative emotions such as fear, anger and anxiety and physical responses such as increased blood pressure, sweating and chest tightness. People commonly react by yelling or acting in ways that stop the sound.

“It’s not just sounds like nails on a chalkboard. No one likes that noise. There are some noises that are very common that don’t bother most people, but do bother others,” says Christopher Owens, LPC, who has misophonia and has written several articles on the subject.

Because misophonia is such a new diagnosis, more research is needed. The few people who specialize in misophonia are not even sure what causes it or who should be able to diagnose and treat it.

“One of the things people struggle with in terms of misophonia is: Is it audiological? Is it brain-based? Is it psychological? All of these things can be true. So misophonia is probably best described as a multidisciplinary disorder,” Brout says.

The History of Misophonia

Audiologists first described misophonia in 2001, but it remained largely unexplored until 2013. That’s when psychiatrists published a series of papers and proposed the name “misophonia” for the condition, derived from the Greek words “miso,” meaning “strong dislike,” and “phonia,” meaning “sound.”

Before that, the disorder was known colloquially as “selective sound sensitivity syndrome” or 4S.

“The research in misophonia really started about 10 years ago. There was some before that, but until there was some private funding put in, there were just case studies and hypotheses and not really any rigorous research,” Brout says.

According to Rosenthal, misophonia typically appears in late childhood or early adolescence. Current research shows that around 2% to 5% of the population has some level of misophonia, which equates to about 1 in every 22 adults.

“That’s more than anorexia, more than autism, more than borderline personality disorder, more than obsessive compulsive disorder, more than schizophrenia,” he said during the webinar. Yet, in comparison, very few adults in the U.S. have heard of misophonia. “This is not a rare disorder. This is actually quite common.”

To add to that, little research has been done on most aspects of misophonia, such as how it affects children or why people have different triggers.

“The interesting part of my work has been discovering not what causes misophonia but rather what drives it. Why do some people seem to suffer only a little, while others feel their entire lives are derailed and controlled by misophonia symptoms?” asks Samantha Bookman, LMFT, who specializes in treating adolescents with misophonia.

Treatment and Coping Mechanisms

While misophonia has no cure, people with the condition find ways to cope. Some solutions, such as wearing noise-canceling headphones or avoiding triggering noises, are obvious, though not always easy to implement.

Two actions that may help people with misophonia are getting enough sleep and working on their cognitive mindset. When somebody isn’t feeling well or is overstressed, it will feel like the misophonia is getting worse, Brout explains. But even then, there are ways to cope.

Counselors can help their clients separate their thoughts from their actions. For example, Brout says, a person’s first thought when hearing somebody chewing might be, “That person is disgusting,” which leads to anger. Replacing that thought with a more positive one or practicing relaxation techniques can help quell the emotion.

“A person can’t control that initial feeling like anger, rage, disgust, but they can practice pausing and using skills to calm their nervous system so that they can move away from the amygdala being in control and come back to the prefrontal cortex being in control so that they have access to good decision-making,” Bookman adds.

She believes in removing the shame associated with misophonic reactions but still having people take responsibility for their behavior.

“Clinicians should encourage parents to both validate their children’s reality (and suffering) with compassion and hold boundaries on dangerous or harmful behavior. Misophonia is a reason that children may act out, but it is not an excuse for damaging behavior,” she says.

Importance of Recognizing Misophonia

Finding out about misophonia can feel validating, Owens explains. He found out about his misophonia after stomping away from “breakfast at dinner” with his wife and child one evening.

The sound of crunching cereal had always upset him. Originally, when the meal had been proposed, he had thought they would be having a feast of eggs, bacon and pancakes, so when his wife and daughter pulled out a box of Cocoa Puffs, he was disappointed.

“I was already tired, stressed and hungry. We sat down. As soon as that sound hit my ear and my brain, I thought, ‘Just focus on your food. Just let it go.’ But eventually it got so overwhelming, I slammed my hands on the table and shouted, ‘I’ve got to get out of here.’ I went downstairs and went onto my computer and Googled, ‘What is wrong with me? Why does cereal crunching bother me so much?’”

That’s when he found out about misophonia. “It was very validating,” he continues. “It’s not just me. It’s actually a thing.”

Misophonia is an extreme reaction on a continuum. Similar to how depression is more than just being sad, misophonia is more than just being bothered by sounds. Counselors who recognize and understand that can effectively increase awareness of misophonia among their clients.

“One of the biggest issues is increasing awareness,” Owens says. “With more awareness comes more validation, and the more people who are struggling with misophonia who come forward, the more likely researchers are going to go, ‘Let’s take a look at this.’ And maybe it winds up in the next volume of the DSM, which leads to more treatment and research.”