Dear Anxious to Angry


How can I deal with my misophonia when there is a trigger near me, or I’m beginning to get anxious about it which then escalates into getting angry? I really want to be able to control the feelings I get as much as possible!

This is very complicated and we all want to know the answer to this question. Unfortunately, there does not yet exist a “cure” or even “treatment” for misophonia. There are a lot of “treatments” on the market that have no evidence or follow up and in my opinion are the result of either a poor understanding of misophonia, or in some cases, attempts at personal profit. This is disheartening to me to say the least. However, this should not discourage you because we do have research underway and we also know some things about the underlying mechanisms specific to misophonia. We know this both from misophonia research, basic science, and studies of disorders with similar symptoms.

I believe that the first step in learning to control the feelings that arise when you are near a trigger is to understand what is happening to your neurophysiological system, and understanding why it is so difficult to control.  This most likely will not change how your body reacts to auditory stimuli, however, with this knowledge, the over-reactivity may be less over-whelming to you emotionally.   Since you have already stated that for you “anxiety escalates into anger”, this demonstrates your natural ability to parse out the different kinds of reactivity and feelings that you are experiencing. This is an excellent start.

When you describe the feeling of anxiety escalating into anger, you are most likely describing increasing arousal within your sympathetic nervous system. The sympathetic nervous system activates the fight/flight response. Research suggests that when an individual with misophonia encounters everyday auditory (and sometimes visual stimuli) that most people would not notice, his or her brain may misperceive this stimuli as though it were dangerous. As a result, the individual experiences the physiological arousal that accompanies what we all know of as the fight/flight reaction. It is important to realize that this response happens so quickly that it is out of an individual’s control. It  is part of an involuntary survival response, and it happens  in milliseconds without conscious mediation.

Does this mean we simply give up and allow ourselves to be aggressive toward others? Of course not! In fact although many people with misophonia discuss “feeling angry” or “enraged” when triggered by specific sounds, there is no research indicating that that many of us actually act upon this. This means, that while  many of us have limited our lives in various ways, or rearranged our lives, we may at least to some degree be coping.  That is not to say that we are not suffering. However, we must give ourselves some credit for the fact that we are fighting against our own bodies.

When alerted to danger, the  brain’s first natural response is to send messages to the body to flee. Think about it. Why fight if you can get away? In the animal kingdom, one has a better chance of survival if one leaves a dangerous situation.  Our systems are set up exactly the same way. If we are able to flee from the stimuli (in this case specific sounds, and sometimes visual stimuli) fight/flight ceases and we go back to a calm state. However, if a person is unable to “flee” or leave the environment and get away from the aversive stimuli, his or her adrenaline level continues to elevate, and other hormonal and physiological changes related to the fight/flight response occur, culminating in what many people describe as experience, “a severe anxiety attack”, “rage”, or “panic”.

I hope this makes sense to you with regard to what is happening to you when you feel yourself escalating. Understanding is just the first small step to developing coping skills.  However, developing coping skills is NOT EASY. It is an  interactive process that includes an understanding of what is happening to you when you are triggered, ways to combat the physiological response, as well as  the emotions that arise with it. Coping also includes strategies to help others understand your needs, and finding the right balance between how much you are able to control your responses, how much you are able to secure accommodations from friends, family and within specific environments. Because misophonia itself and peoples’ life situations change throughout development and over time, this is an ever-evolving process.

I am sure this seems somewhat vague and over-simplified, however, I hope this gives you some perspective and some hope. I think you may be further along with regard to building coping skills than you think you are simply because you asked a question that reflects awareness of what is happening to your mind/body when triggered.  I hope this adds more information to your knowledge and makes you feel positive about yourself and your ability to combat misophonia until we have developed treatment!




Dr. Jennifer Brout
Jennifer Jo Brout is a New York State Certified School Psychologist, a Connecticut Professional Licensed Counselor, and she also holds a Doctorate in School/Clinical-Child Psychology. She graduated from New York University, Columbia University, and Ferkauf School of Psychology (at Albert Einstein School of Medicine) respectively. She is also the mother of adult triplets, and is a Misophonia sufferer herself. Disappointed by her own experiences with the state of the field when seeking help for her own child in 1999, Dr. Brout began efforts to establish better research practice, improved diagnosis, and innovative clinical practice related to Misophonia (under the name “auditory over-resposivity). Dr. Brout has been at the forefront of research in this area for over 18 years, having established the Sensation and Emotion Network (SENetwork) in 2007, along with Sensory Processing and Emotion Regulation Program at Duke University in 2008.