Since I began spreading the word about Misophonia the past couple of years, countless friends, colleagues, and family have excitedly reported some variant of, “OMG – I totally have this thing! Hatred of sounds?! You mean it’s not just me? (Wait…how do you pronounce it?) Wow – I get so ticked off at Matt when he’s eating granola bars!” Well, maybe my loved ones do indeed have Misophonia, but maybe not. As with many disorders, there are different levels of symptom severity. Maybe your sound sensitivity is so extreme that you rarely – if ever – leave the solitude of your home. Or, perhaps you can navigate the outside world, but require headphones or ear plugs to avoid being assaulted by external noises. Maybe you’re fine most of the time, but you really want to strangle your soup-slurping co-worker once or twice a week. What if it’s not really a sound aversion, and it’s simply just being offended by bad table manners? What about the non-stop crying baby that just ruins your long flight, or someone scraping nails down a blackboard? Does any of the above mean you have – or don’t have – Misophonia?
Several disorders contained within the DSM-51 (the diagnostic “Bible” used by mental health professionals) are placed on a continuum or otherwise have ways to describe the severity of the person’s issues. Why not do the same for auditory symptoms? Perhaps what I’ll provide below already exists in the research literature, but if it is present somewhere in the academic aether, it’s likely to be somewhat different – and more fanciful – than my informal description. One of the problems with research literature is that the findings seldom make it to the masses of people that could use them the most. Additionally, in the rare instances that science-y stuff becomes publicly accessible, often it is either too complicated for non-science geeks to “get it,” or the media’s reporting of the research results have been misconstrued. As a trainer for other mental health providers, my career has been built around trying to make practical sense of all things psychological, and translate my understanding of complex scientific information into easily digestible and delicious morsels. (Really, the “science” stuff really isn’t all that complicated once you learn to speak the language, but it can be challenging to find a way to decipher the knowledge into personally meaningful experiences and a helpful native tongue.) Anyway, that’s what I’ll try to do here, by explaining a spectrum of sorts to classify levels of symptom expression present in people with sensitivities to specific sounds.
Before I describe the framework below, I want to stress that I am not proposing a Misophonia diagnostic tool here; there are so many confounding diagnostic factors to consider and rule out before reaching an accurate diagnosis. Rather, only trying to assist people in framing their issues of sound aversion and the impact it can have on their lives.
Two things I hope to achieve with this article: 1) People with (or without) Misophonia can get a basic idea of how their experience compares to others, leading to a sense of understanding and validation; and, 2) Encourage researchers to eventually develop an easy-to-use, self-administered tool that is more scientifically reliable and valid measure than my creation. I’m not a psychometrics guy by any means, but I have not come across a simple, descriptive screening or assessment survey that is widely/publicly available to help people put their experiences into perspective. To me…well, simple and easy-to-use seems kind of important. So, to reiterate, what follows is an attempt to describe the differences between varying levels of experiences with aversions to sounds – NOT to diagnose someone with Misophonia. With that said, there are a variety of ways to put symptoms into a spectrum of sorts, but I’ll go with a fairly common method – None, Mild, Moderate, Severe.
For the category of “None,” it would seem to be fairly self-explanatory. The person has zero negative reactivity to any sort of sounds, and would have no idea what a “sound trigger” is. However, another way of looking at “None” is that perhaps this type of person does have sound triggers, but they are generally of the garden variety that most people would find annoying (i.e. high-pitched squeals). These aversive sounds are often infrequently occurring and do not cause any problem for the person beyond the momentary shock to the auditory system, which says, “Hey – I don’t like that sound! Okay, it’s over now – I’m fine.”
“Mild” reactivity and impairment might describe the person that has identified certain sounds as unpleasant and can cause a slight rise in emotionality (frustration, irritation, annoyance), but the discomfort generally passes within minutes. Because the person’s emotional brain has not high-jacked cognition, the person only infrequently exhibits negative behaviors or outbursts related to the noises. A person with “Mild” reactivity usually has a variety of coping strategies that tend to be effective across situations, but will still have occasional auditory-related difficulties in dealing with life roles (i.e. yelling at and fighting with a partner who dares to chomp on a bowl of Grape Nuts near me, er, I mean near someone else I’m describing that’s definitely not me).
“Moderate” can perhaps be classified as the person has one or more primary trigger sounds that usually cause an affective reaction – often immediately following the noise. Though the person may try to tolerate the noise and hope it will pass, the increased activity in the emotional brain (i.e. amygdala) reduces the ability to simply endure the sound. The person is likely to experience increased levels of anxiety, frustration, anger, etc., and once the amygdala gets more fully engaged, the person may experience a desire to fight (have an outburst) or flight (seek an escape). As a result of the rising tension in feelings, the person may have an outburst towards the “offending” person or object, or otherwise begin to have negative thoughts towards the noise maker. The person that fits into a “Moderate” category has likely experimented with a variety of coping mechanisms and has learned through trial-and-error what does (and does not) help. Coping can be hit or miss, and more frequent and serious problems have begun to appear in the person’s life as a result.
A “Severe” reaction to a trigger sound is similar in description to “Moderate,” but more intense. Again, the person likely has readily identifiable auditory aversions, but when exposed, the emotional reaction is much more swift and powerful. Anxiety may turn into a full-on panic attack; anger might evolve into a blinding, white-hot rage. Disturbing thoughts of physically harming the offender may occur, with a slight risk of physical violence occurring. Beyond fight (directing some form of aggression at the person) or flight (bolting suddenly out of the room), the person may also experience “freeze,” in which they genuinely feel psychologically paralyzed, and cannot take further action, remaining stuck in the overwhelming sound situation. With “Severe,” the person has either not developed coping skills, or very few coping strategies have proven to be consistently successful. As a result, it can become extremely difficult – or nearly impossible – to fulfill basic life duties, perhaps to the point that the person becomes isolated in the safety (and silence) of his or her home.
More on “Impairment”
Beyond the continuum, there is another tricky – and even more individualized – aspect of sound sensitivity, which can be difficult to concretely categorize into a spectrum. The simple questions of “How impairing are the symptoms?” and “What form(s) does your distress take?” are vitally important for you to explore. Just because you experience a bad reaction to specific sounds doesn’t mean you have a disorder. In the DSM-5, there usually a statement along the lines of “the symptoms cause clinically significant distress or impairment in various life domains.” In other words, for you to have a full-fledged disorder, the symptoms you experience must be causing significant problems with work, school, socialization, relationships, self-care, parenting, and/or any other important areas of your life you can imagine.
As a Licensed Professional Counselor, it’s my belief that in order for symptoms or impairment to be significant, the issue is generally one that is frequently occurring. One-time incidents typically don’t count, like in the instance of being on a six-hour flight with a baby that won’t stop screaming – NO ONE finds that disruption enjoyable, so emotional upset in that case is to be expected. However, a one-time event could lead to significant problems for you, depending on the severity of your response. For instance, let’s say that you got up and smacked the parents and the child while screaming “Death to the diapered ones!” just before having a complete panic attack in the middle of the aisle. Yeah, that’s gonna cause some problems for you once the plane lands, if not before. It’s the same dynamic with the “nails on a chalkboard” phenomenon – usually those irritating noises pass and we move on without substantial distress. As the clinician I’d have to ask you, “How often are you really exposed to these triggers? Do you fly often? Do you work in a classroom with an old style chalkboard?” If the answer is “not often” or “no,” then your fleeting, mostly normal reactions to those noises are probably not Misophonia or other sensory disorder. Then again, maybe it is Miso – but I’d prefer to start with the more simplistic, Occam’s Razor2 stuff – were you fatigued, what other stressors were happening, were you intoxicated, do you have another mental health disorder, etc., before I’d assert that galloping hooves in the distance are zebras rather than the more likely horses.
Let me explain further with a personal example about impairment and frequency of symptoms – I am not a fan of snakes. (Actually, if you are a fan of snakes, I’d have to wonder what the heck is the matter with you…they’re creepy!) However, in my day- to-day life, I am not exposed to snakes. In the past 10 years, I’ve encountered maybe a dozen snakes, mostly at a zoo, and a couple of minor freak out moments while landscaping my yard.
While these twisty-turny-side-winding-devil-serpents do indeed give me a serious case of the willies, my exposure is so infrequent that it doesn’t cause significant distress or impairment. I am able to go on with my life without difficulty, as I am not constantly fearful that a black mamba is going to slink up my pants leg; therefore, I should not be professionally (or self) diagnosed with a snake phobia. However, if suddenly my career changed from academia to a national aquarium where I have to walk through a snake pit area every day…no way. A big fat case of NOPE. Couldn’t do it. My ability to function in the world of work would be seriously compromised to the point that I’d get fired, not be able to pay my bills, lose my house and family…all because while at the aquarium, I’d have to curl up in the fetal position several times a day and wet my pants while I sobbed uncontrollably because the evil boa constrictors were looking at me like I was lunch and wanted to swallow my body whole so I must run away but my legs won’t work because my amygdala has shut down the other parts of my brain and ohmygod why won’t the snakes stop slithering everywhere how do they move so fast without legs they must be the work of Satan himself and why can’t I stop thinking about this, someone please go get my mommy….
See? That would be significant distress and impairment! If I genuinely can’t work (or otherwise adequately function in the world) because of my symptoms then I have a disorder. Without that inability to fulfill a life role, all I can be diagnosed with is a somewhat amusing fear of snakes that I can generally doesn’t interfere with my functioning. In terms of my experience with sounds, at present, I don’t feel that I’d meet a clinical threshold for a sound disorder such as Misophonia, and if I did, it would be on the very “Mild” side. My main trigger sound is crunching cereal; I’m not really a breakfast eater, so I’m rarely around others eating cereal. Other chewing noises bother me at times (especially if I am weakened by my SHALTS3) but these sounds are generally easy to avoid or escape when they occur. With the most minor of adaptations, I can manage my mostly mild Misophonic issues. That said…ohhhh…there have been a few occasions where my affective brain was in charge and caused some short-lived, relationship-related difficulties.
However, there is really little-to-no impairment in my day-to-day experience, so as a clinician, I’d make note of these symptoms, but ultimately decide that they’re not severe enough to warrant a diagnostic label. (But, if I suddenly had to eat daily meals surrounded by people eating Crunchy-Grainy-Tree-Branch-Bark-Fiber-Gluten-Free-Granola-Yum-Yums cereal, yeah, sign me up for some professional diagnoses, interventions, medications, voodoo dolls, or whatever else ya got.)
Hopefully my self-disclosure can help provide a bit of reference to better frame your issues. What about your experience? Where do you fit in terms of symptom severity? What about your level of distress or impairment? Depending upon your experience and self-report, yes, you could genuinely have Misophonia or other impairing disorder. Or not.
On a related high-horse tangent, just be aware that if you simply have an occasional quirk that has bothered you twice in your whole life, yet you insist that you have an ever-present disorder… you run the risk of offending the people that genuinely struggle with severe forms of disorders such as Misophonia. Certainly one of the enormous tasks ahead of us all is to increase awareness of Misophonia, but when it’s done with a lack of knowledge about the disorder, it can be counterproductive. It’s similar to commenting about your desire for organization and often reporting that “My OCD makes me organize things! LOL!” (Ask people with OCD if they find that misinformation helpful or funny. Hint: they don’t.) Just like Obsessive-Compulsive Disorder is waaaaay more than simply wanting your stapler in a specific spot on your desk, Misophonia is MUCH more than just a “hatred of sounds.”
Both disorders can be very impairing, but they are also over-(self)diagnosed due to misunderstanding what the disorders actually entail. I’d just like to encourage everyone to be aware – and sensitive – to the fact that for most any issue, there are real people behind the symptoms; the last thing I’d want is for people to feel that their experiences were being devalued or minimized due to a growing – but inaccurate – awareness of what is involved with the struggles with sensory disorders such as Misophonia.
Lastly, I mentioned research earlier. While those professional-researcher-science-types are vital to increasing our knowledge base, what will ultimately drive a better understanding of the disorder is not the research alone – it’s the stories and experiences of those that suffer with the Capital M. If you have Misophonia, speak up, spread the word, let others know what it is – and what it is not. Keep learning. Keep coping. Keep living.
1Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
2Occam’s Razor – you hear loud galloping noises – you should probably think “horses” before you make a claim that you hear “zebras.” Doesn’t mean it can’t be zebras, but we should start with what’s more likely to be the explanation, and work from there.
3SHALTS – Symptoms are more likely to be troublesome if we are compromised in some way. If we are Stressed, Hungry, Angry, Lonely, Tired, or Sick, our sensitivity to sound triggers can be increased, and our ability to cope decreases correspondingly. An article expressing this can be found in our second issue of 2016.