Misophonia is a disorder in which certain sounds trigger emotional and or physical responses that others may consider irrational. It is mainly self-diagnosed because finding a health care practitioner that will diagnose or treat, is a huge challenge. Finding a mental health care practitioner to diagnose and treat is impossible. Why is that? Misophonia is not determined a psychiatric disorder so a diagnosis of Misophonia would not be able to be provided by a behavioral or mental health practitioner. There is a manual called the DSM-V, The Diagnostic Statistical Manual of Mental Disorders published by the American Psychiatric Association which lists all classifications of mental disorders. The DSM-V guides behavioral and mental health practitioners in diagnosing those mental health disorders. Misophonia cannot be found in the DSM-V.
There isn’t any medication or universal established treatment at this time, yet there is hope, ongoing research, support and coping mechanisms you can learn about and utilize. Psychotherapists provide treatment for behavioral and mental health issues. They can be a great resource for support and coping skills to the stress response that you experience after a trigger. The stress response is fight or flight, a natural response and healthy when we need it when we are faced with an actual threat of harm. The stress response helps us fight our way through a dangerous situation or run from it. A therapist can range from Psychologists, Licensed Clinical Social Workers, Licensed Professional Counselors, Licensed Marriage and Family Therapists and more.
Since misophonia is not in the DSM-V, finding a therapist that understands can be puzzling. It is a great opportunity for you to broaden awareness and education to a therapist about your challenges living with misophonia. As a Licensed Clinical Social Worker working in a behavioral health setting, I learn from my patients every day. I believe in learning from them and working collaboratively on their goals in therapy makes me a better therapist and overall a better person. So turning to a therapist can be beneficial and one should not shy away. I have been asked by others that questioned if a health care or behavioral health care provider does not live with an issue would they understand. Everyone can learn about a specific topic or issue. Would you not go to a cancer doctor if they never had cancer? We can teach each other about Misophonia and many therapists are open to learning and understanding. However, there are therapists out there that have an understanding of misophonia. I am one of them.
I have had misophonia ever since I was a young girl. I did not know what it was until just recently working with my audiologist for new hearing aids for both ears. I had just replaced the ones I have had for the last 10 years. I have always been hearing impaired. I began talking about experiences that were puzzling and my audiologist asked more detailed questions leading us to misophonia. I cope very well in many environments. Having misophonia, I believe, helps me truly understand the confusion and distress that it brings. There are many noises I truly enjoy and some that I do not. There are just a few that trigger my stress response and that can be hard to tolerate at times.
I have worked on some behavior experiments of various ways of coping and recovery response time to the stress response has been positive. There are times that ultimately I have been through my coping skills box (figuratively) and I have to take a break and remove myself when I can. I have noticed some trigger noises throughout my experiences with patients and have been able to cope well. I can cope well because, in that timeframe of our sessions, they come first. A lot of times we often put others before ourselves and that tends to happen more so when someone works in a helping profession. In between sessions, when I am not focusing on someone else, I practice many small things that bring me joy and peace to distress. When I am triggered by the noises during those times, it does take some extra care on my part to get through them.
What kind of coping is there that a therapist can help with?
Keeping a journal or diary can be a good place to start. This can show patterns and triggers more closely. The diary can include the time of day and what was happening around you or what you were doing at the time. How did you feel? Sad, angry, joyful, shameful, fearful? What was your body feeling? Did you shake, tense up, and have trouble breathing? What did you do to cope and did it help (can be where behavior experiments take place)? Were there others involved? Were they helpful or contributing to the stress? If the people around you are stressed, you will likely feel that energy and the situation could worsen.
Promoting and educating on healthy self-care. Care of your physical health, nutrition, exercise, healthy sleep practices and activities daily that brings you a sense of accomplishment and joy. These practices are especially important if you are struggling with depression and anxiety. Many people develop depression from isolating and avoiding the situations that can cause a trigger. Or social anxiety having persistent worries about managing misophonia around others, even your family or any other social setting.
Cognitive Behavioral Therapy (CBT) is a therapy model that many therapists use which is an evidence-based treatment for depression and anxiety and many other mental health challenges. CBT helps you become more aware of inaccurate or unhealthy thoughts (the cognitive) so you can see challenging situations more clearly and respond (behavioral) to them in a more constructive way. Thoughts can be very random and people often will panic from thoughts worrying constantly that they are going to act out on them. Thoughts and feelings are different and we chose whether to act on them or not. Some thoughts are not healthy. You may notice some negative appraisals when your stress response is activated from a trigger. These can be inaccurate due to our perceptions of the situation. Just a few types of unhealthy thought patterns are catastrophizing, mental filter, overgeneralizing. Catastrophizing is where people think of numerous worst- case scenarios in a situation and then treat it is if those scenarios were inevitably going to happen. Mental filter is where a person is only thinking of the negatives surrounding something and will not think of the positives. Overgeneralizing is a thinking pattern of taking a past or present situation that is usually negative as all occurring for future situations “everyone” you never, I always” are common in overgeneralizing thoughts. These thoughts and many other unhealthy styles of thought influence how we feel and behave. Therapy can help someone be more aware and challenge these thoughts. Investigate the facts and look at other ways to see the situation.
Stress reduction and self-regulation techniques. Stress regulation and calming methods to help people prepare themselves ahead of time to manage the stress response and minimize the intensity. Calming methods like deep regulated breathing and scanning your body for tension and relaxing the muscles. Progressive muscle relaxation where you tense the muscles purposely and relax them.
There are many behavior experiments or planned activities for coping that you and a therapist can plan to use. Technology such as smartphone apps helps with anxiety, stress, depression, etc. Earphones and white noise machines. Take breaks, be self-compassionate and forgiving. Hold yourself accountable to change a behavior if it is destructive. Remove yourself and take a walk, watch nature, play your favorite music, take a bubble bath, lean on your support system, hug yourself, make a gratitude list of things that you are grateful for, make a list and keep it with you that includes reminders to practice body scans, progressive muscle relaxation, supportive and soothing self-talk statements and affirmations, deep breathing, and acronyms to remind you to calm down such as STRIP (stop, take a breath, relax all your muscles, imagine consequences if you were to act negatively and proceed). Learn about your misophonia or other health-related issues. Ultimately accept and love yourself.
You can find Stacy on the Misophonia Provider Network.
Misophonia is most likely a neurological condition in which the sufferer has negative reactions to sounds. It causes an immediate fight, flight or freeze responses. These responses cannot be controlled any more than the weather, but you can prepare yourself for the storm.
As parents we want our children to be happy, healthy and well-adjusted individuals. Unfortunately, that does not always happen, but we can do everything in our power to help them cope with various situations.
This article is going to be talking quite a bit about safety. Your home is a safe place, in a nice neighborhood, surrounded by family that loves and cares for each other, childproof and safety locks on the cabinets and drawers, you have all bases covered. Do you, really? There is a difference between being safe and feeling safe and that is what I would like you to focus on because living in a world where you are constantly on in fight or flight mode does not FEEL like a safe place. How can you make your child feel safe?
You have observed some obvious triggers for your child whether they got angry, frustrated, covered their ears, ran out of the room, etc. Make a list of those sounds, their reactions and keep a running log of these things. No one knows your child better than you do. Knowing triggers can help you be prepared for various situations. For example, if eating sounds is a trigger, it might be best to skip having dinner at a restaurant, opting for take-out instead. If eating dinner as a family is something you normally do, it is ok to allow your Miso child to eat in another room, or to allow the television or music to play in the background.
When you live with someone with sensory issues, forcing certain behaviors can be devastating to the child and they will not feel safe, not even in their own home. Your child trusts you and expects you to protect him and he needs your guidance until he can protect himself. Never think that exposing your child to triggers will “toughen them up”, not only will it make the triggers worse, he may end up resenting you for it.
Take a moment and think about what things make your child feel comfortable. Does he have a cozy blanket or favorite stuffed animal? Do they like to color, play with blocks, play-doh or Legos? Is there a song or songs that soothe them? I am referring to younger children, but the same concepts will work for older children as well as adults, you just need to make them age-appropriate.
I think it is very important to create a special “ME TIME” space for your child. This does not involve purchasing expensive things, this is about taking a section of his room and making a safe haven for him to retreat when things are overwhelming. I do not want you to think of this as a time out because it is not a punishment at all. When you see your child start to get overwhelmed, take him to the designated place. For younger children you can take them in their room, they may want mommy/daddy cuddles to soothe them, or 5 minutes snuggling with their favorite doll or stuffed animal. Just a few minutes to decompress will help so much, possibly followed by a quiet activity. Have a juice box and finger paint together. Participating in a fun creative activity will divert his attention from the negative feelings, provide an outlet for the negative feelings as well as strengthen your bond. In a nutshell, you want to work on his other senses; looking at pretty pictures, using his hands to mold play-doh or sand, anything to take the focus away from the sound.
Children (especially younger children) do not equate the sounds with being triggered. They just know the sound makes them very upset and angry and they want it to stop but they may not know how to explain it and that is okay, this is a learning process for you. If you see your child being triggered, remove him from the situation before things escalate. Perhaps he is watching a show on tv and something triggers him, hit the mute button. Divert his attention away from the trigger. When you consistently remove your child from the trigger, he will learn “I need to step away” and calm down. Believe me, these habits will be very useful tools that he can use until they discover a treatment or cure.
The next thing I want to talk about is violence. Violence is not acceptable, BUT it is not uncommon for that fight response to make a child want to hit something or someone. Children lack the self-control needed to abstain from this action and may hit their sibling because they coughed too loud. Remove your child from that situation. Personally, I do not think to punish him is the answer because it is a Misophonic response. He just needs some coping skills to redirect that rage. When he is calm, you should address the fact that it is not acceptable to hit. (As an adult sometimes, I have difficulty abstaining from throat punching someone for breathing wrong)
An occupational therapist may also help provide some very useful coping skills that you can use with your child. The goal is to make a safe place for your child as provide the tools and lessons for him to be able to self-soothe so he feels safe.
These resources are designed for parents, educators, and doctors to understand misophonia. By printing these files, you can bring them with you to help explain misophonia to your co-parents, family members, clinicians, and help advocate for your child. As a lesser-known disorder, advocating misophonia can be hard – and that’s why we want to help!
I was invited to go to several upcoming events. There will be triggers at all of them. One of these events is inside a restaurant with a large group of people – luckily chewing is not a trigger for me, but even still, I think I would say yes to this invitation. After several years of avoiding my life and allowing Misophonia to keep me from what I enjoy, I have finally decided that it’s not worth it to live my life in fear. So, after much deliberation I have made the decision that being anxious about the what if is not going to help me live a fulfilling life. Instead of being scared, it’s important to be prepared.
Know there will be triggers but that they’re not fatal
Even though Misophonia is over-whelming and exhausting, it’s not going to kill you. The pain you are feeling is going to end. Eventually you will be back home in your bed. It is not forever.
Bring your headphones, earplugs, and sunglasses (if these help your visual triggers) and know that you have them with you. Give yourself permission to use them. Don’t try to ‘play through the pain’, it’s okay to help yourself!
Take breaks if you must
Go to the restroom. Take a walk-break (like a smoke break with no smoking). Walking away from the situation helps you to reset your sensory system. When you come back it can be easier to handle the triggers.
Don’t over-do it
Try to plan social events so that you’re not doing too many at once. Went to the movies Friday night? It’s probably not wise to wake up Saturday morning to go to a breakfast brunch when you’re still taxed from the night before. Say no to some engagements so that you can enjoy the ones you go to more.
Go with people who understand
Going to social events with people who understand Misophonia can be much easier than having to explain to a new acquaintance why you look so miserable. Try not to feel guilty for ‘spoiling the fun’ by going out with friends and family who want the best for you – and who are happy to enjoy the good moments as they come. Sometimes friends and family are better at identifying ways to calm you down when you’re lost in fight/flight/freeze.
While Misophonia is hard to live with, that does not mean that you have to say no to everything that you once enjoyed. While staying at home, headphones on, is certainly trigger-free, it’s not necessarily the best way to live your life. By preparing in advance and knowing that yes, there might be triggers, but you’re going to be okay, you can start to find ways to have fun and enjoy new activities.