Misophonia
A closer look at the condition in which everyday noises are upsetting
Maureen Salamon
Harvard Health Publications
Enduring a slurping spouse, joint-cracking colleague or throat-clearing friend can be a sigh-inducing, eye-rolling experience. But the reaction goes beyond mere annoyance for people who respond to these everyday sounds — or others like snoring, sniffling, loud chewing, yawning and heavy breathing — with agitation, rage or disgust.
Their aversion is part of a strikingly common sensory processing disorder known as misophonia, which is characterized by an outsized emotional response to sounds others make. A study published online March 22 by the journal PLOS One estimates that nearly 1 in 5 adults deals with the condition, with women responding more intensely than men.
“They can’t stand to be in the room with those sounds,” says Dr. Michael Mufson, a psychiatrist and director of the Complex Diagnostic Center at Harvard-affiliated Brigham and Women’s Hospital. “They try to avoid those situations, but it’s almost impossible to do.”
If you’ve never heard of misophonia, you’re not alone. Only 14% of study participants were aware of the diagnosis before they were surveyed. But the condition’s prevalence is emerging as long-held stigma eases, Mufson says.
“We’re seeing more and more people coming out of the shadows with it,” he says. “Before, people feared their doctor was going to call them crazy. But it’s no longer a hidden disorder.”
While scientists aren’t sure why misophonia occurs, a 2022 study in Frontiers in Neuroscience suggests the disorder may have a unique “neural signature,” meaning it’s traceable to a distinct pattern of nerves in the brain.
Older adults with misophonia have likely had it most of their lives — possibly never disclosing it due to stigma — but the condition can develop at any age, Mufson notes.
“It’s not uncommon that it goes undiagnosed,” he says.
Eliminating culprits
Before pinpointing misophonia, doctors must carefully rule out other conditions that can resemble or overlap with it. These include obsessive-compulsive disorder, bipolar disorder, other sensory processing disorders, affective dysregulation (an impaired ability to tolerate or manage negative feelings), Asperger’s syndrome (a form of autism), anxiety disorders and post-traumatic stress disorder.
Not everyone with misophonia has the same sound triggers or responds with the same degree of aversion. Regardless, those affected often blame themselves for missing out on activities others take part in with ease. Feeling trapped and helpless when they can’t escape sounds that irritate them, some affected individuals even lash out physically or verbally.
“They might avoid eating in restaurants or eat separately from their spouse or family,” Mufson says. “Imagine feeling you have to leave when you’re at the theater and a person coughs. It becomes socially impairing.”
While misophonia has long gone unnoticed, treatment options are expanding. Doctors typically use a comprehensive approach that blends behavior-based therapies with medication.
“It’s not a disorder without hope,” Mufson says.
Misophonia management
Cognitive behavioral therapy is emerging as an evidence-backed treatment for misophonia, according to a small 2020 study published in Depression and Anxiety. More than a third of 54 participants who underwent cognitive behavioral therapy reported improvements in their misophonia symptoms as well as their ability to function socially and within their families. The benefits were still apparent a year later.
In a cognitive behavioral therapy program, the therapist first identifies a patient’s individual sound triggers and then works with the patient to develop new responses.
“We develop strategies and coping mechanisms to interrupt the rage and anxiety,” Mufson says. “If the anxiety is too severe, then we start thinking of incorporating medication. If you can dampen the anxiety, you can really help people feel and function better.”
People with misophonia can also ease sound aversions by:
- Wearing earplugs or headphones.
- Using white noise machines.
- Practicing deep breathing or muscle relaxation techniques.
If you know someone with misophonia, it’s important not to criticize their symptoms, Mufson says.
“Encourage them to go for treatment,” he says. “It’s also helpful if they get some brief, supportive counseling to empower them to seek treatment.”
Weight gain as a side effect
Depression or the drugs to treat it may cause excess pounds
Dr. Howard Lewine
Harvard Health Publications
Q: I take medication for depression. Over the past couple of months, I have developed an uncontrollable craving for sweets, and my weight is up more than 10 pounds. Is it related to my long-standing depression or something else, like my medication?
A: The depression or the medication could be triggering it. Weight gain is a side effect of many of the medications used to treat depression. Changes in appetite and weight are common symptoms of depression, as well.
In depression, weight can go up or down. Some people lose their appetite completely. They can lose interest in food the way they lose interest in all pleasurable activities.
For others with depression, the opposite problem occurs — they can’t stop eating. And often there is no pleasure in that, either, because it’s compulsive eating, followed by remorse.
Increased appetite and weight gain are probably more common in some types of depression. Seasonal (usually winter) depression is one example. But there are no rules about it. Any type of depression can be accompanied by weight gain or loss.
Medications can also induce cravings and weight gain. Any of the antidepressants can lead to a change in appetite and behavior.
Try to figure out what may have changed three months ago, when your craving for sweets got more intense. Here are a few questions I might ask:
- Did you start a new medication at that time? Or increase a dose?
- Did you decrease a dose or stop a medication? Lowering a dose or changing medications could lead to the return of depression symptoms.
- Was something going on in your life that could cause your depression to get worse?
- Did your activity level change?
- Could the change be related to perimenopause or menopause? Some women experience an increase in cravings and appetite during that time.
- Could there be some other medical problem causing you to experience a shift in your eating pattern?
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