Misophonia: what loud eaters, public whistlers, pen clickers, and ticking clocks have in common

Do you hate certain sounds with a passion that you know is unreasonable? You might have misophonia. Greek for hatred of sound, "misophonia" is replacing previous labeling attempts such as Select Sound Sensitivity Syndrome and Sound-Rage.

Misophonia is surprisingly common. It is an involuntary, visceral hatred or disgust felt when a particular "trigger" sound is heard. The heart may race. Classic physiological responses of involuntary alarm, rage, or nausea might kick in.

 

 

First, misophonia is not at this point classified as an auditory, neurological, or psychiatric condition. So with all my loose talk about people having misophonia or not having misophonia, bear in mind that diagnostic criteria have not crystallized yet out from the research world, so the labeling is all going to have to be a bit fuzzy at this point. There have been attempts to outline criteria. For example, from a 2013 PLOS ONE article:

 

A.The presence or anticipation of a specific sound, produced by a human being (e.g. eating sounds, breathing sounds), provokes an impulsive aversive physical reaction which starts with irritation or disgust that instantaneously becomes anger.
B.This anger initiates a profound sense of loss of self-control with rare but potentially aggressive outbursts.
C.The person recognizes that the anger or disgust is excessive, unreasonable, or out of proportion to the circumstances or the provoking stressor.
D.The individual tends to avoid the misophonic situation, or if he/she does not avoid it, endures encounters with the misophonic sound situation with intense discomfort, anger or disgust.
E.The individual’s anger, disgust or avoidance causes significant distress (i.e. it bothers the person that he or she has the anger or disgust) or significant interference in the person’s day-to-day life. For example, the anger or disgust may make it difficult for the person to perform important tasks at work, meet new friends, attend classes, or interact with others.
F.The person’s anger, disgust, and avoidance are not better explained by another disorder, such as obsessive-compulsive disorder (e.g. disgust in someone with an obsession about contamination) or post-traumatic stress disorder (e.g. avoidance of stimuli associated with a trauma related to threatened death, serious injury or threat to the physical integrity of self or others).

Other proposed criteria for diagnosis don't require that the source of the sound be a human, a restriction I personally find overly narrow which may exclude people who still need help. For example, I find certain natural (certain species of bird song) and mechanical sounds (ticking clocks) painfully distracting.

 

I don't know if I have misophonia, but I have trouble ignoring certain benign sounds. I am naturally sound hypersensitive because I have cross-wired senses known as synesthesia, which is a topic for another blog  (Synesthesia is not a disability, I have had it continuously my whole life, and I would be disoriented and freaked out if it ever ceased for even a moment, so please don't feel sorry for me. Sounds and text are automatically colored and textured in a predictable way, and I classify and organize everything based on my unchanging sensory associations. It is not part of my vision, it is in my brain. It is my involuntary organizing system. I honestly don't know how anyone remembers anything without synesthetic associations. But then, you probably don't have to involuntarily sense clock ticks as endless lines of tan dots, either. There are pros and cons.)

Are certain people more likely to have it? People with synesthesia are more likely to describe having misophonia. So are people with other sensory processing issues like those with Asperger's, (it's more common for people with Asperger's to also have synesthesia) and people who have keener-than average interoception. Interoception is the ability to sense your body's internal processes, like heart beat, hunger, thirst, digestion, etc. I know that I am more preoccupied with my own digestion at any given time than most people are with theirs, but I think I have good reasons. Enough said on that. Children who show an early sensitivity to otherwise normal ambient sounds are more likely to develop misophonia, too.

I have to exert mental effort to block out certain sounds to be able to function like a normal person. The intrusion of certain ambient sounds into my mind can make me angry, and I don't anger easily. Anger isn't a feeling that I enjoy and so I do a lot to nip it in the bud. So I have some overlapping interest in misophonia.

 

 

warm thanks to: INFJoe, a cartoonist for introverts. I love this cartoonist. INFJoe is on Facebook, too.
 

Earplugs, earplugs, earplugs. I have them in all my coat pockets and in every room of my house. I wish I had known about earplugs when I was younger. Ticking clocks, pen clickers, people whistling, people fidgeting, and worst of all: THE EVIL BACKGROUND STORE MUSIC; these are my most hated sounds.

Misophonia can alter they way you live your life. Some suffers insist it prevents them from attending certain events or appointments, interfering with their ability to live a normal life. They are disabled by it. I am fortunately not in that category, although I have to admit I can get really worn out being in public for an extended period of time. But that is a common characteristic of introverts, with or without misophonia.

I did ask Tim to replace all the ticking clocks in our house with sweeping mechanisms that don't tick, and thank goodness, most of them have been transformed. He understands. I can't read or write in the rooms with clocks ticking without earplugs in place. (I have often wondered how the first introduction of audible clocks into households must have freaked out the occupants and if there is any historical information on that.)

Recent imaging research uncovered similar activation patterns in the brains of people who say they have misophonia. When all of the misophonics in the study heard a trigger sound, a part of the brain that paints a stimulus with emotional salience got activated (anterior insular cortex). Not surprisingly, a key memory center (hippocampus) plus a part of the brain known to be involved in fear conditioning (amygdalae), as well as the default mode network (which I wrote about in another article are also some of the brain areas that consistently got activated when the misophonics heard their trigger sounds.

Other annoying sounds (like screams, babies crying, jackhammers) which were not triggers for the misophonics did not produce the same brain activation patterns. People who did not describe having misophonia also did not show the same unique misophonic pattern of brain activation to annoying sounds.

Misophonic rage isn't entirely rational. A dentist's drill can, at least in theory, do damage; it is natural for most of us to wince under its grinding whine. The impatient honk of car driver's horn behind you inspires anger, but that is a sensible response. You are reasonable to deduce that your tailgating, trigger-happy horn abuser is a jerk. The cadence of a certain politician's voice may produce instantaneous revulsion, but that also is not unreasonable. I would suggest that these are normal, healthy responses.

 

 

warm thanks to: INFJoe, a cartoonist for introverts. I love this cartoonist. INFJoe is on Facebook, too.

Some people cannot abide hearing other people eating or breathing. Eating and breathing sounds are the most commonly reported misophonic triggers. There is nothing inherently harmful about other people eating and breathing, even though the mechanics of these processes are rather more intimate than I care to think about.

 

Eating or breathing sounds don't bother me, which is a good thing, because when Tim crunches his crackers every afternoon one floor below my office, I swear our whole house shakes. I am so glad he enjoys them! When the walls start shaking, everyone on the property understands that he has finished his sandwich and has moved on to the cracker phase of the meal. Just as sea creatures inhabiting tidal pools anticipate the rise and fall of the tides, our house is accustomed to Tim's daily rhythm of cracker crunching. I would classify his afternoon crunch sessions as distracting, and thus a source of irritation if I am trying to write or read. I put in my trusty earplugs.

Another quality of misophonia that I have mentioned is that it can be disabling. This means that it can alter the way people go about their lives. Some people are so devastated by "mastication rage" that they will avoid dining with other people unless they know ambient noise will drown out the eating sounds they fear hearing. People who have misophonia generally know that their responses are disproportionate. I know some young folks who silently cope with mastication rage. They hide it well.

Treatments for misophonia include cognitive behavioral therapy (CBT) and exposure therapy, and coping strategies like earplugs or sound masking devices like music or environmental sounds. (Speaking of masking sounds, be choosy; white noise is possibly detrimental for the developing brains of infants. 

I can offer a tiny degree of hope, although I am not that disabled by my sound prejudices. The ray of hope is that I have, with some mental jujitsu, neutralized my hatred for cicada whines. It can be done. It was not too hard for me. I was motivated. I did not want to have to move.

 

 

We love our spring peepers! (these are tiny frogs.) Good thing because they were actually 85 dB as measured by Tim's decibelometer thingie. He described them perfectly: "It's like a box filled with low-battery fire alarm devices."

 

I reframed cicada whines. Cicada whines first afflicted me after moving to Door County about ten years ago. The sound amazed me.

First, it was ear-splittingly loud. Second, no one else noticed it.

This insect-based screaming would begin every August or sometimes earlier, in July. This sound was always a high, sometimes fuzzy but mostly quite thin, electric reddish and somewhat silvery line according to my synesthetic perception, piercing my ears, derailing my thoughts.

No one else appeared to take notice of the overhead screaming. Craving consolation, longing for sympathy, I found none. Of course, a lot of my in-laws who frequently visit during the summer are somewhat congenitally deaf, which might explain the consistent lack of support I received. But I would have really liked for someone to just agree with me about the sound. At least, could they notice it?

I would be outdoors with a group of people, and they would just carry on talking (or in the case of my in-laws, shouting, which is their form of communication) around me. Even with all the screaming going on over our heads in the trees, they would carry about as if everything was normal. As far as I was concerned, we may as well have been under the attack a fleet of screeching enemy alien spaceships.

Thus cicada whines once caused me to be filled with helpless rage. And as I have said, I do not get angry easily, and I do not like to feel angry. Now, when you think about it, it is pretty silly for a bunch of insects to poison my mood.

After two years of this, I had enough. I couldn't move. I couldn't remove or disable all the bugs, either. The only thing I could change was my reaction. I set about deliberately re-framing my rage. Here are some of the things I did:

 

1. Relax. First, instead of immediately cringing when the whine would start up, I would try to relax. Loosen all the muscles in my body, that sort of thing. Breathe deeply and slowly.
2. Tune in to the sound. I would examine the sound. Maybe there was something interesting about it. Perhaps there were interesting variations in it. Maybe I could really tune into it instead of trying to not hear it.
3. I tried to think of similar sounds that I loved. I have always loved certain electrical sounds, synthesizer sounds. What if the bug songs were something like that? It did sound similar to certain electrical sounds that I actually groove on.
4. I tried affirmations. "I love this sound!" I would say out loud. Every time the whine started up and I noticed it, I would just say, "I LOVE this sound!" I imagined what it would feel like for me to love the sound. Repeatedly. Until it became a habit.
5. How is sound is healthy or natural? One of my degrees is in biology for crying out loud. A biologist's mind should be able to appreciate the sheer wonder of bug mechanics. I have been known to enthuse over slime molds. Why not cicadas?

 

Gradually, it worked.

 

I would say that, these days, my reaction to the whine of cicadas feels neutral. I don't hate it. I've stopped using my mental tricks years ago, and now I don't even have to think about it. I might even like cicada whines. A little bit.

I don't think these techniques will work with all sounds. I can't imagine tuning out loudly ticking clocks. For such things, I recommend earplugs or a mechanical alteration. I am just saying that some mental work can work for some sounds. A cognitive behavioral therapist would, I imagine, be just the right sort of person who could help a really disabled misophonic.

 

 

My very first newspaper editorial

Misophonic triggers typically start in childhood, but they don't have to. My most hated sound, the sound of background music played in public places, is the first sound that I can remember hating. As a young girl, I honestly believed that background music was bad for our health, and wanted to start a public campaign to do away with it. I still believe it is a public health menace.

Perhaps I should be grateful that all my digital archive digging attempts to unearth my forty-two year old newspaper editorial complaining about background music in public places have so far come up blank. It would be painful to read, but it would provide further evidence that we don't easily change our first antipathies.

This pompous missive was published most likely in some 1970's edition of the Los Angeles Times or the Orange County Register. I remember my mother proudly pinning it to the refrigerator after showing it to her friends. She had enabled this.

She was sympathetic to my raging protest against the widespread use of background store music. I was convinced and alarmed that all of this background music was destroying everyone's health in some subtle way. I still believe this. I still fantasize about towns instituting a "silent Sunday" or something to that effect. For just one day, businesses might agree to let people eat and shop and work out in the blessed peace and quiet which I crave called reality. All the stores and restaurants and public facilities would agree to turn off the continuous blare of background music. We might hear a bird sing. The birds would benefit, too, to be relieved of the stress of hearing our blaring racket. I realize this is just a fantasy.

Can you imagine what that silence would feel like? Maybe just once a month? Perhaps someone could post the average decibel level at which restaurants and stores play their background music? At least we could get a clue of what is going on aurally, environmentally, the auditory environmental equivalent of seeing an ingredient label on a food package. And with that information we would decide what we wish for our ears to ingest. I digress.

But my mother was obviously tickled that, at the tender age of nine, I was denigrating Muzak—which played more often back then—as "castrated musical drool". I remember using that exact phrase. I am also certain I had no idea what the word 'castrated' meant. It sounded perfect!

I think I would be grateful now for the good old days of soft elevator Muzak. The store background music situation has escalated beyond anything that my young mind could have conceived possible. It's an auditory arms race out there for the attention of the increasingly numb-eared populace, and one which is only increasing the numbness of our ears.

To this day I find background store music something I can barely tolerate. After testing the waters in the produce aisle and finding myself paralyzed by noise, my fingers automatically fumble for the conveniently located Earplugs Pocket of my purse and I methodically insert a pair before I get going with my shopping. I've long gotten over the awkwardness of saying hello to friends in the store while fumbling at my ears to temporarily remove the plugs or buzzing past them oblivious to their calling out my name in greeting. They know I am strange, and if they don't, they will.

On the days when my local YMCA or grocery store has their music off, I enter, amazed. Is this Heaven? What is this wonderful peace? This quiet? I LOVE this place!

I'll ask a clerk if the business has instituted some wonderful wise new policy. Holding my breath, I will typically find the clerks sullen. They grumble that the stereo is broken, and complain about they hate the silence and they can't wait for the music to be back on. I then proceed to feel like an alien.

I have been pleased to find, visiting the Green Bay Aurora Baycare Hospital, designated "quiet zones" in several lobbies, with a sign instructing the waiting people: QUIET HELPS PATIENTS HEAL. Nice. There are other lobbies in the same hospital where there is a TV continuously playing. I often find myself wondering who determines which clinic lobbies should be the quiet healing zones and which should be the noisy ailing zones.

If you have a child who is avoiding a sound, you might want to gently work to gently reframe their reaction so that it won't become engrained. You can find out what sounds they love, and help them compare those sounds to the avoided sound, for example.

 

 

Listen to a misophonic's description of his hatred of whistling and his attempts to get over it. It is both funny and tragic. (22 min)

 

 

What do misophonic triggers have in common?
Misophonic triggers are not necessarily loud, as are annoying sounds (screaming, crying). They are also not necessarily high or low in pitch, either. Yet there are common themes:
1. Confrontation may be required to end the sound
2. They are unnecessary
3. They are often, but not necessarily, made by humans
4. The person creating the sound is oblivious to it
5. They often have a repetitive nature
6. There is a sense of helplessness to stop the sound

 

List of common trigger sounds 

The obliviousness factor: fidgeting, whistling, pen clicking and other offenses
There must be a special sort of outrage felt while being acutely aware of a someone making a sound that they themselves are not capable of perceiving. As I mentioned, misophonic triggers often have this obliviousness factor baked into them.

There are a few odd people I don't often see, but they have an extraordinary habit of continuously babbling their stream of consciousness for all to hear, with much of its content, after my brain works at processing it, categorized as information that was completely unnecessary for me to exert effort to process. Am I supposed to pay attention to all this? I ask myself while I try to keep my head from exploding. I don't know if continuous babbling would be categorized as a misophonic trigger, but babbling does possess the feature of obliviousness. It might be a verbal form of fidgeting. It has led to me wondering if you can buy gift certificates for silent meditation retreats.

I have written another article about the metabolic benefits of fidgeting, and while it's healthy for the fidgeter to move their body, it can wear out the unwilling listener. I live with a fidgeter.

Tim unknowingly snaps his toes, taps his fingers, jiggles his legs, shakes his feet, around and around. It's like this endless seizure traveling around his body. I find this movement fascinating from a neurological point of view. I've wickedly enjoyed surreptitiously recording it for up to half an hour with my iPhone before he catches me. He is quite peeved by my voyeurism of this mechanical expression of his subconscious. I feel like a naturalist documenting some exotic animal. I hear the soft narration of David Attenborough, "And here! Here is the nesting place of the wild toe! Notice how it performs a complex dance with its companions."

His twiddling is usually quiet, although sometimes when we are reading in bed I hear whish! whish! whish! and I ask him to please stop snapping his toes so I can concentrate. He says he doesn't even know he is doing it. Lucky man! I put in earplugs to read while he fidgets. I think there is something about his fidgeting that helps him integrate information, as if it the nervous motion is an extension of his central nervous system. He does talk with his hands. He says it helps him think, and I take him at his word. I would not stop it. I love him, and he is a great thinker. I just have to learn to ignore the sounds his peripheral nervous system makes when he thinks.

Workplace sounds are tricky as they may require confrontation. I was relieved to read that many people, not just me, hate pen clicking. I am paralyzed by pen clickers. Pen clicking freezes my brain and I can't think straight. Sometimes people try to talk to me while they click a pen in their hand! I want to ask them to please stop it without my seeming like a nut. When I taught college I would routinely be paralyzed by students clicking their pens while I was trying to lecture.

I'd be deep into balancing a tricky redox reaction or manipulating thermodynamic variables and, out of the blue, a student would unleash a series of CLICK-a-CLICK-a-CLICK-a-CLICK!

 

I'd be stunned into silence, and jerk around to find out what was causing the racket. Pen Clicker would continue clicking away as a few painful seconds would elapse under my dumbstruck gaze. Pen Clicker always took a surprisingly long period amount of time to grasp that they were, in fact, the source of the disruption. Obliviousness. I've even had overly vigorous twiddlers occasionally fling their pen across the classroom, which surprised them more than anyone else. Giving Pen Clicker an amazed stare always worked, but then, I was in a position of authority, which was helpful.

 

Usually if WE make the sounds, they don't bother us, but there are exceptions to this rule documented in the scientific literature on misophonia.  Reading up on the topic, I learned that some people can't abide the sound of other people's footsteps, or even their own.

 

This immediately triggered memories of me unhappily experimenting with wearing high heels when I was a teenager. What I disliked most aboutwearing them was not so much that they rendered me, already awkward, a blundering idiot, but I developed an instant dislike for generating reverberant footsteps. Trying to step quietly in heels on hard floors exhausted me. The repercussions felt like they called attention to myself and I didn't like that.

I have perhaps unconsciously gravitated to only wearing cushy flats or tennis shoes, thus avoiding anything that produces loud staccato beats. Why wear anything uncomfortable that damages my body? But those clicks! Even though my feet created them, they punished my ears. Every click was announcing HEY! HEY! HEY! HEY! To the public. This is not a sound for introverts.

 

 What are people expected to do without tailgate slamming and vibrators?  Photo credit: Ron Clone. Sign in Oak Creek, Wisconsin.

 

Timmy vs. the gas-powered leaf blowers

On the topic of annoying sounds, there are some sounds that might be misophonic triggers, but we should all be able to agree that they ought to be banned. I speak of course of gas powered leaf blowers. They turn my otherwise kind, gentle husband into a raging, swearing maniac. As he transforms into the Incredible Hulk and runs down the street to confront the noisemaker, I shout after him. "You aren't going to solve the problem of human stupidity today! Try turning on the radio instead!"

I grit my teeth and turn on a soothing playlist of music whenever our neighbor (who is always away at the time) hires his leaf-blowing servant to spend several hours pushing his leaves around to more respectable locations like the middle of our street. The servant wears great, big, noise-cancelling headphones to protect his hearing. At least someone's hearing is being protected. I sort of feel sorry for the leaf pusher, being the middle-man in all of this.

Beverly Hills bans gas-powered leaf blowers. Why can't we do the same? Does it really take a wealthy community to do it? Several counties institute bans on the use of gas-powered leaf blowers.

Let's just examine the sound. The bass rumble is something that most nervous systems, with the possible exception of sponges (yes sponges have a primitive sort of nervous system) will recognize as the growl of a predator. Predator sounds are bad for wildlife and stress us out, too. If we react viscerally, imagine how the lives of wild animals get disrupted.

Using gas is wasteful when you could get some exercise using a broom or a rake. Thermodynamics requires that oxidizing carbon-based fuels always produces CO2 which is helping Earth's atmosphere to more closely resemble that of our sister planet Venus. Venus's atmosphere has so much CO2 that surface temperature is hot enough to melt lead. (I have heard the argument that CO2 is a nutrient for plants, but it is hard for plants to grow under lead-melting conditions, they prefer to immolate. Dose matters; that is the first lesson in toxicology, even for so-called nutrients. It's why you don't automatically force-feed your child an entire bottle of vitamins.) Also, leaf blowers blow dry the ground, baking the soil, frying seeds, beneficial microbes, and symbiotic fungi.

 

Our fantasy solution to leaf blower noise

Tim has over 60 patents, mostly biomedical, so he naturally likes to come up with solutions. This idea isn't patentable unless is considered an "application" or business model, he cautions me. But we have thought of calling it The Backatya. It is simply a microphone which records the leaf blowing session, and plays it back at the exact same volume when the Master has returned to his leaf-blown premises. It would be a form of auditory karma, and educational, too.

Tim also hates hearing one side of a cellphone conversation, known as a halfalogue. If you also hate hearing halfalogues, you may be comforted to know that psychologists have studied people like you. The going theory is that your brain tries to fill in the missing responses and this involuntary activity distracts to the point of annoyance.

In one study, he same level of distraction (measured by the performance of subjects focusing on a task) was not experienced by halfalogue haters listening to a dialogue, a monologue, or overhearing speech that was rendered unintelligible. There are some overlaps here with misophonia; the rage felt is all out of proportion, and the obliviousness factor of the noise-maker.

Hating halfalouges is common, yet I find them emotionally neutral. They merely distract me. My theory is that with my synesthesia, I am so used to trying to tune out everything. My mind always wants to interpret general noise as a conversation or something interesting. So halfalogues don't bother me any more than bird songs or dialogues. In other words, it is all a similar amount of annoyance that I just live with every day. After Tim rages about an ongoing public cell-phone conversation I perversely feel comforted. Less alone. I must admit that my first thought is, Welcome to my world. 

 

Ideas about how to manage or reframe misophonia (feel free to suggest more ideas)
1. Talk to someone you trust about it. It might require a confrontation if they are making sounds that bother you. Show them articles on misophonia and tell them you need some understanding support.

 

2. Get help if misophonia is keeping you from living a normal life. See if your primary care provider can refer you to a cognitive behavioral therapist or someone trained in exposure therapy.

 

3. Try earplugs, masking sounds, or altering your environment if possible.

 

4. Expose yourself in small doses to the sound. Try to relax and say "I love this sound!" Try to get to the point where you can listen to the sound it in great detail. Try to discover whether the sound could have any positive purpose, like nourishing someone you love if it is an eating sound. Focus on your joy for their nourishment.

 

5. Are there sounds that you love? Make a list. How are the sounds that you love similar to sounds you hate?

 

I love anything that is electronically flanged. I like the fuzzy, crackly, red and black-splotched silvery old fashioned dialup modem staticky connection sounds. I realized that the cicada sounds that I used to hate were a lot like those sounds.

I love the terribly exciting black-and-white strobe light sensation of helicopters passing overhead. I love the black fluffy fuzzy rumble of thunder. These too are not too different from some sounds that I hate.

 

What would it look like if you loved the sound that you hate?