Misophonia can cause extreme reactions to some sounds
Published Monday, July 13, 2009 3:22PM EDT
TORONTO - The sound of a carrot snapping in two is enough to send Ben Mariano running from a room.
For the 32-year-old Toronto accountant, gum-chewing, lip-smacking and carrot-crunching are akin to nails on a blackboard. Worse, even. The noises other people make with their mouths have driven him to clobber a wall with his fists. Once, he chucked a bag of groceries at the wall.
Mariano hasn't been to a movie theatre in two years because he finds popcorn-noshers unbearable.
Pawel Jastreboff, a professor at Emory University School of Medicine in Atlanta, coined the term misophonia (hatred of sound) in 2000 when he found that some people had strong, negative reactions to specific sounds.
These people didn't necessarily fear sound, so they didn't have phonophobia. And their reactions weren't always due to pain at certain frequencies, known as hyperacusis, or tinnitus, the sensation of ringing in the ears.
Jastreboff says misophonia is a learned condition. "It's a response to sound. You associate sound with something unpleasant or negative."
He claps three times. "That's a pretty loud sound. But a person with misophonia might not react to it. The same person can react very strongly to a soft voice."
Jastreboff says of 149 consecutive patients, he diagnosed 57 per cent with misophonia. Yet the condition isn't well-understood or appreciated, even among audiologists, who are more familiar with hyperacusis.
Mariano's case began when he was a child in Thunder Bay, Ont. Forced to move in with his stepfather and stepsister after his father left, Mariano began fixating on the sounds his new family members made when they ate.
"The best word to explain the emotion is contempt," he says. "When you're 10 years old, right, you don't know how to channel your emotions."
The problem worsened as he grew older. In his hometown, he worked in a cubicle next to a foot-tapping, gum-chomping colleague.
"It was driving me insane."
Mariano developed coping strategies, such as taking a late lunch so he could eat by himself. He considered quitting. Eventually, to his great relief, his boss rearranged the seating plan.
Just last year, Mariano diagnosed himself after watching a couple of YouTube videos about misophonia. In the videos, an American named Scott describes the agony of listening to a woman on the subway smacking her lips.
"I was holding a pen. I was doing a crossword," he says. "I started fantasizing about taking the pen and shoving it through her eyeballs."
Now, Mariano has his own office. When he's out walking or taking public transit, he wears headphones to block irritating sounds.
He lives alone in a bachelor apartment. He's had a couple of relationships, but after two to four months he can no longer tolerate hearing a girlfriend eat. Needless to say, "most women take great offence to you paying attention to what they're eating."
Kelly Robinson, an ex-girlfriend, used to eat crunchy foods in the bathroom. A year after they broke up, Mariano sent her the YouTube videos he had discovered and they began talking again. They're good friends, but Robinson says, "I wouldn't date him if you paid me a million dollars."
While Mariano's usual strategy is to walk away from the sound, he occasionally erupts. Three months ago, he was watching a baseball game on television and grew irritated at the pitcher and the manager as they chomped on gum.
"I took the remote and I just chucked the thing and it went boom and it exploded."
Patricia Towle, a clinical psychologist in Valhalla, N.Y., says misophonia is only a "pseudo-diagnosis," since there is so little research literature about the disorder.
When her young son showed extreme sound sensitivity, Towle began poking around on Internet discussion boards. She found that people complained about a similar set of repetitive sounds including chewing, sniffing, breathing, tapping and the clinking of dishes.
"I feel strongly it's probably not a stand alone condition," she says. "I would almost guarantee that the people who have it have a tendency toward anxiety, mood disorders and obsessive-compulsive disorder, where a negative connection gets entrenched in their brain."
Towle recommends that people with misophonia see an audiologist, since hyperacusis may accompany misophonia. But she also advises consulting a mental health professional who specializes in anxiety disorders and cognitive behavioural therapy. A therapist can identify related problems and teach techniques for controlling attention and reactions to noise.
"People can hear things three rooms away," she says. "Part of that is hyper-vigilance. You can give in and wait for a sound all day long, or you can learn that how you're letting your brain take over is not helping you."
Mariano has tried cognitive behavioural therapy with a psychologist who has helped him talk through his reactions, but says he's made no progress so far. He has been treated for depression and anxiety as well, and takes Ritalin, which seems to be helping.
Towle also suggests confronting relationship issues, since some people feel angry only about the sounds certain people make. "It may be easier to be angry with that person or people over the sound annoyance than with more fundamental problems."
Jastreboff differs. He says misophonia is not a psychological issue. Rather, he says it's due to bad connections between different parts of the nervous system (auditory, limbic and autonomic). He compares misophonia to driving, a task so familiar it's governed by reflexes.
"With misophonia, you need to recondition something subconscious," he says. "It's similar to teaching people how to drive a car on the left side of the road in New Zealand."
He says conditioned responses to sounds are not necessarily bad. The sound of a gun should provoke a response. But people with misophonia experience overreactions that are counter-productive.
Jastreboff says cognitive behavioural therapy may help people cope but won't remove the problem itself. His method is to create positive associations with troublesome sounds.
Treatment takes at least nine months, but Jastreboff claims about 90 per cent of his misophonia patients find success. He asks them to listen attentively to music they like at a comfortable volume while also listening to an irritating sound.
Patients mix the pleasant and unpleasant sounds for 20 to 40 minutes once or twice a day, for three weeks. Each week, the patient sets the volume of the music at a louder level. Then the cycle is repeated.
Aage Moller, a professor of cognition and neuroscience at the University of Texas at Dallas, discussed misophonia in his keynote address at a tinnitus conference in Stresa, Italy last month.
He says he hasn't encountered many people with misophonia, but suspects it's relatively common. When he introduced the term to physicians at the conference, "They said, 'Gee, yeah, that is true."' But most hadn't paid attention to their patients' symptoms.
Like Jastreboff, Moller disputes the suggestion that misophonia is psychological. He has no doubt it's a problem with the nervous system. "It's wired in. Very difficult to change."
A negative reaction to nails on a blackboard is a kind of misophonia, Moller says. "To some extent, for some sounds, everyone has it."
Moller doubts the success of current treatment methods. Anyone can claim to have a treatment strategy, he says, but most don't actually benefit patients.
In response, Jastreboff says, "He has never seen even a single patient."
"Respectfully, I disagree with him."
Towle says controversy between scientists arises when there's no physical diagnosis for a certain set of behaviours. No one can take a blood test for misophonia, for example.
She likens misophonia to chronic pain or fibromyalgia, which can be managed using psychological and behavioural strategies. "Lots of techniques help an individual attend to stimuli versus focus on it."