Misophonia: We don’t have Earlids
Yesterday I was talking to my friend and colleague, Dr. Zach Rosenthal. In addition to his many other roles, he is the Director of the Sensory Processing and Emotion Regulation Program at Duke University. We were talking about misophonia and how hard it is to escape noise. Although I had often spoken about this with many different people, when Zach looked at me and said, “We don’t have earlids,” it truly summed up something very important.
Sound is omnipresent and often unavoidable.
When Zach and I originally developed the program we were mostly interested in a little known disorder called SPD (or Sensory Processing Disorder) and how it impacted emotion regulation. We were most interested in a subtype of this disorder, Sensory Over Responsivity (SOR), that describes individuals who respond aversively to all different kinds of stimuli. Back in the 1990’s before misophonia had been identified we just thought of it as “auditory over responsivity, a part of SOR.” There was no differentiation between whether loud sounds, soft sounds, or repetitive based and pattern-based sounds provoked aversive responding. However, we did know from the SOR research that our fight/flight response was being triggered by all kinds of auditory stimuli.
When I think back to the 1990’s it seemed as though my daughter and I were the only people with this problem so specific to auditory stimuli, and I wonder where everyone else with these exact symptoms were. At the same it makes complete sense to me that a condition, which is unique to auditory stimuli, has become more well known. Compared to other sensory stimuli, sound is so utterly inescapable. I’m not belittling the severity of other sensory issues. Believe me, I’ve seen how impairing these issues can be for individuals and their families. However, a) these non-auditory sensory issues are treatable with occupational therapy and b) with touch and to some extent vision, for example, we have some control over our exposure to these stimuli.
For example we don’t have to wear materials that we find agitating. If we are triggered by a visual, at least we can close our eyes, if even for a moment. I’ve even learned to avoid odors I find aversive by plugging up my nose from the back of my sinuses.
Again, this is not to say that everybody can escape tactile or visual over responsivity easily. Some people have to wear uniforms for their jobs and may find the material horribly aversive. Some people may have severe visual issues and may even find leaving an environment in which stimuli is not under their control difficult or impossible. And of course, babies and young children cannot effectively communicate what they are feeling, and therefore cannot affect changes that might help them. True, those of us who find sound aversive can certainly wear earplugs; we can cover our ears with our hands, etc., and mask sound. Yet despite these accommodations sound is almost always spontaneous.
Sound is unpredictable, and often one has no control over how loud that sound is and/or how long that sound will continue.
Sound travels very quickly. The average speed of sound in air is 364 meters per second (NDE Resource Center).
Sound is powerful. Think about it: sound waves can be used to levitate small and sometimes even larger objects (Foresti, Navabi, Klingauf, Ferrari, Paolikakos, 2013).
Finally, sound is meant to alert us to possible danger. Throughout human evolution sound is one sense that is hard-wired to directly alert us to danger (e.g. predators coming our way.) We use other senses as well (especially vision to scan for danger in the environment). However, as I stated at the top of this post, we don’t have earlids.
-Jastreboff, M. M., & Jastreboff, P. J. (2001). Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia. ITHS News Lett, 2, 5-7.
-Foresti, F., Nabavi, M., Klingauf, M., Ferrari, Aldo, Poulikakos, D. (2013) Acoustophoretic contactless transport and handling of matter in air. Proceedings of the National Academy of Sciences vol. 110, no. 3112549–12554, doi: 10.1073
-Temperature and Speed of Sound. NTD Resource Center. https://www.nde-ed.org
 Some people with misophonia do report problems with visual stimuli as well. However, there have not been enough studies to know the prevalence of visual symptoms and if these are part of misophonia and/or part of a more broad sensory disorder.