That Neuroscience Guy - The Neuroscience of Misophonia

Episode Date: June 5, 2025

In today's episode of That Neuroscience Guy, we discuss the neuroscience behind Misophonia, a disorder that causes increased sensitivity to certain sounds like loud chewing or pen clicking. 

Hi, my name is Olav Krogolson and I'm a neuroscientist at the University of Victoria and in my spare time I'm that neuroscience guy. Welcome to the podcast. When my son was younger, he used to tell me that eating dinner with me was difficult because I chewed so loudly. I can even remember him, you know, he'd put his hands over his ears because the sound upset him so much. I have to admit, at the time, this bothered me quite a bit and I basically told him to suck it up. As this behavior persisted,

I started to really get annoyed. I was a frustrated parent because I just didn't, like I thought I was chewing quietly, I thought I was doing everything and you know, I couldn't eat gum. That was for sure, that wasn wasn't allowed and these sounds just upset him so much But then he got diagnosed with misophonia Something that I'd never even heard of before As I learned more about misophonia his complaints made sense to me and I have to admit I felt a lot of guilt So on today's podcast the neuroscience of misophonia. So I guess the best place to start is what is misophonia?

Simply put, misophonia is a hypersensitivity to certain sounds. Misophonic reactions include autonomic arousal and unpleasant emotional experiences such as anxiety. And this is in response to specific sounds. So what are the typical sounds that trigger people with misophonia? The common ones are chewing, slurping, breathing, things like pin clicking or foot tapping, but realistically it can be almost any sound. Some people with misophonia have a single sound that triggers them. Other people with misophonia have multiple sounds that trigger them. There are several key features of misophonia. Typically, it's trigger specific.

Reactions are to a specific sound and not necessarily the loudness of it. So in the case of my son, it wasn't that I was chewing loudly, it was just the fact that I was chewing. Emotional intensity. The response can be quite extreme, especially with people that are sort of just coming into misophonia, almost basically activating the fight or flight response where they just really disturbs them. They want to either they get angry or they want to get away from it. It's an immediate reaction. It basically happens very quickly after the trigger sound is served. So there's an emotional response, there's a physical response, it's almost instantaneous. And misophonia is often misunderstood. It's not that they dislike the sound, like I don't necessarily like the sound of chewing myself, but this is an involuntary intense reaction.

One of the saddest things about misophonia is that a lot of people, including some doctors and psychologists, don't believe it's a real clinical condition. They use the it's just in your head excuse, which is not great because it's not accurate. Sadly though, further supporting this, misophonia is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, which goes under the name of the DSM-5 for the 5th edition. So while misophonia is recognized in the research literature, and by a lot of experts as a real condition, it does not have official recognition as a distinct disorder than TSM-5. So a lot of people, you know, they still question it because of that.

Now as I've said with that a vast body of research and a large group of scientists and psychologists are arguing that misophonia is a real clinical condition. psychologists are arguing that misophonia is a real clinical condition. I'm a hundred percent in agreement because the research is solid and I've personally seen it with my son and talked to many people who live with it. Now as a neuroscientist in my mind, the most compelling evidence comes from neuroimaging studies. For example, in a, in a recent EEG study of people with misophonia using event-related brain potential,

so that's the neural response to a stimulus, the researchers revealed that the brain response to trigger stimuli, and these were sounds, were different in people with misophonia compared to stimuli that were played that weren't triggers and to the brain response of people without misophonia compared to stimuli that were played that weren't triggers and to the brain response of people without misophonia. So basically they played a series of sounds to people with and without misophonia and they played sounds that were trigger sounds and non-trigger sounds and they found that

the evoked brain response to these sounds that were triggers were significantly different in people with misophonia than to non-trigger sounds and to people without misophonia. In another study, recent study using fMRI, so remember that's taking images of the brain, people with and without misophonia were shown video clips, some that included triggers and some without. And their results revealed that there was increased activation of the right insula, so that's an emotional part of the brain, the right anterior cingulate cortex,

so that's a part of the brain associated with conflict detection and conflict monitoring, and the right superior temporal cortex, which is basically processing and interpretation. And that was during viewing of the misophonic clips compared to neutral clips. And that's for people with misophonia. So they had these three brain regions, an area associated with emotion, an area associated with conflict detection and monitoring, and an area associated with just processing and meaning, they all had

these greater responses to trigger stimuli in people with misophonia. And basically what that means is that the audiovisual stimuli, the trigger stimuli resulted in anger and physiological arousal in people with misophonia. And this was activation of the auditory cortex and salience networks that are trying to draw meaning from the stimuli. And these aren't the only studies. If you just go on Google Staller

and put in neuroimaging in misophonia, you'll find a ton of studies that show these differences in brain processing. So to me, the neuroscience evidence seems very clear. Misophonia is a real phenomenon. And the brain response to trigger stimuli differ from those of non-trigger stimuli and from people without misophonia.

And importantly to me, this shows it's not in your head that psychological argument, because it's not a psychological condition based on these data. The EEG data alone rules this out because these differences in auditory responses to the trigger stimuli they occur so quickly it's at a subconscious level long before there's conscious awareness of what the stimuli is. So that that shows that this is the brain's natural response and not sort of an interpretation which would be the psychological theory. So what are the

theories about what causes misophonia? Well right now no one really knows so there's sort of three competing theories and I'm just going to go over them really briefly. Some people argue it's a physiological state that's potentially inducible at anyone, right? So that you, somehow it's a learned thing. So it's just a condition that the body has, either acquired at birth, possibly genetically, or induced by experience. So for example, some people have proposed that high anxiety stress early in life can cause misophonia to occur. And the fact that something can be induced like this might seem far-fetched. And when looking this up, I actually realized I'm going to come back into a full episode.

But there's a very infamous study in psychology which goes by the nickname of the monster study. a study in psychology which goes by the nickname of the monster study. And basically it was performed in 22 orphan children in Davenport, Iowa in 1939. And I'm not going to give it all away, but look it up. It's interesting and I'll come back and do an episode on it. But basically the researchers induced stuttering in children that didn't stutter naturally. And then they continued to stutter for the rest of their lives. So we actually use it in research methods classes to talk about what not to do when you run studies.

But it just shows that things like misophonia could be induced. A second explanation for misophonia is that it's an idiopathic condition, which might be comorbid with a psychiatric disorder. Basically what that means in English is that some people believe misophonia is a medical condition

and the underlying mechanism is just unknown. The third explanation is kind of similar. Misophonia is a symptomatic manifestation of an underlying psychiatric disorder. Basically it suggests that misophonia is a byproduct of a psychiatric condition. So there is some research that links misophonia to obsessive compulsive disorder, OCD, but the evidence for that is very limited. So there's three possible explanations for what causes misophonia.

If you dive into the brain, there's some other theories about misophonia, but two theories that have been suggested is one that's based on hyperconnectivity. So basically it means the auditory cortex and the limbic or the emotional system are over connected, so they over stimulate each other and that would be problematic because it would allow for these sort of hyper responses and the other possibility is that there's

just the the actual anterior insula and the amygdala so this is emotional processing both these brain regions just have increased activation. So they're just, so not the connectivity with other regions, but the regions themselves are hyperactive. So there is a possible neural basis for misophonia there. So if you do have misophonia, how can it be treated? Again, because it's not as well understood as it needs to be, there's a lot of theories out there. Some people have proposed that tinnitus retraining therapy could be used.

Others have proposed cognitive behavioral therapy as an effective strategy for reducing misophonia symptoms. Others have suggested sound therapy, mindfulness or relaxation, one that I'm familiar with, coping strategies and trigger avoidance, which is what we sort of use in our household now. But the reality is all of these treatment algorithms have to be validated in large population studies. They, you know, misophonia is this thing that, you know, I think the growing consensus is that it's a real phenomenon. That's how I feel based on the research data, but these treatments need to be deployed at

a much larger scale to validate their efficacy, if you will. Anyway, I hope you found that interesting. That's the neuroscience of misophonia. Personally, if you know someone with misophonia, please respect it, because I know in my household, and I'm speaking personally, I was a bad dad for a year or two because I didn't believe this was a real thing.

And the reality is I was torturing my son and I didn't even realize I was doing it. So please, if you know someone with misophonia, look into it and learn all about it. This podcast is just the tip of the iceberg, if you will. Anyway, that's the neuroscience in misophonia. If you have not yet, check out our website, thatneuroscienceguy.com. There's links to Patreon where you can support us by pledging an amount per week, per month, per anything. All of the money goes to students in my lab who are studying neuroscience.

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