The Unbearable Loudness of Chewing

Why do some people find certain sounds intolerable? And why has it taken so long for scientists to get even a preliminary answer?

It’s a teenage rite of passage to explode into rage at your parents. While the usual outburst is sparked by some combination of hormones, insecurity, and authority issues, for me it was a popping sound in my father’s jaw. I first noticed it at the dinner table. Every time he took a bite, the disc of cartilage that cushioned his jawbone would slip out of place and snap back. Chew, click, chew, click. Like a drum, his mouth reverberated the sound, which changed in pitch each time he opened to take a bite. Layered beneath all of this was the wet percussion of normal chewing. The trio — jaw pop, meat squish, fork scraping teeth — became inescapable. And it drove into me, first through my chest, a surprising shock of affront and disgust that then suffused through my whole body. It was the first time I ever got scared that I wasn’t in control of what was inside my own head.

I can’t precisely date this memory, but I was somewhere around the age of 13 when I became unable to tolerate the sound of other people’s mouths. In a world in which everyone eats, my day to day became an obstacle course. I learned to contract the tensor tympani muscle in my middle ear to dampen sounds. In moments of silence, I was sensitive enough that even the subtle parting of lips could trigger in me the urge to flee. There wasn’t logic to what I felt. I knew that. It changed nothing. In my worst moments I started fights, especially with my family, among whom the condition, whatever it was, felt orders of magnitude more severe.

I learned strategies to hide my aversion. Restaurants and the school cafeteria were loud enough to mask eating sounds. You couldn’t eat in my car — it was, I said, just a cleanliness thing. I wore headphones everywhere. Still, I felt the consequences. I became more introverted. My family resigned to eating dinner with the TV on. My high school girlfriend called me out on what had become my habitual death stare when we ate near each other. I fell out with my best friend after I questioned his family’s table manners. I spent hours alone trying to integrate whatever was happening as part of me, hoping I had a wire crossed, afraid that I was experiencing — there was nothing online to help me — an incipient slide into mental illness.

And then in 2011, my first year out of college, I happened upon a piece in the New York Times which described a poorly understood condition some scientists had begun to call misophonia.¹ For its sufferers, certain sounds — often chewing — evoked what seemed an uncontrollable and disproportionate reaction of anger and disgust. It consistently appeared in adolescence. It had no cure. It was, or at least one neuroscientist hypothesized, a hard-wired condition, “a ‘physiological abnormality’ that resides in brain structures activated by processed sound.”

Awash in the relief of diagnosis — not vindication so much as no longer feeling alone — the first thing I did was forward the article to my family. “So please be sensitive toward my ‘physiological abnormality’ when I come home,” I wrote, shielding my sincerity in irony.

13 years later, I feel much less impacted by misophonia. My family knows what it is, even if they don’t fully understand it. In this, they aren’t much different than the general public. But it’s only after spending a few months reading and speaking to researchers that I’ve come to realize that the science of misophonia — at least in what we can say with certainty — isn’t well established either.

It has taken, in fact, more than 20 years since the condition was first recognized to even arrive at a definition. And outside of that, some of the most basic questions remain up for debate. Where does misophonia originate, and why? Is it a medical disorder, a neurological disorder, a psychiatric disorder, or something else entirely? Most important of all — at least to the millions of people who likely suffer from it, many without fully understanding what it is — can it be cured?

Starting conditions

In 1983, Pawel Jastreboff, a Polish engineer-turned-neuroscientist, began studying tinnitus. One of his main contributions from his early research was an animal model of the condition. It was a clever experiment that built on the work of his Ph.D. advisor, Jerzy Konorski, who developed the idea of operant conditioning after working in Ivan Pavlov’s lab.

Jastreboff raised rats to live with a constant, high-pitched ringing sound. They were then trained to expect a mild electric shock when the sound shut off. Next, he gave the rats salicylate (aspirin), which is known to cause ringing in the ears. And then he watched how the rats behaved when he shut off the tone. Rather than behave as if it was silent and a shock was coming, they acted normally. It appeared they were still hearing a ringing. While the model produces only temporary tinnitus, it allowed researchers to validate that animals could be trained to respond to internally perceived sounds, establishing one of the first behavioral methods to measure tinnitus in animals.

Jastreboff also developed a proprietary treatment, “tinnitus retraining therapy,” which drew, as did the animal experiments, on his belief that the condition wasn’t auditory in nature. It consisted of a combination of counseling and sound therapy that promised to “reclassify tinnitus into the category of neutral stimuli.” In other words: to counter-condition the signal. He soon took a faculty position at the University of Maryland that came with a clinic to further his study, where he also saw patients with another sound tolerance disorder called hyperacusis, a rare condition affecting about one in 50,000 people in which noises are perceived as unbearably loud. (The most common cause is damage to the cochlea, but it is more prevalent in those with tinnitus than it is in the general population.)

To meet increased patient demand, Jastreboff’s wife, Margaret, a molecular biologist and pharmacologist, joined him in the clinic. And it was Margaret who noticed something Pawel had not. Some patients were intolerant of sounds, but their symptoms fit the profile of neither tinnitus nor hyperacusis. Several hundred out of a thousand patients appeared to be afflicted by an intolerance to specific sounds, with specific origins.

“I was very skeptical,” Pawel said, “but she convinced me.” And so he came to understand that every patient was a little different. They were triggered by a variety of noises: the drone of an airplane 30,000 feet above, a refrigerator hum, or the clacking of a keyboard. One patient could not bear the sound of his parents’ voices. “Everybody around him had to speak in a whisper. When I met him outside of the clinic, he had to carry a sound generator set at such a high level that I was able to hear it from ten feet away.”

The way these patients reacted to noise was different from those suffering from hyperacusis or tinnitus. They had, as Jastreboff euphemistically put it in the first published piece to use the word misophonia, “a negative attitude to sound,” which seemed to activate their fight-or-flight response.² The next year, the Jastreboffs published the first peer-reviewed article to include the term “misophonia” in the Australian and New Zealand Journal of Audiology. It detailed, they claimed,³ how tinnitus retraining therapy could alleviate both tinnitus and misophonia.

For ten years, it was met by silence.

Quiet

I wish I’d seen that paper when it first came out. I was 14 at the time, and I would wait another nine years to learn the term. I’m sure others feel the same — today, for example, the r/misophonia subreddit has 78,000 members. But between 2002 and 2013, misophonia appeared in journals just 15 times, mostly in case reports, none of which made meaningful advances in the science. (One, “Fear of the Yawning Mother: A Case Study of Misophonia,” was retracted due to a legal dispute.)

Why does it fail to gain any traction? I can think of a few reasons. The first is that the Jastreboffs are clinicians. Their published work relies on their private practice, emphasizing observation over experiment. Nor did the Jastreboffs ever sell the concept: Misophonia doesn’t even appear in most of their article titles.⁴ And so it’s not surprising that, pre-social media, burying a newly coined disorder in the text of an obscure Antipodean audiology journal (impact factor 0.4) is akin — as it were — to shouting into the void.

But I think a second, larger reason is that misophonia is weird. It’s hard to explain and difficult to understand and doesn’t make any intuitive sense. After all, everyone hates the sound of chewing.⁵ What appears to be a deep aversive reaction to sounds that most people don’t like can seem — I speak from personal experience here — like you’re hard to tolerate. It’s easier to be skeptical than empathetic. “Even now, when patients don’t know about misophonia, their friends and family are often quick to dismiss their complaints as them simply being neurotic or over-dramatic,” said Zach Williams, a neuroscientist Ph.D. and M.D. candidate at Vanderbilt who has studied misophonia and decreased sound tolerance.

It doesn’t help that we don’t have clear historical precedents of the condition, the way we see, for example, signs of what we now call PTSD in writing from the First World War. At least so I thought. Misophonia researchers are quick to cite possible cases. Winston Churchill held a lifelong aversion to whistling. Churchill’s bodyguard, in his memoir, recounts England’s PM admonishing a boy for trilling while walking down the street. The man posted signs in his war room bunkers that read “There is to be no whistling or unnecessary noise in this passage.” Then there is Proust lining his room with cork and Kafka’s fixation on the din of his house in “Great Noise.” What we accept as the anality of the great artist might start to appear as something else entirely.

Scientists were also skeptical of Jastreboff’s research when they did encounter it. Jastreboff spoke of being treated as if he’d conjured a condition out of thin air. “You’re totally ignored, you do not exist,” he said, “or you are just talking garbage.” That began to change, ten years later, with an article in the New York Times — the same from my eureka moment — titled “When a Chomp or a Slurp Is a Trigger for Outrage.” The month the story came out, the Google Trends for misophonia erupted into existence. It’s only grown since. It tends to periodically spike for news stories or new studies. (Its second spike occurs in May 2012, when ABC’s 20/20 aired a somewhat sensational segment about a daughter who couldn’t even talk to her mom; it also featured Kelly Ripa, who self-diagnosed with misophonia after reading the Times article.)

Finally, in 2013, misophonia found real traction among scientists. According to Jastreboff, there was a third challenge in the early research breaking through. “Audiologists don’t write that much because it distracts them from other things — mainly making money with patients.” It was only a matter of time until psychologists (who, to be clear, also make money with patients) noticed the condition. “And psychologists,” he said, “like to write a lot.”

Noise

“Some patients report a preoccupation with a specific aversive human sound that triggers impulsive aggression,” reads the abstract to a 2013 paper in PLOS ONE. “This condition is relatively unknown and has hitherto never been described, although the phenomenon has anecdotally been named misophonia.”⁶ Led by Arjan Schröder, a psychiatrist at the University of Amsterdam, the article did more than describe the condition — its subtitle explicitly labeled it: “Misophonia: A New Psychiatric Disorder.”

In broad strokes, it gets the descriptive aspect right: The average age of onset (around 13); the specificity of triggers; the usual response of irritability, disgust, and anger are all now well-validated. But it begins, literally, with a case of selection bias: “Three patients were referred to our expertise centre in obsessive-compulsive disorders (OCD) at the Academic Medical Center in Amsterdam with obsessions focused on a typical sound such as smacking or breathing and the subsequent aggressive impulse to scream and yell or attack the source of the sound in order to make it stop.”

Of the 42 participants (all of whom self-selected into an OCD clinic), 22 met the diagnostic criteria for obsessive-compulsive personality disorder. To boot, the scale the authors created to measure the severity of misophonia symptoms, the A-MISO-S, was adapted from a scale used to measure the severity of OCD.

While Schröder et al. are careful to note that misophonia is distinct from any disorders recognized in the DSM, they also suggest it “should be considered as an obsessive-compulsive spectrum disorder” — a loosely grouped range of conditions that most often includes body dysmorphia, hypochondriasis, tic disorders like Tourette syndrome, and body-focused repetitive disorders such as trichotillomania, in which individuals pull out their own hair.

Figuratively, eating sounds have made me want to pull out my hair. But the idea that misophonia belongs on the OCD spectrum ultimately proved premature. Seven years later, research from the same group found that the comorbidity between misophonia and OCPD traits was lower than that first research: only ~25%. A 2023 paper, designed to tease out the relationship between OCPD and misophonia, found that misophonia isn’t correlated with having a diagnosis. It’s just that misophonia kind of looks like OCPD. I have not come across other research that validates the obsessive-compulsive spectrum placement.

The Schröder paper deserves credit for igniting more formal research into misophonia. But it is also emblematic of the way that first decade of misophonia science often appeared to grasp for scientific purchase at a range of disorders and diagnoses that could serve as a template. One paper, based on just three case studies, suggests that misophonia may be associated with the presentation of eating disorders. Another concluded that “misophonia is better described as a symptom of a) obsessive-compulsive disorder, b) generalized anxiety disorder, and c) schizotypal personality disorder.” It, too, was based on just three case studies.

“The early definitions of misophonia are a bit like Rorschach inkblots,” said Zach Rosenthal, associate professor in psychiatry and behavioral sciences and the director of the Duke Center for Misophonia and Emotion Regulation.⁷ “What you see is based on your own expectations and biases.”

Ideally, science works as a cooperative, knowledge-sharing enterprise in well-coordinated pursuit of the truth. And it can — but sufficient funding is required to foster enough competition that errors and misdirections get corrected quickly enough. Through most of the 2010s, that is not the case for misophonia.

This is a tricky recipe when it intersects with the media. For example, in 2017, Sukhbinder Kumar et al. published fMRI results that shone preliminary light on misophonia’s holy grail: the underlying mechanism. In misophonics, trigger sounds cause hyperactivity in the anterior insular cortex and other parts of the brain responsible for processing and regulating emotions. The authors are careful to conclude that it’s impossible to tell whether this is a cause or consequence of misophonia, but the CBC went on to declare misophonia “the result of a misfire in the brain.” The headline of the New York Times coverage: “Misophonia Sufferers: Scientists May Have Found the Root of Your Pain.”⁸

Part of the problem is that, in the early years, it was hard to find an unbiased and large sample to say anything confident about comorbidities in misophonia. So many of the early papers were drawn from some form of psychiatric clinic or private practice that it’s impossible to say much about misophonia in the general population. In 2017, a sample of 301 qualified as a “large-scale” study of misophonia. That study found that 50% of their sample appeared to have no comorbidities at all, while the other 50% were affected by a variety of conditions, only one of which — PTSD — helped to explain misophonia symptom severity.⁹

There is also the challenge of measuring prevalence without validated scales. The earliest estimates are based on the perennially most convenient population: undergrads. A 2014 paper reported the incidence in the United States to be 20%. A 2017 paper among Chinese students pegged it at 6%. Neither of these studies uses the same scale, nor are those which they use validated. (Remember: We didn’t even get a consensus definition of misophonia until 2022.)

“The science is flawed. Nobody wants to hear it, but it is,” Rosenthal told me over Zoom. There’s few studies with representative or large samples; we know less about men and boys; almost no research has been done outside of WEIRD contexts. “Everything needs to be held carefully in terms of what it is and what we know it is from a scientific perspective.” Rosenthal was sitting in his basement, but his background was sunset on the Green River in Utah, where he had just been on a camping trip. I’d asked for an hour of his time; we ended up speaking for two, and I got the sense he was the sort of person to extend the same generosity to his patients — and to the nascent misophonia research community.

Which in 2019 began to coalesce.

Signal

The turning point is the injection of meaningful research funding. In 2019, the philanthropists Steve and Diane Miller created the Misophonia Research Fund. (The Millers’ daughter was diagnosed with misophonia in 2016.) “They have single-handedly injected $12 million dollars into misophonia research to date and are essentially the sole funder of misophonia research at this time,” said Williams.

Research output on misophonia has tripled since 2019. And with it has come some stepping stones. There are now several better validated scales: the Duke Misophonia Questionnaire, developed by Rosenthal and colleagues; and the S-Five, developed by Jane Gregory and colleagues. Gregory had gotten interested after seeing misophonia patients in her own clinical practice. A key aspect of the S-Five is that it can better track clinical improvements within individual patients, which older scales had not. “My patients were saying, ‘I feel a lot better, but that’s not reflected in the change in scores,’” Gregory said. “Half the questionnaire was based on this section that essentially said, ‘Compared to other people, I am sensitive to these sounds.’” For a misophonia patient, that is almost always true — and so it was important to capture change.”¹⁰

In July of 2024, Laura Dixon et al. published the largest survey to date (n = 4,005) which supports what has been intuitively obvious for some time: While a large proportion of people (78.5%) report sensitivity to trigger sounds, only a small proportion — 4.6% in this study — report clinical levels of misophonia.

MRF now holds annual meetings, “the beginnings of what will probably be our professional society one day,” said Williams. And it funds, for the first time, a project to arrive at a consensus definition of misophonia. It was an intensive Delphi process ( a structured approach to expert consensus) conducted over eight months: 15 experts, 68 references that included definitions of misophonia, and four rounds of voting to arrive at:

Misophonia is a disorder of decreased tolerance to specific sounds or stimuli associated with such sounds. These stimuli, known as “triggers,” are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people. Misophonic responses do not seem to be elicited by the loudness of auditory stimuli, but rather by the specific pattern or meaning to an individual.

But outside of that definition, some of the most basic questions about misophonia remain. Specifically, is it psychological, neurological, audiological, or something else entirely?

“The Committee concluded that the scientific evidence regarding whether or not to classify misophonia as a ‘medical’ or ‘psychiatric’ disorder is currently insufficient but that underlying organic etiology of the disorder cannot be ruled out.”

The researchers I spoke with were similarly cautious on this front. “There’s not even anything reasonably in the proximity of definitive,” said Rosenthal. Or as Williams put it: “If someone tells you they know exactly what causes misophonia down to the molecular or brain pathway (which probably comes with their own patented cure that they conveniently own exclusive marketing rights to), I would consider those claims hyperbolic or not take them seriously at all.”

Still, when I spoke with researchers, they were willing to hazard cautious, caveated answers to the question that I’ve most wanted answered since I was 13: Where is this coming from?

Rosenthal favors a multilevel frame. There are biological vulnerabilities that we might think of as strong antennae, such as sensitivity to sensory input or sensitivity to emotions.¹¹ Then there are environmental vulnerabilities: growing up in an environment of unpredictability, a chronic invalidation of one’s internal experiences, the need for hypervigilance in navigating one’s environment. Call this “walking on eggshells.” The interplay between those two factors translates into a hypersensitivity that, over time, locks onto a particular trigger — possibly one which you first heard at a moment you worried the eggshells were about to break.

Gregory’s view is similar. Her book, Sounds Like Misophonia, a popular take on the science and guide to coping strategies, lays out specific examples of how misophonics learn to associate sounds with stressors: children eating at the dinner table during a period of family conflict; a child bullied near the basketball courts who comes to associate dribbling with social threat; a salaryman frustrated with his career progress who notices how loudly his co-worker taps on her keyboard. (One of my favorite pieces, “Did Kant Suffer from Misophonia?,” speculates that misophonia arises when common sounds violate internalized social norms, specifically Western table manners that dictate demureness when eating, thereby disrupting one’s sense of an orderly world.¹² It’s somewhat compelling.) Dixon’s survey showed that over half of misophonics report eating sounds as their first trigger. If there’s truth in it, it’s that the dinner table — the place where happy and unhappy families alike gather — is a common site for conflict, including over table manners.

Williams notes, however, that “whether misophonia traits and their specific manifestations (e.g., which triggers are most bothersome, how severe the reactions are, how one behaviorally responds, etc.) are learned over time remains an open question.” It’s likely that the avoidance of trigger sounds may be a secondary reaction of classical conditioning but that some of the automatic responses may not be learned in the typical way. “This is all still to be understood, though.”

Some sort of neurological root — as the consensus definition notes — remains on the table. In 2021, Kumar’s lab published fMRI results that point to a motor basis for misophonia. Specifically, the brains of people with misophonia show heightened activation in areas that control facial movements when hearing triggers. The idea that misophonia is a misfiring of mirror neurons then got picked up in a range of outlets, but more recent results have contradicted those findings. Patient advocates seem to appreciate the concreteness of brain imaging studies: Here, see, misophonia is real; it’s in the brain. But fMRI is expensive, and both of these studies were small.

Jastreboff remains adamant that the idea that misophonia is a “psychiatric disorder” is wrong. Much of the evidence pointing in that direction, he believes, is a result of selection bias in recruiting. Theoretically, “it is possible to turn everybody into a misophonia patient towards a specific sound.” His view remains that misophonia is a disorder of conditioned reflexes where the brain has formed strong functional connections between the auditory system and other brain systems (particularly the limbic and autonomic nervous systems).

Harmony

In many ways, misophonia resembles what Scott Alexander has called a “trapped prior.” A belief is “trapped” when it has become so strong it causes you to interpret all new evidence — even contradictory evidence — in support of the belief. A phobia is a basic form of trapped prior. You’re asked to speak in front of the class and you mess up. You get made fun of. Your brain then associates public speaking with social danger, creating a self-reinforcing cycle of anxiety that impairs your speaking performance, which then confirms your belief that speaking is dangerous.

More recent research on psychedelics and depression has provided some evidence for the trapped-priors framework. The theory goes: In depression, high-level priors like "the world is fundamentally threatening" or "I am worthless" become extremely rigid and self-reinforcing. Psychedelics appear to temporarily "relax" these high-level priors by reducing their influence over lower-level sensory processing.

Under the predictive processing/trapped-prior framework, misophonia begins to look a little less strange: Your brain forms, for whatever reason, a negative association with specific sounds. Each new exposure to the trigger sound gets interpreted through the lens of that prior — the brain expects the sound to be unbearable, which causes a strong emotional and physiological reaction, which then reinforces the prior that the sound is unbearable. This self-reinforcing loop is difficult to break.

The evidence for how it might be broken in misophonia, specifically, is thin. A 2023 systematic review of treatments found just one randomized controlled trial, one open label trial, and 31 case studies.¹³ That RCT, which used cognitive behavioral therapy techniques, found modest effects: 37% in the treatment group had clinical improvements compared with 0% in the control. The open-label trial, also CBT-based (and led by Schröder), worked for half. And some case studies suggest CBT can improve symptoms. Still, it’s early days.

The fact that CBT-based techniques sometimes help with misophonia fits the trapped-prior model. By introducing trigger sounds in controlled, low-stress environments, it may allow the sensory "bandwidth" to stay open enough to update the prior — rather than having it override the experience. Some of Gregory’s techniques break the association altogether by, for example, imagining a different origin to the sound. She gave the example (from a workshop, not a patient) of a man bothered by the sound of kids bouncing on a trampoline next door. He appeared to find relief by listening to trampoline sounds while imagining not kids but his cat jumping up and down in joy.

I tend to be self-deprecating about my own experience with misophonia. That is a coping strategy. It’s my way of saying: Heads-up, please forgive me, I know this is weird. I imagine a lot of misophonics feel the same. Pardon us for being crazy. We apologize for taking up space. But that experience is not everyone’s. The severity of my misophonia experience has diminished over time. (On Gregory’s S-Five, I score 48 out of 250, below the score of 87 that she uses as a cutoff for “significant” misophonia.) On a day-to-day basis I feel mostly unimpaired.

Others suffer. Some deeply. The r/misophonia subreddit can be sad and desperate. “My trigger is the worst thing in my life,” “I've honestly felt the urge to punch my own wife,” “I fucking hate it with every fiber of my being,” “I have no friends, and it's often hard to even go outside.” A number of suicides have been traced to misophonia. At least on Reddit, some people report going to extreme lengths — including intentional deafness — to eliminate triggers.

People need help. But this need runs up against practical barriers. There are few places to seek treatment. Misophonia remains poorly recognized. No one technique is yet proven. Official classification as a disorder could help funnel resources and attention, but there is some debate within the advocacy community about the utility of pursuing that. Those who are comfortable labeling misophonia a psychiatric disorder have no issue on this front. But “other people get really mad when that’s even on the table to consider,” Rosenthal said.

The two main options are either Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases. Rosenthal thinks the ICD is the more appropriate place, particularly because it’s not yet clear whether misophonia is best classified as a mental disorder.

“It’s undeniably a good thing to have misophonia in at least one manual,” Williams said. “[N]o code means no billing, and no billing means no reimbursement for services (not to mention less legitimacy in medico-legal contexts, advocacy, etc.).”

Modulation

I had hoped to try some of the CBT-inspired approaches for this piece. Then I got busy. More honestly, I had a hard time overcoming the inertia to even start. I found myself caught in a familiar pattern: avoiding treatment for a condition that makes me avoid things.

Instead, I had an unexpected opportunity: a week-long silent meditation retreat. Assuming misophonia is indeed like a trapped prior, a retreat could offer the space for processing sensory experience in a new light. Meditation, at its heart, is a way to drop all preconceptions and to see things as they are.

Which is how I found myself five days into the deepest equanimity I’ve ever felt curiously observing my own reactivity manifest. The meditation hall was quiet but not silent, punctuated by the subtle sounds of thirty people settling into their seats. Every time the person next to me swallowed, I felt first a brief ripple of anger at the sound itself, followed by a larger wave of frustration at my reaction to it. Here I was exerting intensive focus on something I wasn’t supposed to be focusing on. I was shocked at the extent to which I felt — imagined I could even see — the sounds of other people swallowing around me as tiny darts into and through my chest.

And yet, with time, as I settled, I became better able to notice the space between sensation and reaction. For the first time, I could choose to ignore the signal. To separate it as part of myself. Something happening in my awareness, but not necessarily to me. I could allow it to be, for once, just noise.

There were times researching this piece when I found myself frustrated with the slow pace and sporadic nature of misophonia science. I was angry for my younger self at researchers jumping to conclusions, annoyed at the way misophonia seemed carelessly lumped in with whatever condition the author seemed to know best — back to trapped priors again.

But this now seems unfair. For more than a decade, the field operated with tiny budgets and poor visibility. And I am hopeful that misophonia research is poised to experience something of an acceleration in the coming years. Brain science continues to advance every day. Early research from the Duke Center for Misophonia has shown that targeted brain stimulation combined with CBT techniques can help accelerate treatment. Psychedelics, theoretically, are another area to consider.

These might all pan out to help in small to large ways. But the fruition of this research will take years, if not decades. Even then, it is unlikely we ever see a genuine “cure.” This remains a point of debate among some within the misophonia community. “There’s a lot of quackery and snake oil out there,” Williams said. “This is a context ripe for desperation. And people need to be protected from that.”

I don’t think there is a cure. Our history treating other complex psychological conditions — from depression and anxiety to OCD and ADHD — suggests that while we may yet find more effective treatments, there is no silver bullet. Anyone who says differently may be selling you something. Living with misophonia may require something harder, the answer that was always obvious but many of us prefer not to confront: work.

1. Marsha Johnson, an audiologist in private practice in Oregon who trained with Jastreboff, noticed what we now call misophonia around the same time. In the late ’90s, she termed it “selective sound sensitivity syndrome.”

2. The Jastreboffs consulted a classics professor on the name, which literally translates to “hatred of sound.” Lots of people don’t like this name because neither “hatred” nor “sound” accurately characterize the condition.

3. The Jastreboffs have never submitted their treatment to any form of controlled trial, so I’m being deliberate, not cynical, here.

4. It is, plainly, “Decreased Sound Tolerance and Tinnitus Retraining Therapy (TRT).”

5. To be clear, misophonics are quite a bit more sensitive on this front. Most people dislike the sound of chewing, but at least one study has shown that many misophonics are triggered by sounds such as breathing and swallowing that don’t bother the general population.

6. The paper actually cites Jastreboff here as the “anecdotal” evidence.

7. Probably the largest center dedicated to the study of misophonia in the world. (It’s six people full time, plus grad students.)

8. One point of caution with respect to Kumar et al. — and this is argued by Schröder in a commentary — is that they recruited patients on the basis of an unvalidated questionnaire. Having looked at the questions, which are quite open-ended, I tend to think this is fine.

9. Tantalizingly, they also find that 50% of their sample reporting experiencing an “unfamiliar phenomenon called autonomous sensory meridian response (ASMR).” I’ve spoken with a few friends with misophonia, and they all report also enjoying ASMR. Weirdly, I’ve seen almost no follow up on this.

10. It’s still, however, a work in progress. As Gregory noted to me, a flaw in the S-Five is that it doesn’t differentiate between hyperacusis and misophonia. “We didn't have that in mind when we were designing it. We were working from the clinical experience we had. So that’s the next step of the research.”

11. Whether these are truly biological is an even harder question to answer.

12. Kant was apparently sensitive to a variety of sounds, including boats, prison singing, and, most notably, the crowing of a rooster — one which irritated him so much he tried to buy and kill it.

13. A few more RCTs are on the way. One seeks to compare acceptance and commitment therapy to progressive relaxation training. Another is testing the effectiveness of CBT combined with psychomotor therapy in children and adolescents.