Understanding Misophonia: The Link between Sound Sensitivity and ADHD
Misophonia, a term literally meaning "hatred of sound," is a condition where certain sounds, often commonplace and repetitive ones, trigger emotional or physiological responses that seem disproportionate to the situation. Sounds like eating noises, breathing noises, vocal sounds, clicking or whirring sounds, or animal sounds may trigger sounds for individuals with misophonia. One client I saw was triggered by the sound of water pouring into a vessel, and had developed a silent method for pouring water.
Responses to these sounds can range from mild discomfort or annoyance to severe distress, anger, or even panic. Some individuals might even experience an intense urge to escape from the location where the trigger sound is present.
Misophonia is not a commonly known condition, and is subsumed within the general category of sensory sensitivities which are more common in people with ADHD and autism. I first learnt of it in 2021 when a client presented with it as their main problem that was causing significant functional impairment, and I had to do some digging to understand what she was explaining to me. I talked to an audiology master's student who had never been taught, nor heard anything about it in her training.
While misophonia is not officially recognised as a standalone condition in clinical settings, I see it as a relevant issue in relation to ADHD. In my household, eating crunchy foods is likely to result in a loud and angry rebuke from my son. Myself and other family members often end up eating these foods in another room as my son simply becomes increasingly enraged if we continue to make crunching sounds. My son chose the image for this blog post, stating that it accurately represented how angry he felt hearing these sounds.
Implications for Treatment and Management
At the time of writing there are no peer-reviewed research studies into the efficacy of treatment approaches for misophonia. The Misophonia Association lists a number of therapies with anecdotal reports of success. These include psychological therapies, physiological therapies including those provided by audiologists, lifestyle changes, and suggestions that anti-anxiety medications might be useful.
One thing I have recommended to clients is to wear earmuffs if they find particular environments auditorily challenging. The wife of one ADHD client mentioned that her husband would become enraged by the eating sounds at the dinner table. That's a time to wear earmuffs. People can be surprised when I suggest this, as to many it can feel like they are being rude. For me, it's about reducing a noxious stimulus so that the person doesn't become enraged, or require others to modify their behaviour excessively. My husband and I regularly put on ear muffs when our children get too loud and we start to feel angry. We also keep a pair in the car. While I don't have misophonia, decreasing the volume of noise in my household (and car) can allow me to keep calmer and not become angry myself. You don't need fancy and expensive noise-cancelling headphones for this task.
Just a note of caution, wearing ear muffs or ear plugs much of the time can result in increased sound sensitivity as the brain increases the sensitivity of hearing which can lead to serious issues with tolerating everyday sounds. So, if you want to try ear muffs or ear plugs to reduce misophonia triggers, only use them when you need them.
As with many aspects of mental health, our understanding of misophonia and its potential link to ADHD is still evolving. Increased awareness of misophonia as a significant concern in the lives of some individuals with ADHD can help clinicians and therapists provide more targeted, effective care.
Dr Edward Hallowell gives a brief summary of misophonia in When Soup Slurping and Gum Popping Push You Over the Edge