Misophonia is an excessive response

Dear Dr. Roach: My grandson suffers from misophonia. He is unable to attend school or be in the same room as anyone eating. He runs away when someone clears their throat or coughs.

He is totally isolated and has no friends. He is soon to be 16 years old and is homeschooled. Are there any treatments? — G.H.

Misophonia was described first in 2001 as a fear or hatred of certain specific sounds. While misophonia is not yet a recognized medical condition, researchers are beginning to document its characteristics so that it can be studied. Until then, researchers have noted similarities of misophonia to obsessive-compulsive disorder, or anxiety disorders.

Misophonia typically starts in late childhood or adolescence, but it has been seen up to age 52. The most common noises that trigger misophonia are eating noises, and breathing and nasal sounds. Most people note an immediate irritationthat turns to anger.

Many people get uncomfortable around such sounds, and some sounds provoke an emotional response in some people. However, the response in misophonia is excessive, unreasonable or out of proportion to the provocation, and this is recognized by the person.

Some propose that the neurological basis of misophonia is abnormal neuroanatomical connections in the brain in an area called the anterior insular cortex that’s involved in emotion processing, so that sounds abnormally activate this area.

I can’t provide evidencebased recommendations. I have read case studies showing improvement with cognitivebehavioral therapy. Other possibilities are “counterconditioning,” in which the trigger sound is paired with something positive.

Given how severe his symptoms are and how deeply it has affected his life, I would recommend looking into one of these therapies.