Synopsis: A surprisingly large number of people may become agitated or even enraged when they hear “mouth sounds” such as chewing or slurping, sniffling, or crunching of paper. This disorder, misophonia, is largely unknown, but researchers believe audio processing of these sounds is mis-routed to rage centers in the brain. Experts and a sufferer discuss the syndrome.

Host: Reed Pence. Guests: Paul Tabachneck, IT professional, musician, and misophonia sufferer; Judy Krauthamer, author, Sound Rage: A Primer of the Neurobiology and Psychology of a Little Known Anger Disorder; Dr. Aage Moller, Professor of Behavioral and Brain Sciences, University of Texas at Dallas.

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REED PENCE: Paul Tabachneck is an IT professional and musician who suffers from an unusual disorder called misophonia. He literally can’t stand sounds like someone chewing or scraping a knife on a plate.  

MISOPHONIA SONG: Oh, we’ve got the plastic plates.  It might have been the worst mistake.  No one should have to live that way.  

PENCE: Tabachneck wrote this song to try to explain to friends why at dinner, he might snap at them or his eyes might suddenly flash with fury, instantly provoked by an innocent sound that most of us wouldn’t even notice.

PAUL TABACHNECK: It’s an anxiety, more than anything.  Like, you don’t understand why it’s happening.  You try to rationalize it; you try to see things from their perspective, but you just can’t, you know. Rationality just kind of leaves you.  So, I guess that’s rage.  But, it really is just a lot of cohesion.  Everything suddenly becomes about the sound.  

MISOPHOMIA SONG: It’s been my constant companion all my days.  And it’ll spin me in my grave.  

JUDY KRAUTHAMER: Everyone with this disorder would say the primary feeling that they have is, indeed, rage.  

PENCE: That’s Judy Krauthamer, a scientist and Tourette’s Syndrome activist who is author of the book Sound Rage: A Primer of the Neurobiology and Psychology of a Little Known Anger Disorder.

KRAUTHAMER: When they hear a sound like chewing, the popping of gum by the person next to you on the bus, or the crunching sound of popcorn at the movies; there is a physiological buildup of absolute anger.  There’s a physiological need to flee, to get out of there as fast as you can.  And there’s an emotional component as well, which is hatred.  There’s a feeling of the person who’s doing that is doing it on purpose.  I guess that’s actually a cognition.  So, the overall thing to this disorder is just tremendous, tremendous anger.  

PENCE: The disorder is known by several names–misophonia, soft sound sensitivity syndrome, or sound rage. It’s much more common than you might think. One study reportedly found that 10 percent of a European population suffers from it. And Krauthamer says it almost always starts between age 8 and 12 or 13.

KRAUTHAMER: One day you’re fine, and the next day it’s there.  The next day a sound sends you into rage.  And the research that I’ve done indicates that it’s neurological, rather than this sort of learned behavior, because people all over the globe describe the same age of onset, the same physiological flight response, and that same overwhelming emotion of rage.  

TABACHNECK: I started experiencing the issue when I was 13 and my dad was eating a bowl of ice cream and kind of scooping together the last bit of melted stuff at the bottom.  And he just kind of kept clinking his spoon against the plate to gather it all up.  I paused whatever we were watching, turned around, and tried to control my response and failed.  I just kind of said, “Are you done with that?  Is that over?”  After that I noticed it all the time, that people were just scraping their plates for no good reason.  

PENCE: School became torture. Kids with colds sniffling, or others popping their gum, made it almost impossible for tabachneck to concentrate. But, nobody could help him.

TABACHNECK: Even the doctors hadn’t figured out what misophonia was.  They hadn’t even figured out that there was a syndrome to look into, you know.  My parents took me around to ear doctors when I was a kid and they just kind of said, “His hearing’s fine.  He’s got perfect pitch, that’s the only thing that’s different.”  

PENCE: Misophonia was never mentioned in any major medical text until 2010, so many doctors have been unaware of it. That’s left Tabachneck to deal with it like most other misophones. He became a loner. He says he never hung out with many people, and dating was often disastrous.

TABACHNECK: My idea of a first date when I was going on a lot of those wasn’t going out for a meal, so much as, “Let’s go, I don’t know, let’s go do anything but eat.”  I’ve had relationships fall apart because when somebody is told that what they’re doing is annoying you beyond reasonability, they tend to get defensive about it, “Well, what do you mean?  Everyone does this.”  

KRAUTHAMER: People with this disorder build, through time, a need for an expanded personal space.  It’s a way to protect yourself.  That leads to difficulties in trust, which leads to difficulties in intimacy, literal difficulties.  It’s difficult to sleep next to someone who snores.  It’s difficult to have intimacy if breathing sounds bother you.  But, I must say that people with this disorder do prevail, have children, fall in love, and are certainly worthy and deserving of a life of joy.  

PENCE: Tabachneck says he’s found an understanding girlfriend. But his song still describes intimate meals in separate rooms. Finding joy often takes a long time and a lot of misdiagnosis. Tabachneck’s parents, for example, became convinced he had a mental illness.  Krauthamer says that’s common.

KRAUTHAMER: If you have this disorder, and you get on the metro in the morning to go to work, you’re going to look around to see who’s reading a newspaper, ‘cause of the crumpling sound.  Or, if you’re on a date and you go to the movies, you’re going to look around before you sit, because you really need to know who’s going to be chewing that popcorn, or who’s going to be sucking on a straw.  Well, that’s called “hypervigilance.”  And if you go to a therapist and say, “Every day I’m constantly on the lookout for who has a cold,” they say to themselves, “Ah, hypervigilance.  You have post-traumatic stress disorder.  And maybe you were sexually abused.” I’ve read or spoken to many people who got that diagnosis and had to create a story from their childhood of an external event.  

PENCE: Or someone with misophonia may describe their suffering another way when they go to a therapist, prompting a different misdiagnosis.

KRAUTHAMER: I say to them, “These sounds, these visuals take over my life,” and the therapist says to themself, “Ah, you’re obsessed with sounds.  You have OCD.”  So, when you’re misdiagnosed, of course, the therapy is inappropriate.  And so, people who do go for help, often don’t get the help.  Or, you go to a psychiatrist and they think, “This is an anxiety disorder.  You have so much anxiety about living with this.”  Well, this is not anxiety.  This is not a fear-driven disorder.  It’s an anger-based disorder.  So the pharmaceutical solution may not be the right one.  And then, of course, there’s many people out here who just think they’re crazy, or think this is a quirk, or who think that they are alone.  And so, they don’t know where to go to seek help.  

TABACHNECK: I was put on a cocktail of anti-depressants and anti-psychotics at one point that did very little but calm me down and make me unable to really communicate, but still angry, still constantly angry whenever I would hear the sounds.  

PENCE: Scientists are only beginning to look into the causes of misophonia.  But some of the disorder’s characteristics have enabled experts to make some firm conclusions.

AAGE MOLLER: Oh, it’s a physiological disorder, absolutely.  It’s not people are crazy or anything like that.  It’s not psychological.  

PENCE: That’s Dr. Aage Moller, Professor of Behavioral and Brain Sciences at the University of Texas at Dallas and a specialist in how sound is reflected in brain activity.

MOLLER: It is a pure physiological thing with this nerve activity.  When the sound arose in the brain it is simply in the wrong place.  It should never have ended up there, giving all these reactions.  It’s simply routed wrong.  Any information that comes down is, of course, traveling in many different places, too many different places in the brain.  The route they take is the same in most people, but here, sound is definitely not supposed to go to these parts of the brain that elicit those kinds of reactions.  So, it’s something fundamentally wrong in the wiring.  

PENCE: Moller says there is a specific place in the brain for rage, and it appears that’s where these sounds are erroneously routed.  But why?  Moller says since it’s only very specific sounds that produce symptoms, those sounds must already be highly processed by the brain before the problem occurs.  He and Krauthamer say the age of misophonia’s onset also provides a clue.

KRAUTHAMER: Late childhood, there’s a neurological shift.  The brain, now, is processing these ambient, normal sounds differently.  We don’t know why.  Perhaps, it’s a change in neurotransmitters.  Perhaps, the pruning of synapses that happens in late childhood did something.  But, we do know that something changes.  

MOLLER: The first 2 or 3 years, many nerve cells are actually eliminated and there are lots of changes in routing of different sounds.  There’s one thing that I actually have been studying and that is routing of normal sounds that seems to change and is different in children who are younger, say, 12, 14 years, compared to older people.  That means that sounds in a child who is younger than say 15 years, 14 years, take a different route in the brain than they do in adults.  

PENCE: Adults can often choreograph their lives to deal with misophonia. But children often can’t.  That’s why Krauthamer says researchers and therapists who deal with patients should be focusing on children.  For them, the disorder is new, and still so unknown that they’re especially vulnerable.

KRAUTHAMER: Children, by virtue of the fact that they’re kids, feel powerless.  And, in fact, they really are powerless.  They may be in a family where the family really thinks the child’s simply acting out or being aggressive or is making it up.  So, the child’s in pain and suffering and being forced to sit at a table or is forced to go to the restaurant, or is forced to sit in the classroom with a kid behind him who has allergies and sniffs all day, so that you have this 10 year-old-child who can’t focus on their schoolwork.  

PENCE: For now, most treatments are band aids. Ear plugs, white noise generators, and even anger management can help misophones cope, but Krauthamer says familiarity with misophonia may be most important.  One place to start is at her website:  

KRAUTHAMER: The more we talk about it, the more that we remove the stigma of craziness and look at it as a real, neurological disorder, the closer we will come to realizing that there probably are more people that have it and we will, ultimately, help reduce the pain and suffering that people with this disorder really do have.  

MISOPHONIA SONG: No one should have to live this way.  

PENCE: I’m Reed Pence.

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