What is Misophonia?


The term “Misophonia” was coined in 2001 by Drs. Pawel and Margaret Jastreboff. Previously, the same condition was identified by Dr. Marsha Johnson, AudD, who in 1999 called it “Selective Sound Sensitivity Syndrome,” or 4S. Although there has been increasing awareness of Misophonia in both the medical community and in the public, there is, to date, no diagnostic code for this condition, either in the ICD-10 (the updated code directory used by medical practitioners worldwide) nor in the DSM-5 (the updated code directory used by mental health practitioners worldwide). Without a code, there is no “official” diagnosis for Misophonia, and no insurance billing directly possible.

Audiologists have been using other somewhat related diagnostic codes in order to allow for billing, but until the condition has its own unique code, it does not officially exist!

In January, 2013, a group of psychiatrists in Amsterdam who have been investigating this condition proposed a specific diagnostic picture that is unique to Misophonia/4S, which defines the disorder in the manner of any other disorder contained in the DSM (The Diagnostic and Statistical Manual) as follows:


  1. The presence or anticipation of a specific sound, produced by a human being (e.g. eating sounds, breathing sounds), provokes an impulsive aversive physical reaction which starts with irritation or disgust that instantaneously becomes anger.
  2. This anger initiates a profound sense of loss of self-control with rare but potentially aggressive outbursts.
  3. The person recognizes that the anger or disgust is excessive, unreasonable, or out of proportion to the circumstances or the provoking stressor.
  4. The individual tends to avoid the misophonic situation, or if he/she does not avoid it, endures encounters with the misophonic sound situation with intense discomfort, anger or disgust.
  5. The individual’s anger, disgust or avoidance causes significant distress (i.e. it bothers the person that he or she has the anger or disgust) or significant interference in the person’s day-to-day life. For example, the anger or disgust may make it difficult for the person to perform important tasks at work, meet new friends, attend classes, or interact with others.
  6. The person’s anger, disgust, and avoidance are not better explained by another disorder, such as obsessive-compulsive disorder (e.g. disgust in someone with an obsession about contamination) or post-traumatic stress disorder (e.g. avoidance of stimuli associated with a trauma related to threatened death, serious injury or threat to the physical integrity of self or others).

Misophonia: Diagnostic Criteria for a New Psychiatric Disorder
Arjan Schröder, Nienke Vulink, Damiaan Denys
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (Jan, 2013)


In addition to the above proposed diagnostic criteria, these traits seem to be common:

  • Anger/Aggressive Reactions vs Assertive Responses
  • Initial triggers often begin with family meals
  • Typical age of onset is early puberty or during adolescence
  • Assumptions/Moral Judgments ascribed to behavior of the “offender” creating the trigger sounds
  • Black-and-white, all-or-nothing thinking
  • Triggers increase over time
    Dinner table argument

    • Offensive Sound
    • Person Making the Sound
    • Ascribing Meaning
    • Anticipating the Sound
    • Connecting Sound to Visuals
    • Examples of Visual Triggers:
      • the appearance of the pack of gum, before the gum is taken out
      • foot or leg jiggling
      • hair twisting

How is Misophonia Treated?

Because Misophonia is relatively recently identified, there is no one recognized treatment protocol. Dr. Marsha Johnson uses a 24-week model she calls MMP (Misophonia Management Protocol), which combines audiology (sound generating devices) and CBT. Other approaches currently being tried are medications (to decrease anxiety and depression), NFB (Neurofeedback) to try to re-wire the neurological system, Mindfulness Based Stress Reduction (MBSR), and other combination approaches.

The other pages of this website focus on two specific counseling/psychological approaches to treatment: Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT).