Noise sensitivity and anxiety

What Happens?

Misophonia is a disorder in which certain sounds trigger emotional or physiological responses that some might perceive as unreasonable given the circumstance. Those who have misophonia might describe it as when a sound “drives you crazy.” Their reactions can range from anger and annoyance to panic and the need to flee. The disorder is sometimes called selective sound sensitivity syndrome.

Individuals with misophonia often report they are triggered by oral sounds — the noise someone makes when they eat, breathe, or even chew. Other adverse sounds include. keyboard or finger tapping or the sound of windshield wipers. Sometimes a small repetitive motion is the cause — someone fidgets, jostles you, or wiggles their foot.

Similarly, people with misophonia also say they often react to the visual stimuli that accompanies sounds, and may also respond intensely to repetitive motions. Researchers believe that those with misophonia may already have issues with how their brains filter sounds and that one of the features of “misophonic sounds” may be their repetitive noise. That repetition then exacerbates the other auditory processing problems.

The disorder appears to range from mild to severe. Individuals report a range of physiologic and emotional responses, with accompanying cognitions. If you have a mild reaction, you might feel:

  • Anxious
  • Uncomfortable
  • The urge to flee
  • Disgust

If your response is more severe, the sound in question might cause:

  • Rage
  • Anger
  • Hatred
  • Panic
  • Fear
  • Emotional distress

The disorder can put a cramp in your social life. Those with the misophonia have been known to develop anticipatory anxiety when going into situations where trigger sounds may be present. You might avoid restaurants or eat separately from your spouse, family, or roommates.

Over time, you may also respond to visual triggers, too. Seeing something that you know may create the offending sound may elicit a response.

Driving and music, the perfect combination?

Our world is full of (unexpected) sounds. A phone ringing, an alarm going off, a car suddenly honking its horn, a person bursting out in laughter, the list is endless. And where those occurrences could make us jump, it is way worse for a person with phonophobia.

Phonophobia
explained

Phonophobia (or ligyrophobia) is an anxiety disorder, so not a hearing disorder. With this disorder, sudden loud and unexpected sound can cause anxiety attacks. This means that people living with phonophobia become very uneasy in their everyday life, as they are always fearing the moment when an unexpected sound can occur. Here are a couple of symptoms that can show that you have phonophobia (occurring after you hear a loud, unexpected noise):

  • Excessive sweating
  • Desire to flee
  • Panic attack
  • Fainting
  • Severe mood swings
  • Irregular heartbeat

How to cope

There is no cure for phonophobia. There is treatment, however. This is quite similar to the treatment of misophonia, in where you have strong reactions to specific sounds. A reason for this is that phonophobia can sometimes refer to an extreme form of misophonia.

Exposure therapy is very popular. With exposure therapy, you expose people with phonophobia to sudden, loud noises and try to get them to get used to this occurrence. With cognitive behavioral therapy, one tries to develop coping strategies. These strategies help to change unhelpful cognitive patterns (thoughts and beliefs for example) that lead to certain behavior.

Also, there are more ways that can help you to cope with phonophobia. Use headphones and/or wear earplugs when outside or in noisy surroundings. Try to distance yourself from noisy triggers. Furthermore, explain to others what you are dealing with. Social support helps, plus they will do their best to not trigger your phonophobia by accident.

Living with phonophobia is tough. We want to stress that seeing a professional is essential. However, finding solace by others always helps, we find. There are various support groups on the internet that could be a great help. We wish you all the best and would love for you to share your story with us.

Misophonia: When Life’s Noises Drive You Mad

For people with a rare condition known as misophonia, certain sounds like slurping, chewing, tapping and clicking can elicit intense feelings of rage or panic. Photo illustration by Meredith Rizzo/NPR hide caption

toggle caption Photo illustration by Meredith Rizzo/NPR

For people with a rare condition known as misophonia, certain sounds like slurping, chewing, tapping and clicking can elicit intense feelings of rage or panic.

Photo illustration by Meredith Rizzo/NPR

For 18-year-old high school senior Ellie Rapp of Pittsburgh, the sound of her family chewing their dinner can be … unbearable.

“My heart starts to pound. I go one of two ways. I either start to cry or I just get really intensely angry. It’s really intense. I mean, it’s as if you’re going to die,” she says.

Rapp has been experiencing this reaction to certain noises since she was a toddler. She recalls a ride home from preschool when her mother turned on the radio and started singing, which caused Rapp to scream and cry hysterically.

“That’s my first memory ever,” Rapp says.

Over the years, “everybody was pretty confused, but on the inside I felt like I was going insane,” she says.

It wasn’t until middle school that she found a name for it. Her mom, Kathy Rapp, had been searching for years for help. Then she found an article on the Web about a condition known as misophonia.

“And I read it and I said, ‘This is what I have. This is it,’ ” says Ellie Rapp.

Misophonia is characterized by intense emotion like rage or fear in response to highly specific sounds, particularly ordinary sounds that other people make. The cause is unknown.

The sound of a retractable pen clicking can trigger strong emotions in people with misophonia. Photo illustration by Meredith Rizzo/NPR hide caption

toggle caption Photo illustration by Meredith Rizzo/NPR

The sound of a retractable pen clicking can trigger strong emotions in people with misophonia.

Photo illustration by Meredith Rizzo/NPR

For people who suffer from it, mouth sounds are common triggers.

“Chewing is almost universal. Gum chewing is almost universal. They also don’t like the sound of throat clearing. Coughing, sniffing, nose blowing — a number of things,” says Jaelline Jaffe, a psychotherapist in Los Angeles who specializes in misophonia and works with Rapp.

For some, the sight of someone chewing or a specific smell or even humming, tapping or pen-clicking can trigger a negative reaction.

“It’s as if the survival part of the brain thinks somehow it’s being attacked or it’s in danger,” says Jaffe.

Misophonia got its name just a few years ago, and it is not officially listed as a diagnosis in any medical manuals. Many doctors have never heard of it, and if patients do mention their symptoms, they are sometimes dismissed or diagnosed with a mood disorder.

While many people with misophonia also have anxiety or depression, not all of them do. There are few studies on misophonia, and experts disagree over whether it should be classified as its own disorder or a subset of another.

Because it’s so little understood, the people around those suffering from it have trouble believing or understanding how painful their symptoms can be.

Some people with misophonia are troubled by sniffling, throat-clearing or coughing. Photo illustration by Meredith Rizzo/NPR hide caption

toggle caption Photo illustration by Meredith Rizzo/NPR

Some people with misophonia are troubled by sniffling, throat-clearing or coughing.

Photo illustration by Meredith Rizzo/NPR

A small, recent study offers potential new insight into how misophonia works.

“We’re pretty convinced that we’ve found some very good evidence for relating this disorder to particular patterns of brain activity.” says Phillip Gander, who studies how the brain makes sense of sound at the University of Iowa. He was part of a team that published a study in Current Biology in 2017 that suggests that the brains of people with misophonia respond differently to certain sounds.

The team looked at 20 adults with misophonia and 22 without it. They had the participants rate the unpleasantness of different sounds, including common trigger sounds like eating and breathing, universally disliked sounds like nails on a chalkboard, and neutral sounds like footsteps or a bird chirping.

“What happened was that the response to the neutral sounds and negative sounds were the same in both groups,” he says.

But the people with misophonia rated the eating and breathing sounds as highly disturbing. Those without the condition did not.

The ones with misophonia also showed classic signs of stress when hearing these trigger sounds: “Their heart rate increased and it made their palms sweat more,” he says.

Also, the people with misophonia appeared to have some unusual brain activity when the trigger sounds were played.

Crinkling a chip bag or other rustling sounds are cited as noises that can set off someone’s misophonia. Photo illustration by Meredith Rizzo/NPR hide caption

toggle caption Photo illustration by Meredith Rizzo/NPR

Crinkling a chip bag or other rustling sounds are cited as noises that can set off someone’s misophonia.

Photo illustration by Meredith Rizzo/NPR

“In the misophonia group, the activity was far greater in particular parts of their brain,” Gander explains — including parts of the brain that process emotions.

It’s an interesting study, agrees Steven Taylor, a professor in the department of psychiatry at the University of British Columbia who specializes in mood disorders. But there are a number of important problems with it, he says. First, it was very small, and the subjects’ misophonia was diagnosed with only a short questionnaire. “In studies of clinical conditions like misophonia, diagnosis by questionnaire is typically inadequate. A face-to-face interview with a trained clinician (e.g., a psychologist) is typically needed,” he says.

Also, the study doesn’t show what causes misophonia, only that it is associated with some brain regions and their connections, he adds.

Gander agrees that more work needs to be done. “What it does help us do is identify some targets in the brain to look at,” he says.

For the misophonia community, the brain study was a big deal.

Marsha Johnson is an audiologist in Portland, Ore., who specializes in misophonia. “It was phenomenal. It was the first piece of research that showed our population that what they had was real,” she says.

Johnson is one of the first to identify misophonia. She began recognizing that a number of her young patients had symptoms that couldn’t be easily explained as either hearing disorders or psychological problems.

“They were perfectly developing normal kids until the certain period of time from like 7 or 8 years old through about 13 or 14 — and mostly girls,” she says. Also, their triggers were most likely to come from close family members.

Repetitive sounds like typing on a keyboard or fingers tapping on a table can be triggering. Photo illustration by Meredith Rizzo/NPR hide caption

toggle caption Photo illustration by Meredith Rizzo/NPR

Repetitive sounds like typing on a keyboard or fingers tapping on a table can be triggering.

Photo illustration by Meredith Rizzo/NPR

Back in 1999, she dubbed it selective sound sensitivity syndrome.

But a more melodic name — misophonia — would later catch on after it was so named by scientists who wrote a paper describing symptoms of decreased sound tolerance in 2001.

Misophonia means hatred of sound, which, as Johnson points out, is not technically accurate.

“Most of these people don’t hate sound; they only hate particular sounds,” she says.

Johnson began speaking at conferences and leading online group chats to draw attention to misophonia, and thousands came. She developed a network of providers to work with misophonia patients, including therapist Jaelline Jaffe.

But the community is still relatively small, and recognition of the condition is still not universal. Misophonia is listed by the National Institutes of Health on its rare diseases website as a chronic disorder (though Jaffe and Johnson say it is likely underdiagnosed and may not be so rare).

And it’s not listed in the bible of mental disorders, the DSM-5, which makes it hard for doctors to identify it and rare for insurers to cover treatments related to it.

Crunching, chewing, lip-smacking or other mouth noises are often listed as irritants. Photo illustration by Meredith Rizzo/NPR hide caption

toggle caption Photo illustration by Meredith Rizzo/NPR

Crunching, chewing, lip-smacking or other mouth noises are often listed as irritants.

Photo illustration by Meredith Rizzo/NPR

“The problem is, the whole field currently lies undefined,” says Johnson.

And there aren’t any bulletproof treatments. But there are some strategies that can help someone cope. Flooding the ears with noise, noise-canceling headphones, mindful breathing, or just getting up and taking a brisk walk can redirect attention. Others have found antidepressants or exercise helpful.

For Ellie Rapp, a combination of noise-canceling headphones and learning to look at life a little differently have helped her excel in school and cope at home.

“Misophonia … I would say it used to define who I am, but now I just see it as another part of my life,” she says.

She graduates from high school this spring and plans to study cognitive science at Case Western Reserve University in the fall.

“I want to basically be a Dr. Jaffe and get my Psy.D or Ph.D. and eventually solve the mystery and cure it,” she says.

Ellie Rapp’s mom, Kathy, stresses that family support plays a big role in helping people with misophonia. At conferences and meetings, they’ve met adults who experience isolation and despair because their families did not believe them.

“It sounds bizarre, but it’s very real and a family’s help I think is critical in helping somebody live a fuller life,” she says.

April Fulton is a former health and food editor on NPR’s science desk. Follow her on Twitter @fultonhere.

Jane Greenhalgh contributed reporting to this story.

From the Experts

Treatment

There are no evidence-based treatments for misophonia.
To date, we lack clinical trials (or treatment studies), and recommendations are currently based on clinical experience and case reports. Most psychological interventions focus on reducing distress or dysfunction associated with heightened sensitivity to sounds (e.g., anger, avoidance). Some preliminary reports have indicated treatments such as exposure and response prevention (ERP), psychoeducation, and habituation training may be helpful. Given the overlap with obsessive compulsive and related disorders, ERP may be an appropriate intervention for some patients. However, it is posited that exposure therapy may not be sufficient (or appropriate) for extinguishing the relationship between the sound trigger and the irritability/disgust reaction. In some cases, habituation to the auditory trigger (e.g., using graduated, real-life exposures) may reduce sensitivity and/or behavioral responses such as tantrums, anger, and irritability. Nevertheless, in other cases, even repetitive exposure to a target sound might not reduce the sensitivity or subjective distress.

Consequently, learning to “sit with” distress, as well as learning ways to reduce emotional and behavioral reactivity in the presence (or anticipation) of the triggering sounds may be
a core component of psychological treatment. Additionally, treatment can focus on breaking the associations between sound triggers and other stimuli (i.e., using extinction strategies to break the associations between locations where the sound may occur and the people/objects associated with the sound).

For children, it is recommended that distress tolerance skills be taught. Over time, prompting the use of these skills can become a replacement for rage outbursts, avoidance, or refusal when faced with triggering sounds. Child treatment is often focused on decreasing the rage outbursts and working extensively with parents to both (a) decrease accommodation around misophonia (e.g., such as setting special meal times to allow the child to avoid trigger sounds), and to (b) encourage/reward use of distress tolerance skills and managing discomfort/anger when triggers are encountered.

Until studied, the use of accommodations such as protective equipment (e.g., noise cancelling devices or ear protection)
or quiet-zones (e.g., quiet places in the home, school or workplace) should not be considered treatments of misophonia but might be helpful with managing symptoms while more adaptive strategies are implemented. In other words, accommodations (headphones, white noise, noise cancellation) alone, without cognitive behavioral strategies that develop new distress tolerance and other adaptive skills, is not recommended as a sole treatment strategy. Avoidance of sound triggers (e.g., homeschooling, eating in isolation) is strongly discouraged as a treatment strategy because of interference with the development of more adaptive strategies and possible negative social impacts.

In summary, there is no definitive psychological treatment
for misophonia. Until evidence-based treatment programs
are developed and tested, treatment should be individually tailored and based on research-supported techniques that address the targeted problems (e.g., avoidance, anger/rage, anxiety/fear, rituals/compulsions). In other words, knowledge of treating anxiety, OCD spectrum disorders, and anger/rage/ reactivity can be flexibly adapted.

There are no medications with specific indications for misophonia. Nevertheless, pharmacotherapy may be indicated for co-occurring problems such as severe anxiety or reactivity/anger/rage.

Dr. Lewin is an associate professor of pediatrics and director of the OCD, Anxiety, and Related Disorders Behavioral Treatment Program at the University of South Florida. Dr. Storch is the Guild Professor of Pediatrics at the University of South Florida, director of research in developmental pediatrics at All Children’s Hospital, and clinical director for Rogers Tampa Bay. Dr. Murphy is the Rothman Professor of Pediatrics, division chief of pediatric neuropsychiatry and vice chair of faculty affairs at the University of South Florida.

Suggested Reading

Wu, M. S., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2014).

Misophonia: Incidence, Phenomenology, and Clinical Correlates in an Undergraduate Student Sample. Journal of Clinical Psychology, 70(10), 994-1007.

Hypersensitivity To Sound And Anxiety Disorders

It’s no secret that our upbringing and experiences can lead to anxiety. While genetics play a role in the development of anxiety; stressful experiences may reinforce fear and other negative emotions creating anxiety to emerge.

Hypersensitivity, or “oversensitivity” is extreme sensitivity to a specific experience, such as sound. Auditory hypersensitivity, or hypersensitivity to sound, may include sensitivity to specific triggering noises, or loud noises in general. Individuals with auditory hypersensitivity experience distress upon hearing the triggering sound. Some people with anxiety may experience this type of sensitivity.

Understanding the Variations of Noise Anxiety

Hypersensitivity to noise is somewhat of a broad term as sensitivity may cause varying responses. Depending on the way a person experiences anxiety, the triggering noise may cause minor irritation or something much more impairing.

Generally, the following represent auditory hypersensitivity. Remember, your experience may be different than others:

  • Specific Noise Triggers Some people develop a sensitivity to particular sounds. Often these sounds are related to a past trauma or a recurring cause of anxiety. This type of sensitivity is the product of conditioning. Conditioning has occurred when a response is elicited to a specific trigger. With concern to auditory hypersensitivity, this may be the experiencing of a negative feeling as a result of a specific sound. where your mind immediately associates a sound with some negative feeling or experience. This symptom is very common in those with PTSD but may affect people with all types of anxiety.
  • Quick Startle Reflex Anxiety causes your body to constantly be on high alert. The greater stress and anxiety you experience, the more likely you will have a higher natural baseline of stress. If anxiety levels reach a certain height, a person may be more prone to startling, often described as being “jumpy.” This is due to the body being on high alert for danger.
  • Irritation Anxiety may cause irritation. Irritation can cause people to experience a rush of negative emotions when they hear loud or triggering noises, or sounds that disrupt the thought process. Disruptions of silence may be particularly likely to trigger irritability.
  • Stress Related Tension Finally, when a person is feeling anxious, it can cause physical symptoms such as tension headaches or nausea. A person experiencing these symptoms may be especially prone to auditory hypersensitivity. Certain sounds may exacerbate these physical symptoms or increase the general feeling of unease associated with anxiety attacks. In some cases, a person may perceive noises to be louder than they actually are.

All of these fall under auditory hypersensitivity as they are all way that you and your body react to sound.

It’s also important to remember that you can experience this type of sensitivity even when you don’t feel anxiety or have anxious thoughts. Anxiety is largely a physical experience, and you may find you are tense even when your thoughts are relaxed and calm, leading to the presence of hypersensitivity.

Controlling Your Reactions to Noise

Dealing with hypersensitivity can be difficult but help is available. Cognitive behavioral therapy has proven to be very helpful for individuals experiencing many varying symptoms of anxiety. Exposure techniques, in particular, may also be useful in reducing hypersensitivity.

What is Exposure Therapy?

Exposure therapy is the process of gradually being exposed to your anxiety trigger in a safe and controlled setting. Over time your anxious reaction should decline and eventually be eliminated. It is recommended that a person start with the least distressing form of their anxiety trigger and work their way up to experiencing the actual trigger.

For example, if you have a fear of spiders, you might start by thinking about spiders. Once that no longer causes significant anxiety you may move on to looking at photos of spiders. Next you may move to videos of spiders, then spiders across the room, then a spider right next to you, and finally a spider on you. You only move on to the next step when you no longer experience anxiety at the level you’re on.

If you would like to attempt to implement exposure therapy at home for noise, you can follow the steps below:

  • Figure out what sounds you’re most sensitive to – especially the ones that you want to be less sensitive to over time.
  • Make a recording of the noise.
  • Sit in a place that you’re comfortable and initially just thinking of the noise. Practice relaxation techniques if you notice your anxiety level rising.
  • Once you are able to tolerate imagining the sound, follow the same procedure while listen to the recording of the noise. At first, you will likely experience intense anxiety. For this reason, it is important to be prepared to implement relaxation techniques. it’s going to bother you a great deal.
  • While you’re listening, do something that relaxes you such as meditation or deep breathing. There are plenty of techniques you may use to calm your body so that your anxiety symptoms feel easier to tolerate.
  • Over time increase the length of time you expose yourself to the sound and eventually you’ll find the sound causes a lower level of distress than previously.
  • To truly master exposure therapy you may wish to repeat these exercises in progressively less calming environments to fully extinguish the negative response to the trigger.

These exercises help you to build tolerance for the sound and decrease your hypersensitivity.

Once you have reduced your hypersensitivity, you should continue to learn to cope with and manage your symptoms of anxiety in order to prevent recurrence of negative symptoms and future development of hypersensitivity.

You hear your spouse breathing nearby and you instantly get angry. Your 6-year-old yawns and it triggers a fight-or-flight reaction in you. You avoid restaurants because you can’t stand the sound of chewing. Sounds other people don’t even seem to notice, drive you up a wall. You might have misophonia.

What is misophonia?

People with misophonia are affected emotionally by common sounds — usually those made by others, and usually ones that other people don’t pay attention to. The examples above (breathing, yawning, or chewing) create a fight-or-flight response that triggers anger and a desire to escape. Misophonia is little studied and we don’t know how common it is. It affects some worse than others and can lead to isolation, as people suffering from this condition try to avoid these trigger sounds. People who have misophonia often feel embarrassed and don’t mention it to healthcare providers — and often healthcare providers haven’t heard of it anyway. Nonetheless, misophonia is a real disorder and one that seriously compromises functioning, socializing, and ultimately mental health. Misophonia usually appears around age 12, and likely affects more people than we realize.

What causes misophonia?

New research has started to identify causes for misophonia. A British-based research team studied 20 adults with misophonia and 22 without it. They all rated the unpleasantness of different sounds, including common trigger sounds (eating and breathing), universally disturbing sounds (of babies crying and people screaming), and neutral sounds (such as rain). As expected, persons with misophonia rated the trigger sounds of eating and breathing as highly disturbing while those without it did not. Both groups rated the unpleasantness of babies crying and people screaming about the same, as they did the neutral sounds. This confirmed that the misophonic persons were far more affected by specific trigger sounds, but don’t differ much from others regarding other types of sounds.

The researchers also noted that persons with misophonia showed much greater physiological signs of stress (increased sweat and heart rate) to the trigger sounds of eating and breathing than those without it. No significant difference was found between the groups for the neutral sounds or the disturbing sounds of a baby crying or people screaming.

The brain science of misophonia

The team’s important finding was in a part of the brain that plays a role both in anger and in integrating outside inputs (such as sounds) with inputs from organs such as the heart and lungs: the anterior insular cortex (AIC). Using fMRI scans to measure brain activity, the researchers found that the AIC caused much more activity in other parts of the brain during the trigger sounds for those with misophonia than for the control group. Specifically, the parts of the brain responsible for long-term memories, fear, and other emotions were activated. This makes sense, since people with misophonia have strong emotional reactions to common sounds; more importantly, it demonstrates that these parts of the brain are the ones responsible for the experience of misophonia.

The researchers also used whole-brain MRI scans to map participants’ brains and found that people with misophonia have higher amounts of myelination. Myelin is a fatty substance that wraps around nerve cells in the brain to provide electrical insulation, like the insulation on a wire. It’s not known if the extra myelin is a cause or an effect of misophonia and its triggering of other brain areas.

There is some good news regarding misphonia

Misophonia clinics exist throughout the US and elsewhere, and treatments such as auditory distraction (with white noise or headphones) and cognitive behavioral therapy have shown some success in improving functioning. For more information, contact the Misophonia Association.

When Noise Annoys: Coping with Hypersensitive Hearing

By Stephanie Stephens

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    Do sounds that don’t bother anyone else make you want to tear your hair out? Hearing hypersensitivity is a fairly common mood symptom with bipolar.

    When Lynn was younger, she realized that sometimes she would hear things at work that no one else could. It was all so unsettling: a rattle in the overhead air conditioning unit, a cricket down the hall, cars on the highway late at night—and her house wasn’t even near the road.

    Lynn says that before she was diagnosed with bipolar disorder at age 38, she attributed her heightened aural response to incidents that affected her hearing. There was that loud rock concert she’d attended, and later, a car accident that resulted in sandy water inundating her left ear.

    Yet the Florida woman “couldn’t account for the rage” that went along with her episodes of hyped-up hearing. After a decade of learning to manage her bipolar, she now sees a connection between her moods and noise sensitivity.

    Anecdotal evidence suggests that a significant slice of people with bipolar experience an almost painful reaction to noise, especially during mood episodes—usually mania. When it comes to scientific proof, however, no one’s doing the research that would validate that connection.

    There’s occasional recognition in scientific circles, such as in a 2013 study at Baylor College of Medicine that was actually looking at a specific gene’s role in bipolar disorder.

    As a result, he says, “colors are brighter, sex is enhanced, and you feel smarter. There’s a heightened openness to experience, so it doesn’t surprise me that there’s heightened sensitivity to sound. Meanwhile, almost the opposite happens with depression.”

    As part of the overall revved-up reactivity that people experience in hypomanic and manic phases, “they’re more attuned and aware of ambient noise,” he notes.

    For Kevin, it’s during downswings that noises become downright painful.

    “My disorder affects my relationship to sounds—especially music—as much as it affects my mood,” he says. “When I’m depressed, I don’t want to hear music or any sounds at all, although I deeply love music.”

    When he’s hypomanic, though, bring on the tunes: “I play music at a normal volume, and I sing along with everything,” says Kevin, a world-class sailor from New Zealand. If he escalates to mania, the volume control ticks upward, too.

    “That makes it feel ‘concert loud’ in my head,” he says. “But I find it very distracting and frustrating if it’s someone else’s music, maybe coming from next door.”

    As described in his memoir Black Sails, White Rabbits, Kevin struggled for a number of years after he was diagnosed with bipolar at age 20. He went on to medal in a half-dozen international sailing competitions, coach national teams in the U.S. and Denmark, and represent the U.S. in the 2004 Olympics.

    Now 46, he’s also a happily married father of three. How he reacts to his children’s incessant drumming on the table also varies with his mood state.

    “If I’m in a really good head space, it doesn’t bother me and it’s cool to imagine the drumming as music,” he says.

    If he’s not in a good space, the sound becomes torture.

    “It’s not like it’s annoying, the way hearing that same song from the movie Frozen for the seventh time is annoying. It’s sharp and visceral and aggravating—more like a pain than an annoyance—and makes me want to scream or lash out or run.”

    He avoids doing any of those things because he and his psychiatrist developed a coping plan.

    “He reminds me to ask myself if I really think they’re doing it to upset me or if they’re doing it for fun or to manage their own inner world through activity,” Kevin reports. “The answer is usually—but not always—that they aren’t doing it to annoy me, which makes me tolerant.”

    He adds, “I have to remind myself that because I’m a little depressed, it’s natural that I feel partly like the world just isn’t really being very nice to me.”

    Heightened Awareness

    One Nebraska woman has developed an array of coping techniques for her noise sensitivity. Jamie M., 58, has bipolar II with hypomanic episodes that tend toward irritability and hypersensitivity.

    That makes it all the harder to endure the housing construction that’s been going on around her for almost three years. It began with cutting down a grove of trees, which broke her heart. Then came the seemingly interminable low-pitched noise of the grader, then street installation, then the sound of saws, hammering and framing, and much more to disturb her peace.

    “My mind fixates on it—especially if it’s repetitive—and I can’t concentrate on reading, or focus on anything else,” she says. She closes all the windows and turns on music, but alas, “that’s one other thing to irritate me.”

    Then she may start to snap at the people in her life. All in all, it ruins the day and “keeps me from being able to enjoy other things,” she explains.

    It’s not only the dull roar of construction that pushes her buttons—which is why she’s learned to limit her exposure to noisy places such as concerts, sporting events, and large family gatherings.

    “l tend to be very selective about what l go to,” she explains. “For example, there might be a lot of excellent concerts coming up, but I’ll just pick one or two of my favorites to see. Or I’ll attend performances in smaller venues: fewer people equal less noise.”

    She also loves to dine out, but sometimes finds herself irritable and distracted “when people are talking and laughing loudly at a table next to me.” As a result, she explains, “my husband and l like to go out to dinner at less busy times, or he’ll get takeout that we can enjoy in the quiet of our home.”

    In addition to recognizing her triggers and making “wise decisions” to minimize them, Jamie proactively pursues self-nurturing activities: “l spend a portion of each day enjoying silence as I read, meditate, cook or hang out with my dog.”

    She notes that with both sides of the equation covered—avoiding triggers and practicing self-care— “l keep better balanced, with fewer ups and downs.”

    Turning It Down

    Lynn also steers away from places when her intuition signals that noise might aggravate her symptoms. And she’s come up with defenses to deal with things like cranky air conditioners, bothersome crickets, whooshing traffic, and the like.

    Lynn began playing her radio at night so she could sleep better. Before she took medical retirement, she wore earplugs or earphones at work to quash intrusive sounds.

    She’s adapted that plug-her-ears approach as a way to keep calm in restaurants, stores, libraries, and other trouble zones. She knows that noise is just a part of life, and that managing how you react is the key.

    “In the end, the best you can do is really all you can do,” she says.

    * * * * *

    How to Deal with Noise Sensitivity

    Here are coping suggestions from people who grapple with noise sensitivity, whether individuals or medical experts:

    Be prepared. Do some problem-solving with your therapist and make a plan for the next time noise intrudes into your life.

    Know your triggers. Once you understand what sets you off, you can do your best to avoid those situations or at least “mute” the effects. For example, use earplugs to eliminate unwanted noise, or earphones to listen to something you find more pleasant. (Something neutral like white noise or the sound of a waterfall may be especially helpful.)

    Check your state of mind. When sounds are starting to bother you, analyze where you are mood-wise. Putting your noise intolerance into the context of symptomatic hypersensitivity may highlight the need for some overall self-care.

    Consider the source. If someone, not something, is creating an intolerable noise, try to ask yourself if the person actually intends to aggravate you. Chances are, the answer is no. Remembering that may help keep you from overreacting.

    Set up quiet zones. Create a designated area in your home where silence reigns supreme.

    Noise Sensitivity from the Medical Perspective

    Unwanted noise can be a real pain in the ear. In the medical field, noise sensitivity (or noise intolerance) is called hyperacusis. According to the American Academy of Otolaryngology–Head and Neck Surgery, hyperacusis arises from a problem in the way the brain’s central auditory processing center perceives sounds.

    As a result, noises that don’t seem loud to someone else will feel overpowering. Something as innocuous as shuffling papers or running a faucet could be as jarring as a jackhammer. High-frequency sounds may be especially troublesome.

    In the general population, hyperacusis may be caused by exposure to a loud noise, some medications, and a few medical conditions. Although it hasn’t been formally linked to bipolar disorder, there is a recognized association with other neurologic conditions such as depression, post-traumatic stress disorder, extreme fatigue, and migraine headaches. (Migraines, by the way, have a significant crossover with bipolar).

    There’s also a body of research that ties stress and emotional exhaustion to hearing problems. In 2013, scientists at the Karolinska Institute and Stockholm University’s Stress Research Institute in Sweden found that women with chronic emotional exhaustion were especially susceptible to stress-induced hyperacusis. After brief exposure in the lab to a physical, mental or social stressor, those women experienced the sound level of a normal conversation as uncomfortably loud.

    Misophonia is a separate kind of sound sensitivity—specifically, “selective sound sensitivity syndrome.” In misophonia, someone has an intense dislike of a sound or group of sounds. An extreme negative reaction (anything from anxiety to violent rage) may be triggered by something like gum chewing or foot tapping, or even someone breathing.

    * * * * *

    Printed as “When noise annoys,” Summer 2016

    • Most of the time, this is done with a device you wear on your affected ear or on both ears. The sound usually sounds like static, so it shouldn’t bother you or cause pain. It can take 6 months to a year or more to get the full benefit of the therapy.

      There hasn’t been enough research done on some other treatments used for hyperacusis to know if they’re helpful. These include acupuncture and relaxation exercises. Another experimental treatment is called auditory integration therapy (AIT). It’s often used in autism treatment. It involves listening to music at different volumes for a period every day.

      Your doctor also may give you medicine to help you manage the stress the condition can cause.

      If you have hyperacusis, you might be tempted to use earplugs to muffle sound or stay away from social situations where there might be the kinds of sounds that bother you. While these can give you short-term relief, they can, over the long-term, make your symptoms worse. That’s because when you eventually take out your earplugs or go into a social setting, the sounds can seem even louder.

      Misophonia

      It is natural for people to sometimes be annoyed with sounds throughout their day. Nails on a chalkboard, loud chewing, incessant pen clicking, etc. However, those with misophonia suffer extreme physical and emotional reactions to sounds. Feelings of anger and anxiety can arise from hearing innocent, everyday sounds others might not even notice. Misophonia is a newly identified health disorder and one that may affect many people unknowingly.

      Table of Contents

      Misophonia Definition

      Literally translated, misophonia means “hatred of sound”. In fact, it refers to a dislike or hatred of very specific sounds that trigger an emotional or physical response. It can be very similar to the fight-or-flight response and can put those affected into a state of high discomfort. Hearing the sound triggers a desire to escape and anger. How strong a reaction is and how someone with misophonia responds varies a lot. Some may just become irritated while others can go into a complete rage.

      Both men and women can start to develop it at any age. However, people generally start to show misophonia symptoms in their late childhood and early teenage years. That said, it can develop at any time across the lifespan. Often, it will start with one sound that will trigger a reaction. Following that initial episode, other sounds can also get the same response.

      An interesting note is that people with misophonia can see that their reaction to these sounds seems disproportionate to the sounds themselves. Because of this, they might feel like they are losing control of themselves. The feelings can be very intense and might give them feelings of embarrassment or shame. In fact, people often feel too embarrassed to talk to their doctors about it.

      Associated Disorders

      Misophonia has some conditions associated with it as a result of the toll it takes. Depression, anxiety, obsessive-compulsive disorder (OCD), and sleep deprivation are a few of the more commonly seen problems. However, it is not always clear whether they come from misophonia or the other way around.

      This sound sensitivity syndrome can have a profound effect on someone’s life. It is a very real disorder. It is a condition that can make it difficult to function, putting stress on one’s mental health and social life. But because we don’t know much about it, it can be difficult to talk about.

      Examples of Annoying Noises

      Apparently, not all sounds have the same likelihood of triggering misophonia. While sound sensitivity can of course change between people, there are certain sounds that seem to get more of a response. According to a study in Amsterdam, the most common triggers of people were as follows:

      • Eating sounds – eating sounds seem to affect the highest percentage of people. At 81 percent, this is the most common stimulus that affects people with misophonia
      • Loud breathing or nose sounds – this one comes in at second place, with 64.2 percent of people being affected.
      • Finger/hand sounds – any type of sounds involving hands rubbing, or fingers moving comes in third with 59.5 percent.

      But these are just a few of the things that really seem to be difficult for a person with misophonia to deal with. Sound sensitivity can really be for anything. It is generally unique to the person. Many more sounds can be triggers for people with misophonia.

      • Wheezing
      • Teeth grinding
      • Chewing with your mouth open
      • Slurping
      • Lip smacking
      • Loud throat clearing
      • Pen clicking

      While it is defined as only applying to sound, it is possible that a sound and action combined can make someone with the disorder have a response. The combination of the sound and action of someone biting their nails or shaking their leg on a table can be a trigger.

      Interestingly, humans produce most sounds and sights that trigger people with misophonia. If the sound comes from an animal eating, it often will not trigger the same physical and emotional reactions.

      It is important to note that while these are generalizations, anything can be a possible source of sound sensitivity. Keeping track of sounds that trigger you and what you feel assist you in being in control.

      Misophonia Treatment

      Medical Help

      In all truth, this disorder can affect daily life. Many people who have misophonia avoid social situations where they feel they might be triggered. With proper care, education, and treatment, misophonia can be managed. There are many healthcare professionals who can provide assistance to you and your friends and family, and treatment can help it become less of a barrier to living your normal life. Therefore, education for yourself and your family and friends can make life-changing differences.

      Because sufferers of misophonia often have other conditions associated with it, certain medications may be available. These can treat things like anxiety, depression and lack of sleep. However, no medication is available today to treat misophonia itself.

      Audiologists are able to take a look for other auditory problems and see if there are other concerns as well. One common treatment is an in-ear white noise generator. Depending on what sounds you are hearing that trigger you, the earpiece can generate white noise at a frequency that will help hide the trigger sounds. Similarly, just wearing headphones can help deal with the everyday sounds outside that are so distracting and make them difficult to hear.

      Cognitive behavioral therapy can be another way to get help. Therapists can teach you how to find coping mechanisms to deal with sounds as they occur. It can also make it easier to deal with triggers and help lessen the impact. Occupational therapists can help people have a full sensory diet. It is a system used to balance out the sensory system and help lower the impact of triggers. This is useful in self-regulation when you can’t control what is happening around you.

      Personal Lifestyle

      Last but not least, you have some control. Your personal lifestyle matters. Getting regular exercise and plenty of sleep help you manage your stress and put you in a positive mindset. Maintaining a quiet or safe place in your home can also help, giving you somewhere to escape to when the symptoms become too overwhelming.

      The key is to have a variety of things working together. A multi-disciplinary approach gives the best results.

      Misophonia: Final Thoughts

      We have many new conditions and disorders we are learning about in this modern age. The brain is a mystery we are still unraveling, and so is misophonia. While experts don’t know much about it yet, there is no reason to feel alone with many other sufferers in the world.

      Remember, be sensitive to someone suffering from Misophonia. It is a disorder that can be difficult to live with. Proper education for both the people with the condition and those around them can make it much more manageable. In the end, it is still new, but the research being done to find out more about misophonia really can help those with this disorder comfortable lives.

      Sources

      Stress makes exhausted women over-sensitive to sounds

      The study, which is published in the online scientific journal PLoS ONE, involved exposing 348 people (208 women and 140 men) between the ages of 23 and 71 with low, medium or high levels of ’emotional exhaustion’ to five minutes of experimentally induced physical (hand in ice), mental (performance on a stress test) and social (being observed) stress.

      The results show that women with a high level of emotional exhaustion exhibit higher sound sensitivity after an experimentally induced stress exposure than those who were not exhausted. Some even experienced sound levels as low as 60 decibels, the level of normal conversation, as uncomfortably loud. People with a low level of exhaustion, on the other hand, became less sensitive to sound immediately after being exposed to five minutes’ stress, a phenomenon that the researchers describe as ‘shutting their ears’ — a normal stress reaction. The same trends could be observed in men, but the differences were not statistically significant. The researchers also point out that, interestingly, there was no difference in sensitivity to sounds between the groups prior to the stress exposure.

      “When you are hypersensitive to sound, some normal sounds, such as the rattle of cutlery or the sound of a car engine, can feel ear-piercing,” says Dan Hasson, Associate Professor at Karolinska Institutet’s Department of Physiology and Pharmacology and affiliated to Stockholm University’s Stress Research Institute. “Given how common it is for people to work in environments with different kinds of disturbing sounds, this hypersensitivity can be really disabling for certain individuals.”

      An earlier study by the same research group shows that some 32 percent of working Swedes report some form of auditory problem (impaired hearing, tinnitus or both). It has already been established that stress is linked to hearing problems, although the mechanisms are not fully understood; the present study, however, is the first to demonstrate empirically a direct association between experimentally induced stress in humans and hypersensitivity to sounds.

      “Serious forms of sound hypersensitivity can force people to isolate themselves and avoid potentially distressing situations and environments,” says Dan Hasson. “Our study indicates that exhaustion level and stress are additional factors that might have to be taken into account when diagnosing and treating hearing problems.”

      The study was funded with grants from the Swedish Research Council, the Swedish Council for Working Life and Social Research (FAS), the Tysta Skolan (Silent School) Foundation, AFA Försäkring insurance company, the Bliwa Foundation and Karolinska Institutet Funds.

      Mental Health Hotline

      1. Should I Call a Mental Health Helpline?
      2. What Questions Should I Ask?
      3. What Is Mental Health?
      4. Free Crisis Hotline Numbers

      Calling Mental Health Helplines

      People reach out to mental crisis hotlines for all sorts of mental health problems, including depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), and eating disorders.

      If you are experiencing a mental health crisis, you are not alone. Many people experience similar struggles, and there are resources available to help. During a crisis, you might feel like things will never change. Contacting a mental health crisis hotline is a good way to begin reaching out for much-needed support. But if you are afraid that you or someone you know might hurt themselves or someone else, call 911 immediately.

      Mental health problems disrupt the way you think, feel, and act. They can begin at any age, affecting your mood or interactions with others. Many mental health disorders occur alongside other issues, particularly substance abuse and addiction. Without treatment, some conditions become worse over time. If you think you might have a mental health condition, calling a hotline number could be your first step toward finding effective treatment.

      Should I Call a Mental Health Helpline?

      About PTSD or Trauma Some people react quickly to traumatic exposure, while others will experience PTSD-type symptoms months or years later.

      It is normal to feel nervous before calling someone you don’t know on a mental help hotline, but the people staff at mental health hotlines have extensive experience talking to people just like you. Everything you say to them is private and confidential—you don’t even have to give them your name if you don’t want to.

      Most mental health hotlines are free to call, so they are a good place to start if you have never sought treatment from a psychiatrist or therapist before. You can learn more about mental health issues and the types of treatment available, plus what to expect when you visit a mental health doctor or counselor for the first time. Many hotlines can help connect you to treatment facilities and other resources in your area.

      It can be helpful to talk about your experience with someone who knows what you are going through.

      Watching someone you love struggle with bipolar disorder, PTSD, or other mental health condition can be challenging, frightening, and frustrating. That’s why mental crisis hotlines are also available to friends and family members of those struggling with mental health issues. It can be helpful to talk about your experience with someone who knows what you are going through. Or, if you are concerned that someone you know may need treatment, a mental health hotline can provide more information about symptoms and what steps to take in order to help your loved one.

      People call mental health hotlines for all sorts of reasons, including to:

      • Learn about the symptoms of various mental health disorders.
      • Talk to someone who understands.
      • Get anonymous and confidential help.
      • Discuss a personal problem.
      • Find a therapist or psychiatrist.
      • Find a mental health treatment center.
      • Learn more about treatment options.
      • Ask questions about what’s healthy and what’s not.
      • Learn tips for talking to a friend or loved one who is experiencing mental health challenges.
      • Ask questions about a related substance use disorder.
      • Find a sympathetic ear.

      What Questions Should I Ask?

      Calling a mental help hotline is the perfect opportunity to answer all your questions about behavioral and emotional disorders. Many people have questions they are afraid to ask their friends, family, or doctors. Calling a mental health hotline lets you speak to someone knowledgeable about mental health conditions and treatment options. These hotlines exist to provide people like you the information you need to make good decisions. Questions you might ask include:

      • How do I know if I have a mental health disorder?
      • What do I do if I’m having a panic attack, a manic episode, or other crisis?
      • Can mental health disorders be treated?
      • Do I need medication?
      • What are the symptoms of mental health disorders?
      • What if I have multiple mental health issues?
      • What if I’m addicted to drugs or alcohol?
      • Do I need to go to a special treatment program?
      • How much does mental health treatment cost, and will my insurance cover it?
      • Will I ever feel normal?
      • What are the next steps I should take?

      If you are having a tough time understanding what is going on with a friend or family member, a hotline can help you learn more about mental health disorders and their treatment. Talking to a loved one about mental health can be difficult, but you can prepare for that conversation by calling a mental health hotline and asking questions first.

      Questions you can ask a mental health hotline include:

      • What should I do if I think my friend or family member needs help?
      • What resources are available to me and how can they help?
      • Should I talk to the person about my concerns?
      • What should I say to someone I love who is displaying symptoms of depression, anxiety, or other condition?
      • What are the symptoms of common mental health disorders?
      • How can I help someone who is addicted to drugs or alcohol?
      • How can I help someone with a behavioral addiction, such as gambling, porn, or shopping?
      • What are the treatment options for my loved one?
      • What can I do to be supportive while they are in treatment?

      What Is Mental Health?

      Your mental health is your emotional well-being. It encompasses the way you feel, think, and react to situations in your daily life. Mental health affects your mood, the way you handle stress, relate to others, and make decisions.1 Positive mental health allows you to reach your full potential and live a healthy life. But if you feel depressed, are overwhelmed by anxiety or stress, relate to others inappropriately, or have a history of trauma or abuse that triggers flashbacks or other symptoms, then your mental health is likely preventing you from leading the life you truly want.1

      Positive mental health allows you to reach your full potential and live a healthy life.

      Mental health disorders have unique symptoms doctors look for when making a diagnosis. However, there are some general signs that indicate that some type of mental health issue is present, and the person experiencing them should seek a more thorough evaluation. These signs include:2

      The Nature Of Suicide If you have the urge to engage in self-injurious behavior, it is important that you seek mental health care.

      • Personality changes.
      • Changes in eating or sleeping patterns.
      • Problems coping with normal stress or daily activities.
      • Strange or grandiose ideas.
      • Excessive anxiety.
      • Prolonged depression or apathy.
      • Thinking or talking about suicide.
      • Substance abuse.
      • Extreme mood swings.
      • Excessive anger, hostility, or violent behaviors.

      Many people with mental health disorders also struggle with substance abuse and addiction. In fact, people with mental health problems are about twice as likely as the general population to have a substance abuse problem.3 The reverse is also true: Compared to the general population, people who abuse drugs and alcohol are about twice as likely to suffer from depression and anxiety.3

      Common Types of Mental Health Disorders

      Depression: Depression is much more than just feeling sad; it is a disorder of the brain. Depression affects more than 19 million people in the U.S. and is becoming increasingly common all around the world.4 Depression can happen to anyone, at any age, though it often begins in the teenage years, and is more common in women than men.4 Several factors can combine to cause depression, including genetics, biology, and environment.4 Symptoms of depression include:4

      • Prolonged feeling of sadness or emptiness.
      • Losing interest in favorite activities.
      • Difficulty sleeping, or sleeping too much.
      • Feeling tired all the time.
      • Overeating, or not wanting to eat at all.
      • Feeling hopeless.
      • Feeling irritable, anxious, or guilty.
      • Chronic aches or pains, like headaches or stomach aches.
      • Thinking about death.
      • Thinking about suicide.

      Depression is treatable, and many patients are able to lead emotionally healthy lives. Depression is typically treated with a combination of medications (antidepressants) and psychotherapy (sometimes called “talk therapy”).

      Depression is treatable, and many patients are able to lead emotionally healthy lives.

      Anxiety: Anxiety disorders are the most common mental health problem in the U.S., affecting more than 40 million adults.5 Anxiety is normal when it has a cause, such as nervousness before public speaking. When anxiety has no specific cause and continues for months, it is considered an anxiety disorder. Women are far more likely than men to be diagnosed with an anxiety disorder.6 Other risk factors include: 6

      • Shyness in childhood.
      • Having a lower income.
      • Being divorced or widowed.
      • Exposure to stress or trauma in childhood.
      • Experiencing major stress or trauma in adulthood.
      • A family history of anxiety.
      • Parents with mental disorders.

      There are several different types of anxiety disorders, each with distinguishing symptoms. For example, social anxiety includes intense worry about social situations and a fear of public places, while panic disorder involves repeated panic attacks. People with generalized anxiety disorder display daily symptoms for months and experience chronic, excessive worry. Symptoms of generalized anxiety disorder include:6

      • Feeling wound-up or on edge.
      • Restlessness.
      • Being easily tired.
      • Difficulty concentrating.
      • Irritability.
      • Difficulty controlling worry.
      • Problems falling asleep or staying asleep.
      • Muscle tension.

      Anxiety disorders can be treated with a combination of medicine and talk therapy. Cognitive behavioral therapy (CBT) is a type of therapy that has been successful in treating anxiety.6

      Bipolar Disorder: People with Type 1 bipolar disorder, sometimes referred to as manic-depressive disorder, experience dramatic mood swings from periods of mania to periods of depression. A manic episode is a period of feeling intensely energized, irritable, and impulsive, while a depressive episode is a period of intense sadness or hopelessness, often accompanied by fatigue. Symptoms of both periods are severe enough to cause major interferences with daily life.7

      Episodes of mania and depression may continue throughout life, but with treatment they will be less frequent and less severe.

      A known risk factor for developing bipolar disorder is having family history of bipolar disorder.7 Genetics and brain structure also have shown to be contributing factors.7 Bipolar disorder is a lifelong condition, but it is manageable. Episodes of mania and depression may continue throughout life, but with treatment they will be less frequent and less severe. Treatment typically includes a combination of medications (mood stabilizers, antipsychotics, antidepressants) and therapy.7

      Obsessive-Compulsion Disorder (OCD): OCD is characterized by obsessions, which are chronic, uncontrollable thoughts, and compulsions, which are behaviors the person feels the urge to repeat again and again.8 Researchers don’t know what causes OCD, but there is some evidence that it runs in families. People with a history of childhood trauma are also at increased risk.8

      People with OCD can have symptoms of obsessions, compulsions, or both. Symptoms significantly impact life and interfere with work, school, and relationships. Symptoms of OCD can include:8

      • Obsessions such as fear of germs; unwanted or taboo thoughts about sex, religion, and violence; aggressive thoughts; and keeping things symmetrical or in order.
      • Compulsions such as excessive cleaning or handwashing, ordering and arranging things, repeatedly checking on things, and compulsive counting.

      OCD is treated with medication, talk therapy, or a combination of both. Most people with OCD respond with treatment, but some continue to experience symptoms. OCD often co-exists with other mental health disorders, like anxiety and eating disorders.8Eating Disorders: Eating disorders are serious behavioral health problems that can be dangerous and even fatal. Some people believe that eating disorders are merely a lifestyle choice, but the truth is that eating disorders are significant mental health conditions that require medical treatment. While there are different types of eating disorders, they all involve obsessions about food and body image. Risk factors for eating disorders include being female, being a teenager, having an anxiety disorder, and having a substance abuse problem.9 Depending on the severity of the eating disorder, treatment can include hospitalization, medication, or talk therapy.

      Signs of the three most common eating disorders include the following:9

      • Anorexia—characterized by extreme thinness and dieting, intense fear of gaining weight, distorted body image, and an intense pursuit of thinness.
      • Bulimia—characterized by binge eating (periods of eating large amounts of food in a short time) followed by purge behavior (self-induced vomiting, diuretic and/or laxative abuse, excessive exercise) in association with distorted body image, and an intense fear of gaining weight.
      • Binge Eating Disorder—characterized by eating abnormally large amounts of food in short periods of time, feeling out of control during a binge, scheduled binge episodes, intense guilt and shame around binges, and chronic on-and-off dieting.

      Free Crisis Hotline Numbers

      If you think you or someone you love may be struggling with a mental health disorder, call one of these numbers to learn more about various mental health conditions and connect with valuable resources near you.

      • National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

      If mental health difficulties are leading you to consider suicide or think about death often, call the National Suicide Prevention Lifeline’s national network of local crisis centers. This 24-hour hotline is available to anyone in crisis and provides free and confidential emotional support and crisis intervention.

      • Crisis Text Line: Text “home” to 741741

      This unique hotline is available via text message to anyone experiencing mental health difficulties or an emotional crisis. Highly trained counselors offer support and guidance to calm you down and make sure you are safe.

      • Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)

      If you’re ready to seek professional treatment for your mental health condition, SAMHSA’s helpline and web-based behavioral health treatment services locator can help you find information about treatment providers, therapists counselors, support groups, and community resources in your area.

      • National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI (6264)

      The NAMI Helpline is available Monday through Friday, 10 a.m. to 6 p.m. EST to answer your general questions about mental health issues and treatment options. You can get information on mental health services in your area and learn how to help a loved one find treatment.

      Sources

      Help! Every Sound I Hear Makes Me Anxious and Irritable

      I cannot stand hearing just about anything. Whispering, chewing, breathing, sniffling, slurping, humming—all of these make me irritated, anxious, and can send me straight over the edge. My best friend has a baby-talk voice that is pretty much guaranteed to make me angry immediately. There are times when I’m extremely stressed that people talking normally makes me mad. I know logically this kind of stuff should be mildly annoying, but emotionally I can’t handle it. I’ve cried just from listening to my dad eat soup or listening to my mom hum along to the radio as she cleans the kitchen. None of them bother me too much when I’m engaged—I can eat just fine around other people, but as soon as I’m finished, I have to bite my tongue and try to keep calm as my family finishes their meals. Occasionally I have to excuse myself entirely because I’m past my limit. Usually putting headphones on and drowning it all out is my solution, but several of my classes this year do not allow headphones at all since they’re lectures and some of my labs don’t allow them either. Sitting next to someone in lecture for three hours who is chewing gum is a nightmare scenario that happens regularly. I feel like such a b*tch if I ask them to spit it out, but if I don’t I’m so agitated by it that I can’t pay attention to what my professor is saying. Sometimes moving seats is an option and I’ll take it, but sometimes it’s not. I need a new solution. My parents think I’m just fussy and I need to get over it, but it’s been going on for years and shutting out everything is no way to function in the adult world. I’m growing up, and I’d like to grow out of this. How do I do it? —Sounding Off
      Dear Sounding Off,

      I find myself filled with compassion for you. It sounds like so many of the common, everyday sounds of life are extraordinarily uncomfortable for you. I imagine it makes engaging with the world around you nearly impossible. It must feel very limiting for you. I hope that you can find this compassion for yourself, too.

      While I certainly cannot make a diagnosis from your brief note (nor is this my expertise), it sounds like you could be describing a condition called misophonia—a sound sensitivity disorder. It is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or International Statistical Classification of Diseases and Related Health Problems (ICD-10), but it has recently been getting attention in the mainstream media and has therefore gained some exposure. There is a website, www.misophonia.com, that has news and information about the condition plus a support forum where you can connect with others.

      Whether you are dealing with misophonia or not, I would recommend that you consider partnering with a therapist for support.

      Whether you are dealing with misophonia or not, I would recommend that you consider partnering with a therapist for support. It certainly sounds like this is causing you considerable stress and anxiety. You mention that the sound of your best friend’s voice immediately angers you and that your parents think you are “fussy” and “need to get over it.” It sounds like your sensitivity to sound is also having a significant impact on your relationships. Working with a therapist will enable you to explore all of the ways you are impacted by this sensitivity to sound, and to develop some strategies for coping with them.

      Whatever steps you take to address this, I hope you do seek out help. You mention sometimes feeling like a “b*tch” and wanting to “grow out of this.” These sentiments suggest you feel your sensitivity is a character flaw rather than acknowledging that you might well be dealing with a condition (misophonia). Regardless of the cause, you are struggling. Being kind and compassionate with yourself will get you much further than being punitive.

      Best wishes,
      Sarah

      Sarah Noel

      Sarah Noel, MS, LMHC is a licensed psychotherapist living and working in Brooklyn, New York. She specializes in working with people who are struggling through depression, anxiety, trauma, and major life transitions. She approaches her work from a person-centered perspective, always acknowledging the people she works with as experts on themselves. She is honored and humbled on a daily basis to be able to partner with people at such critical points in their unique journeys.

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