Why do people with misophonia become so upset and angry at sounds that don’t bother most people?

The part of our brain that controls emotions is the limbic system. It is part of the midbrain, located in about the center of your head, and has several different parts. One part is the amygdala.

The amygdala looks kind of like an olive, and its job is to prioritize everything that comes into your brain — the smells, the sights, the tastes, the sounds, the feelings. There are so many things in our world that we can’t handle being aware of all of them. Some need to be weeded out. Some need to have high priority. It is the job of the amygdala to sort this all out.

If the amygdala decides that whatever one is experiencing is unimportant, a low priority will be assigned, and you might even forget about the stimulus. Did you put on shoes this morning? Did you forget about them? The amygdala doesn’t think they’re very important anymore. Your brain has habituated to the feel of the shoes.

However, if your shoes are too tight and might cause harm or injury to your feet, you may feel pain, and your amygdala tries to get you to pay attention to this pain and fix the situation. It may be hard to habituate to this pain — it’s something that warrants your attention and needs you to take action.

If the situation is urgent enough, the amygdala sets other processes in motion for your reaction. It is the fight-or-flight response. Is this a dangerous situation; do you need to take action immediately? Sometimes your life might depend upon your immediate action. The amygdala will spur you on. What’s that unfamiliar and unexpected footstep? Who is in the room that shouldn’t be there? Where is that child going that is dangerous? The amygdala alerts your autonomic system and you react without thinking. It keeps you — and perhaps your family — alive. There are more pathways going from the limbic system to the thinking brain than from the thinking brain to the limbic system. It’s by design. Our emotions — fear, anger, alert — will get us moving faster than our thinking brain will.

In the case of misophonia, it is thought that the amygdala has identified some specific sounds (and sometimes specific sounds by specific people) to be dangerous, unwanted, or maybe just plain unacceptable. The sounds really need to stop, so the amygdala will focus on these sounds and locate them so that they can be stopped. And another part of the brain actually makes these sounds louder in the brain (better able to hear them and identify them) even if you don’t want them louder. Your brain thinks it is keeping you alive.

So a person with misophonia has a brain that keeps focusing on obnoxious and gross sounds. The amygdala keeps them on alert. They become anxious (When’s it going to stop? How can that person be so rude?), fearful (It’s going to start again. I have to sit at the dinner table again tonight and it will be TERRIBLE!), and angry (These people MUST STOP making this noise! It’s driving me crazy, and they don’t care!). The emotions take over, and the person is out of control. Parents, teachers, and friends don’t have a clue.

Treatment strengthens those connections from the thinking part of the brain to the emotional, alerting part to retrain the amygdala to not put the priority on these sounds that it once did. We are retraining the thought process. Remember that our brains are ‘plastic’ — we can learn and change some pathways and, therefore, some habits. We want to start enhancing those connections from the thinking part of the brain to the emotional part in order to retrain the amygdala.

Because misophonia trigger sounds are so intrusive, it is necessary to cushion these sounds in the brain so the brain can deal with them. If we eliminate the triggers altogether, the brain is unable to deal with them at all, and the misophonia becomes worse. It’s a balancing act that requires the help of a professional.