Understanding intrusive thoughts brought on by Misophonia

BY CJ GIBSON

Misophonia, a disorder involving negative emotional reactions to a particular sound, is often associated with the unwanted thoughts that come with it—thoughts that tend to be violent in nature.

By venting in online forums, misophonia sufferers have expressed some examples of these aggressive thoughts.

While few known cases have been reported of misophonics acting on these kinds of aggressive, assault-related intrusive thoughts, the unwanted but all-consuming notions of hurting the people who cause them psychological pain can cause those experiencing the intrusions to feel overwhelming shame and guilt. After all, it can seem like only supervillains would be prone to such despicable ideas, especially when the noises that prompt them do not seem to affect most others around them.

Dr. Zachary Rosenthal, director of the Center for Misophonia & Emotion Regulation at Duke University, assured misophonics that “Intrusive thoughts are unpleasant and unwanted, and they happen to everyone.”

Unlike the unaffected population, for those with misophonia, intrusive thoughts usually revolve around activators.

“I would hypothesize that, compared to people who do not suffer from misophonia, intrusive thoughts in people with misophonia are significantly more focused on the anticipation of triggers, associated cues, contextual variables related to a history of misophonia, and imagined outcomes when triggered,” Rosenthal said.

Dr. Whitney Whitaker, social psychologist and associate professor at FHSU, drew from the I3 Model to explain why misophonic intrusive thoughts are so closely related to aggression.

“There are many models or theories of aggression, but the I3 model is a metatheory that has been used widely to predict when aggression may occur for a variety of people (both clinical and non-clinical populations),” Whitaker said, 

Whitaker provided an example of the model in action with respect to someone with misophonia.

The first part of the I3 model is Instigation: the factor that provokes an aggressive reaction.

“For someone with miso, an auditory trigger – the sound of someone eating and/or repetitive sounds like the ticking of a clock – may elicit emotional responses, such as anger, frustration, and hostility (see Potgieter et al., 2019; Vitoratou et al., 2021),” Whitaker said. 

But according to a recent study by (Schroder at al., 2019), the aggressive response may be more than what happens inside the person with misophonia’s head.

“Researchers used neuroimaging data to examine areas of the brain associated with miso triggers. Physiological responses – elevated heart rate; increased skin conductance/sweat – as well as activation of certain areas of the brain were seen in those with miso compared to those without miso. Thus, reactions to a trigger for someone with miso could be emotional and physical,” Whitaker said.

The second aspect of the I3 model is Impellance: traits that may affect someone’s aggressive response, such as genetics, personality, or situational factors.

“For example, someone with severe miso may show a comorbidity to other conditions, such as anxiety and mood dysregulation (see Potgieter et al., 2019) as well as PTSD following a traumatic experience (see Schadegg, Clark, & Dixon, 2021). Those possible comorbidities could be something that exacerbates the emotional/behavioral/physiological reaction to the sound trigger,” Whitaker said.

A study by (Schadegg et al., 2021) suggests that anxiety sensitivity and biological sex both could play a role as impellance factors in people with misophonia.

“The researchers found that anxiety sensitivity (AS) strengthens the relationship between experiencing miso and aggression,” Whitaker said, “Something pretty interesting about this study also includes biological sex – the researchers noted conditional effects such that biological males in the sample reported greater miso symptoms with higher levels of AS contributing to more aggressive tendencies. What’s all this mean? After experiencing a trigger, other impellance factors may help us to better understand the reactions for people with miso.”

The final part of the I3 model is Inhibition: coping strategies and self-regulation techniques that help prevent aggressive action.

“One such factor related to the connection between miso and aggression may be coping strategies that serve to decrease hostile or aggressive thoughts/feelings/behaviors,” Whitaker said, “Some research suggests that those who experience miso may avoid certain social situations so as not to trigger a reaction (Schneider & Arch, 2017; Schroder et al., 2019). Other coping strategies, such as mindfulness and acceptance-based approaches may also serve to decrease aggressive reactions following a sound trigger.”

When considering the I3 Model, inhibition is the aspect of aggression that people with misophonia have most control over through their coping strategies, skills that can be developed through therapy, particularly cognitive behavioral therapies (CBTs). 

“No studies have been done yet with misophonia to address [intrusions and negative self-related thoughts], but it seems reasonable to think that the same evidence-based therapeutic procedures that work for people with a wide range of disorders could also be helpful in misophonia,” Rosenthal said. “This includes, for example, mindful awareness of intrusions without being attached to their literal truth – something sometimes called cognitive defusion or decentering – and cognitive reappraisal of these thoughts.”

Aggressive intrusive thoughts, while common in those with misophonia due to the instigation and impellance that the disorder brings, are not unique to the disorder and, with help from a therapist who works with CBT, can be better managed.

In other words, these thoughts are just thoughts—they’re normal, uncontrollable, and do not define the person you are.

If you feel that your intrusive thoughts are overwhelming and are in need of mental health support, here are some resources available to help:



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