Does the sound of a dripping tap want to make you run and hide? Perhaps hearing someone chewing their food sends you into a state of stress or blind rage. Are you absolutely unable to tolerate the noise of a crowded shopping mall without becoming anxious?
If you answered yes to any of these questions, you might suffer from phonophobia, misophonia, or hyperacusis. Read on to discover the different types of noise anxiety, what causes them, and how you can cope with them.
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It’s easy to become confused over the differences between phonophobia, misophonia, and hyperacusis because they are often blanketed together under the term “noise anxiety.” It’s important to differentiate between them because the causes, symptoms, and treatments are different.
Phonophobia is also the name for sensitivity to noise resulting from a migraine, but we’re discussing the specific phobia in this article.
Phonophobia¹, also known as ligyrophobia or sonophobia, is a very rare condition defined as a persistent, abnormal, and unwarranted fear of sound. This could include normal environmental sounds, such as the sound of traffic, someone working in a kitchen, or loud speech.
An important aspect of phonophobia is that the sound is not damaging under normal circumstances. People with phonophobia can experience stress reactions to any noise, but they have the most intense reactions to loud noises.
Phonophobia is classified as an anxiety disorder, falling under the subtype “specific phobias.” There is no known abnormality¹ of the peripheral neuro-auditory systems in true phonophobia, but there may be possible dysfunction in the brain's central auditory system.
Misophonia is not currently classified as an anxiety disorder but falls under the broad umbrella of decreased sound tolerance syndromes. As the condition is studied more, it is likely that the classification will be refined and better defined.
Some researchers¹ consider misophonia a milder form of phonophobia (or phonophobia an extreme form of misophonia). As with phonophobia, the origin of the reaction seems to occur in the brain's central auditory system.
The main sign of misophonia² is an excessive, spontaneous, and disproportionate annoyance or discomfort in response to sounds that do not usually provoke discomfort in most people. This could include the sound of someone chewing, someone breathing, or a clock ticking.
Trigger sounds provoke intense levels of anger or distress. Responses can vary between people, with some having severe reactions to many sounds and others having a somewhat milder reaction to just a few sounds.
Although dislike of certain sounds (such as the sound of a fork scratching a plate) is common among the general population, misophonia is more than just a dislike. People with misophonia often experience such significant and intense emotion when exposed to the trigger sound that it can lead to social impairment.
Studies³ suggest that the dominant emotional response to a trigger sound in phonophobia is fear, but it’s anxiety, distress, or anger in misophonia.
If you suffer from misophonia or phonophobia, you may have a physiological response to trigger sounds: Tightness in your chest, muscle tenseness, sweating, shortness of breath, palpitations, and raised blood pressure.
Hyperacusis⁴ also falls under the umbrella of decreased sound tolerance syndromes. However, it is different from phonophobia and misophonia because it is associated with physical discomfort to sound. Many people with hyperacusis also have tinnitus.
Hyperacusis is an abnormally increased sound sensitivity arising from the auditory system. Hyperacusis gets diagnosed using measures of sensitivity to loudness on audiological exams, known as loudness discomfort level (LDL), uncomfortable listening level (UCL), or uncomfortable loudness level (ULL).
People with hyperacusis can develop misophonia or phonophobia because they experience sounds more loudly than people without hyperacusis, which can cause more discomfort.
The most common cause of hyperacusis is exposure to high decibel (sound pressure) levels, such as at construction sites or concerts. The root cause is not fully understood, but it’s believed to be due to damage to the inner ear and cochlea. Hyperacusis is also associated with the following disorders:
Ramsay Hunt syndrome
Head injuries or stroke
Hyperacusis treatment involves treating the underlying cause and interventions such as sound therapy or retraining therapy by an audiologist and counseling.
Acoustic therapy, or retraining therapy, is used to decrease your sensitivity to sounds, while counseling alters your perception of noise.
Sound therapy delivers music or noise to a small device similar to a hearing aid. This desensitizes the auditory nerves and should enable you to tolerate normal environmental sounds over time.
There is limited accurate data² on the exact prevalence of noise anxiety in the general population. This may be because the condition has only recently been recognized as a distinct psychiatric entity, and the diagnostic criteria are still blurred.
Interestingly, before 2015, most articles on noise anxiety were published in audiology journals. After 2016, studies on misophonia were more likely to be published in psychology or psychiatric journals.
One large study² on misophonia in the general population estimated the prevalence at 12.8%. This would suggest that about one in eight people suffer from some form of noise anxiety.
Phonophobia is a rare condition without any known prevalence rates. Studies indicate⁵ that the chance of you developing a specific phobia anytime in your life ranges from 3% to 15%. However, phonophobia is one of the rarest specific phobias: Your chances of developing phonophobia increase if you have preexisting noise anxiety.
Noise anxiety symptoms are fear, distress, anxiety, irritation, or anger evoked by certain sounds. Physiological symptoms such as a racing heart, shortness of breath, sweating, and muscle tension may also occur.
Researchers are not entirely sure what the cause of noise anxiety is. There may likely be a few contributing factors. These things have links with noise anxiety, but studies have yet to confirm the precise relationship:
Some studies³ have shown that people with chronic tinnitus, or ringing in their ears, are more likely to suffer from misophonia. Other studies² have not found the same correlation.
In one study², 43.5% of people diagnosed with noise anxiety had a first-degree relative with similar symptoms. Other studies³ corroborated positive family history.
Some studies³ have found that people who struggle with misophonia or phonophobia often have coexisting psychiatric disorders². These include attention deficit hyperactivity disorder, obsessive-compulsive disorder, bipolar disorder, substance abuse disorder, panic disorder, trichotillomania, and Tourette’s syndrome.
In the case of phonophobia¹, there may have been an event linking loud noise and emotional trauma in the past.
In one study² on misophonia, two-thirds of people reported that their symptoms began during childhood or adolescence.
Noise anxiety can be tricky to diagnose because there are no well-established diagnostic criteria².
As with all fears and phobias, phonophobia is characterized by anxiety or fear triggered by exposure to a specific object or situation (in this case, a particular sound), which leads to avoidance behavior.
If you answer yes to the following questions, you may be suffering from noise anxiety:
Do specific sounds cause significant anxiety, distress, or fear when hearing them?
Do you experience an intense negative emotional reaction to the trigger sound?
Have you tried coping mechanisms (such as wearing earplugs) to avoid being exposed to trigger sounds?
Are your symptoms severe enough to cause significant interference with daily activities? For example, would your anxiety about being exposed to a certain sound cause you to avoid a place or situation?
A study² looking at misophonia in 541 people found the following sounds to be the likeliest to trigger noise anxiety symptoms (anxiety, distress, fear, anger, irritation, or rage), in order of frequency from most to least common:
Fly or mosquito buzzing
Eating, chewing, or lip-smacking sounds
Slurping when drinking
Sound of dripping water
Sound of a fork scratching on plate
Squeaking of floor, door, or fabric
Music or television through walls
“Um,” “uh,” or “er” speech
Unfortunately, very few studies³ focus on the treatment of noise anxiety, so there is no broad evidence base to guide management pathways.
Treating tinnitus or offering tinnitus retraining can alleviate³ noise anxiety symptoms in people who suffer from tinnitus and noise anxiety.
Treatment for noise anxiety involves adopting various coping mechanisms, such as the use of earplugs, as well as cognitive behavior therapy.
The mainstay of CBT is exposure therapy, which involves repeated, graduated exposures to trigger sounds and subsequent desensitization and perception reframing.
Adopting positive coping strategies
It might be tempting to manage your noise anxiety by isolating yourself, avoiding social situations, or challenging the people triggering your noise anxiety. However, replacing these negative behaviors with the following positive coping strategies³ would be more helpful:
Using headphones to listen to music
Focusing on your own sounds
Using positive internal dialogue
Cognitive behavior therapy
Cognitive behavior therapy (CBT) is successful across a wide range of anxiety disorders, and it’s associated⁶ with an improved quality of life in people who struggle with anxiety.
CBT alters your thoughts, which leads to changes in emotional states and behaviors. It focuses on challenging maladaptive thoughts, emotions, and actions.
The two most common CBT treatment methods for anxiety are exposure therapy and cognition therapy.
Although current evidence suggests that exposure therapy may be more effective than cognition therapy in treating anxiety, this may result from study bias rather than a true reflection of treatment efficacy.
Most therapists now use a combination of therapies in their practice to improve client outcomes.
Exposure therapy is particularly useful in the treatment of specific phobias⁵. Exposure therapy involves virtual or real-life exposure to triggers with subsequent desensitization and changes in thought and behavior processes.
If you are struggling with phonophobia, exposure therapy may help your symptoms.
Perhaps you have noise anxiety and another condition such as panic disorder or generalized anxiety disorder.
Your physician may suggest treating your conditions with medication such as selective serotonin reuptake inhibitors (SSRIs), which may alleviate your noise anxiety symptoms. However, this is currently speculation³, and we need further trials to validate this assumption.
Noise anxiety describes phonophobia and misophonia. Diagnosis can be tricky because researchers are still trying to classify noise anxiety accurately and create a set of diagnostic criteria.
To be diagnosed with noise anxiety, you need to have adapted your lifestyle to try to cope with the anxiety-provoking sound, for example, by using earplugs. Your symptoms would be significant enough that they impact your daily life. You may find that you start avoiding places or situations that may expose you to sounds that trigger your anxiety.
Specific phobias (2020)