Signs of Misophonia: How to Know If You Have It

The main signs of misophonia are strong, immediate reactions, usually irritation, anger or disgust, to specific sounds that most people barely notice, most often other people's eating, mouth or breathing sounds. The reaction feels out of proportion and hard to control, it often comes with physical tension, and it tends to be worse with certain people. Symptoms usually start in childhood or the early teens.

I have misophonia, and mouth sounds are my hardest trigger. This guide goes through the signs researchers describe, gives examples of common triggers, and explains what a proper assessment looks like. It can help you recognise yourself, but it isn't a diagnosis.

What misophonia is

The 2022 consensus definition, agreed by an international panel of experts, describes misophonia as "a disorder of decreased tolerance to specific sounds or stimuli associated with such sounds", which "tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people" (Swedo et al., 2022).

It's common: in a UK study, an estimated 18.4% of people experienced misophonia to an extent that caused significant burden, yet only 13.6% had heard the word (Vitoratou et al., 2023).

8 signs of misophonia

1. Specific sounds trigger a strong emotional reaction

Not general noise, but particular sounds. The consensus definition lists the most common reactions: "Anger, irritation, disgust, and anxiety are most common, though some individuals may experience rage" (Swedo et al., 2022).

2. The triggers are mostly sounds people make

Especially with the mouth and nose. "Sounds associated with oral functions are among the most often reported misophonic trigger stimuli", and triggers are "often repetitive" and mostly produced by another person (Swedo et al., 2022). Your own chewing usually doesn't bother you.

3. You know the reaction is out of proportion

Many people with misophonia recognise that their reaction is excessive, which makes it even more frustrating. Researchers who proposed diagnostic criteria described intense irritation, anger or disgust "of which the individual recognizes it is excessive, unreasonable or out of proportion to the circumstances" (Jager et al., 2020).

4. Your body reacts too

Triggers "may evoke increased autonomic arousal such as increased muscular tension, increased heart rate, and sweating" (Swedo et al., 2022). Brain imaging has also measured raised heart rate and skin conductance in response to trigger sounds (Kumar et al., 2017).

5. You avoid, escape or try to stop the sound

People with misophonia often avoid or leave situations with triggers, try to make the sound stop, or mimic it (Swedo et al., 2022). Eating alone, wearing headphones at the table or leaving the room are common examples.

6. It's worse with certain people

The same sound can be bearable from a stranger and unbearable from someone close to you. In a large clinical study, people "often stated the emotional response to be far more intense towards loved ones" (Jager et al., 2020).

7. Some things you see trigger you too

Visual triggers are common, such as "cracking knuckles and jiggling or swinging legs, as well as visual stimuli associated with an auditory trigger, such as watching someone eat" (Swedo et al., 2022). In the Amsterdam study, 68% reported repetitive movements as a trigger (Jager et al., 2020).

8. It started when you were young

"Misophonia symptoms are typically first observed in childhood or early adolescence" (Swedo et al., 2022). In the Amsterdam study, the average age of onset was about 13 (Jager et al., 2020). It can still appear later in life.

Examples of common misophonia triggers

Based on the consensus definition and the large Amsterdam study:

Type	Examples
Mouth and eating sounds	Chewing, crunching, slurping, lip smacking, swallowing
Throat sounds	Coughing, throat clearing
Nose and breathing sounds	Breathing, sniffing
Repetitive sounds	Tapping, clicking a pen
Visual triggers	Leg jiggling, knuckle cracking, watching someone eat

Eating sounds are by far the most common: 96% of patients in the Amsterdam study were triggered by them, and 85% by nasal and breathing sounds (Jager et al., 2020). If chewing is your main trigger, why do chewing sounds bother me so much? goes deeper.

Misophonia, hyperacusis or phonophobia?

These three are often confused. An article in the American Journal of Audiology defines them like this (Henry et al., 2022):

• Hyperacusis: physical discomfort or pain when sound reaches a certain loudness that most people would tolerate.
• Misophonia: intense emotional reactions to certain sounds, often body sounds like chewing and sniffing, that "are not influenced by the perceived loudness of those sounds".
• Phonophobia: anticipatory fear of sound.

The key test is loudness. If a quiet chewing sound bothers you as much as a loud one, that points to misophonia rather than hyperacusis. The two can also occur together.

Is there a misophonia test?

There's no blood test or scan, and misophonia isn't yet included in the DSM-5 or the ICD-11. Cleveland Clinic explains that a healthcare provider can recognise its common features by asking about your experiences, adding: "However, that's not the same as a formal diagnosis." (Cleveland Clinic).

Researchers and clinicians use validated questionnaires to measure it:

• Duke Misophonia Questionnaire (DMQ). An 86-item questionnaire covering triggers, emotional, physical and cognitive responses, coping and impairment (Rosenthal et al., 2021). Duke makes it available on its resources page.
• S-Five. A 25-item questionnaire assessing the severity of misophonia, used in the UK prevalence study (Vitoratou et al., 2023). Its scoring guide is available on request from its authors.
• AMISOS-R (Amsterdam Misophonia Scale-Revised). Developed at Amsterdam UMC and published as an appendix to their 2020 study (Jager et al., 2020).

These are self-report tools. Filling one in can help you put words on your experience and bring something concrete to an appointment, but none of them gives a diagnosis on its own. Online "misophonia tests" that aren't based on these questionnaires are best treated as curiosities.

A few questions to ask yourself

This isn't a test, just a way to reflect before talking to someone:

• Do specific sounds, especially other people's eating or breathing, make you feel angry, irritated or disgusted almost instantly?
• Do you know your reaction is stronger than the situation deserves, but can't stop it?
• Do you avoid meals, places or people because of certain sounds?
• Is it worse with family or people close to you?
• Does it affect your work, studies, relationships or mood?

If you answered yes to several, and especially to the last one, it's worth discussing with a professional.

How to get assessed

The Duke Center for Misophonia and Emotion Regulation suggests that psychologists, psychiatrists, social workers and other licensed providers can treat misophonia alongside other conditions, and recommends finding an audiologist who specialises in decreased sound tolerance (Duke CMER).

Not every clinician knows the term yet. Duke suggests that when you call, you may get further by asking for an evaluation of a highly distressing over-responsiveness to certain sounds that affects your daily life, rather than asking for a misophonia evaluation.

What to do next

• How to deal with misophonia day to day: practical strategies that help.
• Noise cancelling headphones for misophonia: what they can and can't block.
• How to watch YouTube with misophonia: if mouth sounds in videos are a trigger for you. That's also why I built CalmEar.

Frequently asked questions

How do I know if I have misophonia?

The key signs are strong, fast reactions of irritation, anger or disgust to specific sounds, usually other people's eating, mouth or breathing sounds, that you recognise as out of proportion and that affect your daily life. Only a professional can assess it properly.

Can I self-diagnose misophonia?

You can recognise the signs, and questionnaires like the Duke Misophonia Questionnaire can help you describe them. But misophonia isn't yet in the main diagnostic manuals, and a clinician can check for related conditions and suggest what would help.

What is the Duke Misophonia Questionnaire?

It's an 86-item self-report questionnaire developed at Duke University to measure misophonia triggers, reactions, coping and impairment. Duke makes it available on its website for clinicians and researchers.

At what age does misophonia start?

Usually in childhood or early adolescence. In a large clinical study, the average age of onset was about 13, though it can appear at any age.

Is misophonia a mental illness?

It hasn't been formally classified as a neurological, audiological or psychiatric disorder yet, and it isn't in the DSM-5 or ICD-11. Researchers did agree on a consensus definition in 2022, which describes it as a disorder.

Sources

• Swedo S. E. et al. (2022). Consensus Definition of Misophonia: A Delphi Study. Frontiers in Neuroscience.
• Vitoratou S. et al. (2023). Misophonia in the UK: Prevalence and norms from the S-Five in a UK representative sample. PLOS ONE.
• Jager I. et al. (2020). Misophonia: Phenomenology, comorbidity and demographics in a large sample. PLOS ONE.
• Kumar S. et al. (2017). The Brain Basis for Misophonia. Current Biology.
• Henry J. A. et al. (2022). Sound Tolerance Conditions (Hyperacusis, Misophonia, Noise Sensitivity, and Phonophobia): Definitions and Clinical Management. American Journal of Audiology.
• Rosenthal M. Z. et al. (2021). Development and Initial Validation of the Duke Misophonia Questionnaire. Frontiers in Psychology.
• Brout J. J. et al. (2018). Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda. Frontiers in Neuroscience.
• Cleveland Clinic. Misophonia.
• Duke Center for Misophonia and Emotion Regulation. Choosing services and Resources for clinicians and researchers.