Misophonia Is Not Just About Sounds: Visual Context Matters

How visual context influences reactions to misophonic trigger sounds.

Reviewed by Abigail Fagan

Key points

• Misophonia is typically thought of as a disorder of auditory processing.
• New research shows that visual context can influence reactions to trigger sounds.
• Misophonic reactions were reduced when sounds appeared to originate from non-triggering visual sources.

By Ghazaleh Mahzouni.

Imagine sitting in a classroom, and suddenly, someone walks up to the chalkboard and drags their nails across it. Can you feel the surge of irritation in your body? Perhaps your face twisting into a grimace and your muscles tensing up as the unbearable sound grates on your nerves?

Now imagine experiencing the same intense reaction every single day to the most ordinary sounds: your partner’s breathing, dogs barking outside, a refrigerator humming, etc.

This is the reality for people living with misophonia, a recently recognized clinical condition where specific sounds – known as trigger sounds – provoke intense psychological and physical reactions. Trigger sounds are usually human-generated mouth sounds like chewing, slurping, and sniffling but can also include other sounds like fork tapping, window squeaking, or finger drumming. While the prevalence of misophonia has long been underestimated, a recent large-scale study by Laura J. Dixon and colleagues (2024) estimates that approximately 4.6% of the U.S. population experiences misophonia at a clinical level severe enough to interfere with daily functioning.

The Role of Beliefs and Context

It’s tempting to think that misophonia is solely about the sound – after all, the name itself literally translates to "hatred of sound.” However, as misophonia is gaining popularity among researchers, more and more studies are noticing that beliefs and expectations about the source of the sound also play a critical role in misophonic reactions. For example, a study by Marie-Anick Savard and colleagues (2022) found that embedding varying levels of white noise into trigger sounds, making them less identifiable, significantly reduced their impact. That is, the less identifiable the trigger sounds were, the less likely they were to provoke negative emotional reactions in participants with misophonia.

In our most recent study published in last month's issue of Multisensory Research, my colleagues and I investigated whether altering the visual source of a trigger sound can influence how individuals with misophonia experience the sound. In other words, we wanted to know if changing the visual context of a trigger sound can trick misophonic participants into believing that the sound they’re hearing is not a trigger but rather a positive or neutral non-triggering sound. And if so, would this shift in belief affect how pleasant or unpleasant they found the sound?

To do so, we recruited 31 participants with misophonia, all of whom had relatively high scores on the symptom severity scale of the Duke Misophonia Questionnaire (DMQ; Rosenthal et al., 2021), and 26 control participants with low scores on the DMQ.

We presented all participants with a series of sound-swapped videos from our recent paper (Samermit et al., 2022), where 13 common trigger sounds (eg. squeaking) were paired either with a Positive Attributable Visual Source (PAVS; eg, puppies barking), or with their Original Video Source (OVS; eg., cleaning a window). After watching each video, participants rated its pleasantness or unpleasantness and the intensity of any bodily sensations they felt. Participants also had the opportunity to write short descriptions of their bodily sensations. Click below to see examples of PAVS and OVS that use the exact same sound:

Visual Sources Matter

Our results showed a strong reduction of negative reactions when trigger sounds were heard under positive visual contexts compared to original visual contexts. Both misophonia and control participants rated the trigger sounds as more pleasant when they heard them under the PAVS context. Interestingly, compared to the control group, misophonia participants reported a much stronger reduction in negative bodily sensations when the trigger sounds were presented in the PAVS context. The results can be seen in the figure below.

Even more compelling were misophonia participants' subjective descriptions of their bodily sensations for PAVS and OVS stimuli. For example, one misophonia participant described their reaction to a gulping sound under its original visual context (OVS) as: “My nose scrunched up and I felt the tension in my body,” while describing their reaction to the same sound under PAVS context as “ I felt relaxation in my chest.” We analyzed the valence of these subjective descriptions and found that, overall, participants used more negative language to describe their bodily sensations in response to the OVS clips compared to the PAVS clips, even though the sounds were the same.

The idea that visual perception can change how we experience sounds is nothing new. In fact, a classic example of this type of visual dominance is demonstrated in the McGurk Illusion (McGurk & MacDonald, 1978) where an auditory utterance of /ba ba/ paired with a visual mouth movement of /ga ga/ leads to a fused perception of “da da”. Because vision is our dominant sense, we tend to trust it more when we are faced with conflicting information from other sensory sources.

The results from our experiment support this notion and suggest that a positive visual source can override the negative reactions that are typically associated with a trigger sound. Furthermore, these benefits are more pronounced for those who experience high levels of misophonia. This suggests that misophonia should be considered more holistically, taking into account the visual context in which trigger sounds occur. This research may also open up new avenues for creating interventions that incorporate sound-swapped stimuli.