I want to discuss the similarities and differences between misophonia and Obsessive Compulsive Disorder (OCD) - but why is this important?
It's important to address the similarities and differences because we have an effective treatment called ERP (exposure and response prevention) that works for OCD. If misophonia is a form of OCD, then the treatment for OCD should work for misophonia as well.
Similarities Between Misophonia and OCD
At first glance, misophonia seems to share some similarities with OCD. There is an overlap between the two conditions. Extreme discomfort when experiencing sound triggers seems to mimic obsessions (hyperawareness of specific noises) that cause extreme distress, followed by compulsions which are behaviors intended to get rid of the discomfort (e.g., various forms of avoidance such as using headphones or leaving the room).
Despite these similarities, ERP does not seem to work for misophonia, at least in its traditional application. We don’t find any clinical evidence suggesting that simply exposing oneself to sound reduces sensitivity to the sound.
Key Differences Between Misophonia and OCD
1. Primary Emotional Response: Fear vs. AngerThe primary emotional response that people experience with OCD is anxiety and fear. For example, people with contamination OCD are scared that if they touch something dirty, they will get sick or make somebody they care about sick at a later date. Fear is all about anticipation that something bad will happen in the future.In contrast, the primary emotional response that people with misophonia experience are frustration and anger. Anger is a response when people feel that others are being inconsiderate or hurting them. When experiencing misophonia triggers, people feel assaulted by the sound in the present moment. The triggering sound feels unjust and unacceptable, leading to thoughts like: "Why can't they just stop?! Don’t they know how much I hate it?!"The intensity of misophonia is partially due to the difficult reality of living in a world where people will make triggering sounds on a regular basis - and there is little they can do. People are going to eat, breathe, cough, and sniff. The distressing unacceptable reality is already here - in the present.In short, anxiety emerges when anticipating an undesirable event, while anger arises when that unwanted event has already occurred.Both emotions are triggered by the presence of something undesirable, but OCD is about fear of the future, while misophonia is about the discomfort that comes with the reality of triggers in the present.Both are striving towards the impossible: People distressed by OCD want to completely eliminate the possibility that something bad will happen in the future. While people struggling with misophonia are trying/wishing to change the present reality – that people are and will continue to make triggering noises.
2. Relational Component: Misophonia Feels PersonalIndividuals with misophonia tend to find that when their misophonia initially developed, they were only triggered by a select few people. Typically, these are people close to them such as partners, parents, or siblings. Over time, triggers may generalize to other people and may eventually include everyone making the sounds.Misophonia seems to include a very relational component - it's personal. There is something about being triggered by specific people that impacts the intensity. Feeling as if a stranger was inconsiderate when they trigger you is one thing but feeling mistreated after being triggered by someone you are close to is another.In contrast, using our earlier contamination example, OCD doesn’t care about who or where the contamination came from. The only concern is the fear of what may happen if you are contaminated.Addressing these differences are crucial for successful treatment
These two components—anger/frustration with the reality of present discomfort that won't stop, and the relational component - feeling as if people who are triggering you are inconsiderate and doing it intentionally—both need to be addressed.
EASE (Experiential Acceptance and Stimulus Engagement) is a therapy specifically for misophonia that addresses these crucial nuances – Click here to learn more.
If the therapy for OCD is designed to help sufferers learn to live with the risk and discomfort of a future unwanted possibility, then misophonia therapy is about learning how to accept and stop fighting to change the current reality that people will continue to make noises - even if we feel that we can do something about it.
What is OCD? Obsessive-compulsive disorder (OCD) is a mental health condition that affects millions of people worldwide. It involves two key components: 1. Obsessions – Intrusive, repetitive and unwanted thoughts, images, or urges that cause significant distress. 2. Compulsions – Repetitive behaviors or mental acts performed to reduce the distress caused by obsessions or to prevent a feared event. For example, someone with OCD may fear that they will get sick from germs (obsession) and compulsively wash their hands for hours each day (compulsion) to relieve their anxiety. While compulsions may provide short-term relief, they ultimately make OCD worse, strengthening the cycle over time. How the Vicious Cycle of OCD Begins and Continues The Natural Response to Pain To understand why OCD is so persistent, it helps to compare it to physical pain. Imagine touching a hot stove—your instinctive reaction is to pull your hand away. This response is automatic and protective, helping you avoid harm. Similarly, when people with OCD experience distressing thoughts, they instinctively try to "pull away" from them by performing compulsions. However, unlike touching a hot stove, where avoiding the heat prevents injury, avoiding distressing thoughts through compulsions only strengthens the cycle. The thoughts always come back… The Brain’s Role in Reinforcing OCD OCD tricks the brain into thinking that avoidance is necessary for safety. Two key mechanisms drive this process: 1. Avoidance reinforces the perception of danger – When we repeatedly avoid something, our brain starts to categorize it as dangerous. We don’t avoid things unless they pose a real threat, right? The brain applies the same logic to OCD thoughts, reinforcing the false belief that they are dangerous and must be avoided. 2. Increased sensitivity to triggers – Once the brain labels something as dangerous, it becomes hyper-aware of it. The more an individual avoids or reacts to an obsession, the stronger and more distressing it becomes over time.
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