The dinner table is often a battleground for families where one or more members experience the misophonic response. I know this all too well as a sufferer of misophonia. Holidays are fraught with experiences that can cause sensory dysregulation, including frequent family dinners, blinking lights, loud music and events, and more. So, I ask, is the point of the festivities to spend time together regardless of the emotional aftermath, or is the purpose to spend meaningful time together?
For those who suffer from misophonia, holiday dinners can be a painful experience. Misophonia is a neurophysiological condition where otherwise normal sounds like chewing, whistling, coughing, and more cause a physiological fight-or-flight-or-freeze response. This condition was named in 2001 by Drs. Pawel and Margaret Jastreboff, and despite a growing body of research, it has not yet made it into diagnostic manuals worldwide. More recently, misophonia has been linked to neurodivergent experiences, such as sensory processing differences and autism.
The term misophonia means "hatred of sound," but hatred does not aptly describe the fight-or-flight response. Imagine you're sitting in a room, and suddenly, after hearing a sound, your heart rate skyrockets, your palms sweat, and your skin feels like pins and needles. The panic seeps in, and before you realize what you're hearing, you're feeling physical and mental distress. Unlike phobias, which often improve with gradual exposure, misophonia does not get better the more you hear; instead, the response escalates until the sufferer experiences what is often described as a shutdown, a period of intense lull, or a meltdown, a period of intense distress.
For me, misophonia often feels physically and mentally painful. If I am unable to get away from the triggering sounds, this increases. In the past, I have had to skip family events and meals because I was unable to handle the sensory distress and overwhelm. Unfortunately, there is no cure for misophonia, and the condition has a neurophysiological brain basis, as noted by Sukhbinder Kumar in his research studies. The lack of treatment can lead to more frustration on top of an already fraught experience.
Something I am commonly asked in my private practice as a therapist (LCT-C) is, "If misophonia is so distressful, how can families mitigate the distress during holiday festivities?"
The first piece of advice I always give to sufferers of misophonia, their parents, or extended family is that there may need to be adjustments to expectations over the holiday season. Families can consider activities that do not include food, such as decorating the home, going for walks to see Christmas lights if the lights are not bothersome to the sufferer, doing puzzles or watching movies without snacks, or any activity that is both social and does not lead to the fight-or-flight-or-freeze response for the individual.
Frequent breaks from family and social events can also help tolerance levels. Since sensory information is cumulative, the ability to go to a safe space and calm down is imperative. I frequently suggest noise-canceling headphones and areas where the individual can go to take breaks from the sensory stimuli. This can look like going outside, a spare bedroom at a family member's home, your own bedroom if at your home, or a bathroom if no other space is available, such as at a restaurant or public event.
The final advice I often give is that, while misophonia is difficult to live with, this does not mean that there is no hope for family relationships and events. While misophonia may make family time harder to arrange and require more accommodations, these events can still carry great meaning and importance.
Holidays can be stressful for families with or without any form of neurodivergence or necessary accommodations, but this doesn't mean that they are not worth the effort. In my own family, I have utilized regular breaks, movie nights without snacks, and the ability to come and go as needed so that I am not overstimulated. Some family members have been more understanding than others, but over time this has become the usual expectation rather than a deviation from the norm. Some families may find difficulty with extended family that does not understand sensory-based accommodations for misophonia, and in these cases I often suggest psychoeducation and tight boundaries.
Misophonia International provides free downloads for clinicians, parents, teachers, and sufferers of misophonia, including a holiday survival guide.
If there is one thing I'd like to leave individuals with misophonia, parents, or family members this holiday season, it's this: Misophonia is challenging, but there are ways to cope and accommodate the condition. A loved one does not have to understand misophonia, but they do have to respect the accommodations of the individual with misophonia.