For Whom the Bell Tolls: Misophonia as a Complex Experience of Hope and Dread in Self-with-Other Regulation

Misophonia is a condition in which everyday sounds evoke pain and reactive aversion. The etiology of misophonia is largely unknown, with discordant conceptualizations of its roots, ranging from psychiatric, to neurological, to a combination of auditory processing and neurobiological dysfunction. Common protocols are focused on symptom reduction and management, though have not been proven to be clinically effective. For these reasons, it is generally considered to be difficult to treat. In this paper, I re-consider misophonia as a complex interweaving of auditory, neurobiological and relational experience. Reflecting upon a clinical case, I present misophonia in the context of self-with-other regulation from a developmental lens, traverse the landscape of misophonic self states, explore the complex toll of dissociation and intergenerational trauma in relational space, and consider ways in which the painful somatic-auditory bell of misophonia concretizes self and relational “hope” and “dread”. Finally, I will offer some thoughts on how psychoanalytic psychotherapy can create new relational-neurobiological pathways out of the misophonic experience.