In this brief clinical review, I examine misophonia as a relational phenomenon rather than just a sensory or neurological problem. I highlight the primacy of sensory reception in early development. Psychodynamic formulations of misophonia describe it as a manifestation of disgust, fear of mental contamination, and interpersonal violence. I offer a brief literature review, and reconceptualize misophonia as a disruption of intimacy through perceived relational violence and breach of relational boundaries. I encourage clinicians and researchers to reimagine misophonia as symbolic of unspoken conflicts that interfere with intimacy and attunement, with implications for psychoanalytic psychotherapeutic work.