Misophonia and Autism: When Sound Becomes a Threat, Not a Quirk
Tuesday, April 29, 2025.
Misophonia is not simply “being annoyed” at sounds.
Autism is not simply “thinking differently.”
And when you combine them, you don’t just get “quirky.”
You get a relationship to sound that can feel like living inside a siege.
The connection between misophonia and autism isn't a coincidence. It’s a shared language of sensory processing—a nervous system that reacts to sounds the way most people react to a fire alarm or an oncoming car: fight, flight, or freeze.
And yet, both in research and popular imagination, we have treated misophonia as a psychological oddity, and autism as a social disability.
We have not, until recently, taken seriously the idea that sound sensitivity itself might be a kind of emotional and neurological trauma in slow motion.
Let’s fix that.
What Is Misophonia Really?
Misophonia (literally, “hatred of sound”) was formally defined less than two decades ago, although people have been suffering from it for much longer (Edelstein et al., 2013). It involves strong emotional and physical reactions—rage, panic, disgust—toward specific trigger sounds, most often human-made: chewing, sniffing, breathing, tapping.
It's not about volume.
It's not about being picky.
It's about how the sound lands on the nervous system—as a kind of assault.
Misophonia is currently classified as a disorder of auditory processing and emotional regulation (Jastreboff & Jastreboff, 2001). And that distinction matters. It’s not just the ears—it’s the brain’s interpretation of the sound as an existential threat.
If you grew up with auditory defensiveness, you know the drill:
You're not overreacting. You're reacting to a level of threat your body cannot rationalize away.
Autism and Sound Sensitivity: Why They're Related
Now add autism to the mix.
Autism spectrum disorder (ASD) is fundamentally a difference in sensory processing, not just social behavior. Many autistic people experience the world as overwhelmingly loud, bright, textured, and fast (Robertson & Baron-Cohen, 2017).
In fact, the DSM-5 includes hyper- or hypo-reactivity to sensory input as a core diagnostic criterion for autism (American Psychiatric Association, 2013).
In the case of autistic sound sensitivity, ordinary noises can cause:
Immediate autonomic arousal (heart racing, sweating)
Emotional dysregulation (panic, rage, shutdown)
Physical pain (yes, sound can hurt the brain)
One study found that 70% of autistic souls reported hyper-reactivity to auditory stimuli, compared to just 17% of neurotypicals (Kern et al., 2007).
In other words, misophonia is not rare in autism—it is expected.
Misophonia in Autism: Not Two Problems, but One Nervous System
Misophonia and autism often coexist because they are different expressions of the same underlying phenomenon:
Nervous systems that register benign sensory input as dangerous.
When we treat them separately—autism as a social issue, misophonia as a psychological curiosity—we misunderstand both.
An autistic person with misophonia is not "extra sensitive" to sound.
They are living in a body where sound routinely triggers a full defensive posture: increased cortisol, narrowed blood vessels, hypervigilance (Williams et al., 2021).
This is not mere annoyance. This is sensory trauma.
And here's the brutal twist:
In many cases, autistic folks are forced to mask—to hide their sensory pain—leading to higher rates of internalized stress, emotional exhaustion, and eventual autistic burnout (Raymaker et al., 2020).
Misophonia doesn’t just hurt their ears.
It churns up their lives: social isolation, workplace struggles, breakdowns in family and intimate relationships.
How Misophonia Shows Up in Everyday Autistic Life
Common scenarios where autistic misophonia explodes into visibility:
At Dinner: Someone's chewing sounds are intolerable. The autistic person grits their teeth, shakes, or leaves the table, and is told they are being rude.
In Classrooms: Pencil tapping, whispering, crinkling paper—all act as unbearable background noise that no one else seems to notice.
In Open-Plan Offices: The drone of conversation, keyboard clatter, the hum of air conditioners turns the day into an endurance test.
In Public Spaces: Crowded restaurants, echoing malls, even family gatherings become potential sites of auditory overwhelm.
Often, autistic individuals internalize shame around their auditory processing differences.
They are told to "toughen up," "stop being dramatic," or worse: "it's all in your head."
It is, in fact, in their nervous system.
And it’s real.
What Science (Finally) Tells Us: Misophonia as a Neurodivergent Phenomenon
Recent research shows that misophonia is associated with increased connectivity between the auditory cortex and the areas of the brain responsible for emotion regulation and threat detection—the anterior insula, amygdala, and prefrontal cortex (Kumar et al., 2017).
This supports the idea that misophonia is not "being annoyed," but being neurologically primed to experience threat from sound.
Similarly, in autism, auditory hypersensitivity has been linked to differences in the way sound is filtered and interpreted at the cortical and subcortical levels (O'Connor, 2012).
There’s overlap in the brain signatures of autistic sensory overload and misophonic emotional triggers.
Different names. Same battlefield.
The Cultural Problem: Misunderstanding, Masking, and Mistreatment
In a neurotypical world, masking becomes a survival strategy.
An autistic person with misophonia might:
Pretend they're not bothered by the unbearable sounds.
Withdraw socially to avoid triggering environments.
Develop coping rituals (earbuds, white noise apps) that are mocked or misunderstood.
Experience cumulative sensory trauma over years of forced exposure.
This leads to predictable outcomes:
Social anxiety. Depression. Relationship struggles. Work burnout. Self-alienation.
It’s not just the noise that hurts.
It’s the demand to act as if it doesn’t.
Misophonia in Autism: A Therapist's Guide to Doing It Right
If you're a therapist working with a client who has both autism and misophonia, your first and most sacred duty is this:
👉 Stop treating sound sensitivity as a behavior problem.
👉 Start treating it as a sensory injury.
Misophonia in autism is not a sign of immaturity, defiance, anxiety, or emotional fragility.
It’s a nervous system adaptation to chronic sensory threat (Williams et al., 2021).
You are not coaching someone to "tolerate" sounds.
You are helping them repair the long-term assault of forced exposure.
Let’s talk about what that really demands of you.
Step One: Sensory Validation Before Any Intervention
Your autistic client with misophonia has been gaslit for most of their life:
"You’re overreacting."
"You’re so sensitive."
"Everyone else deals with it. Why can't you?"
Therapy has to start with radical sensory validation.
Script you might use:
"You are not crazy for hating those sounds. Your body is reacting exactly as it should to something it experiences as painful. Let's respect that response before we talk about changing anything."
In autism, sound is often experienced as physical pain (Robertson & Baron-Cohen, 2017).
Pain is real even when it is invisible.
Respect it, or lose the therapeutic alliance.
Step Two: Understand Auditory Defensiveness as a Form of Sensory Trauma
We don't use the word "trauma" lightly here.
Repeated forced exposure to painful or threatening sensory input creates the same neurochemical pattern we associate with trauma:
Heightened amygdala activation
Cortisol surges
Dissociation and shutdown
Hypervigilance (Porges, 2011; Williams et al., 2021)
Misophonia, in autistic clients especially, is an injury to trust:
Trust in their own perceptions.
Trust that their pain matters.
Trust that the world is survivable.
You are not just doing exposure therapy.
You are doing trauma repair.
Step Three: Accommodations Over Desensitization
Old-school behaviorists loved exposure hierarchies. Gradually exposing the client to distressing stimuli until the nervous system "habituates."
But habituation assumes the distress is irrational. In autistic misophonia, the distress is physiological.
Accommodations—not exposure—should be the therapeutic foundation:
Active Noise-Canceling Headphones (even during therapy if needed)
Personalized Sensory Kits (earplugs, weighted vests, tactile fidgets)
Environmental Design (quiet rooms, controlled soundscapes)
Permission Structures ("You can leave the room if the noise is too much.")
We are not teaching autistic people to endure pain.
We are teaching the world to stop causing unnecessary pain.
Step Four: Nervous System Regulation Before Cognitive Work
Trying to do cognitive work (CBT, problem-solving, relational repair) while your client is in a sensory-induced sympathetic state is worse than useless—it can be re-traumatizing.
Start with bottom-up regulation techniques:
Polyvagal-informed safety practices (Porges, 2011)
Breathwork adapted for sensory defensiveness (short, low-intensity)
Body scanning without pressure for full attention (gentle, opt-in)
EMDR modified for sensory triggers (Raymaker et al., 2020)
Only once the autonomic nervous system feels safe can top-down reflection begin.
Step Five: Address Masking and Internalized Ableism
Autistic masking around sound sensitivity looks like:
Forcing smiles while wincing internally
Staying in loud environments to avoid looking "weird"
Minimizing or lying about distress to please others
Long-term masking is a major contributor to autistic burnout (Raymaker et al., 2020).
Therapy must include deconstructing the shame around sensory needs:
Therapist prompt:
"What would it mean if your need for silence was not a weakness, but a signal of intelligence and self-preservation?"
Move the frame from coping to sovereignty:
Sound sensitivity isn't a failure to adapt; it’s a blueprint for self-respect.
Step Six: Integrate Sensory Boundaries Into Relationships
One of the greatest practical challenges your autistic client with misophonia will face is negotiating sound boundaries in intimate relationships—family, partners, friends, coworkers.
Your job is to coach clear, non-apologetic sensory boundary setting:
"I need to eat separately when crunchy foods are being eaten."
"I need to leave noisy environments without negotiation."
"I need to use headphones without it meaning I don’t care about you."
Model the idea that good relationships make room for sensory differences, not demands to override them.
Step Seven: Create a Long-Term Sensory Sustainability Plan
Misophonia and autism are both lifelong neurotypes.
There’s no magical "cure" coming.
Instead, help clients build sustainability plans:
Routine quiet days
Predictable sensory recovery rituals (nature walks, sound baths, silent spaces)
Social circles that respect sensory needs
Career paths that don't require constant sound endurance
The goal is not to become less sensitive.
The goal is to live well within the architecture of their sensitivity..
Toward a Compassionate Model: Accommodations, Not Tolerance
If we stop pathologizing misophonia and autism as isolated malfunctions, and start seeing them as variations in sensory architecture, we can begin to ask the right questions:
How can environments be designed with sensory diversity in mind?
How can relationships adapt to sound boundaries instead of dismissing them?
How can therapy move from "desensitization" to sensory validation?
Good accommodations are simple, humane, and long overdue:
Noise-canceling headphones in schools and offices.
Opt-out zones in public events.
Permission to leave, no apologies needed.
The goal is not to teach autistic people to "handle" pain better.
It’s to stop requiring them to live in pain.
What Misophonia and Autism Teach Us About Listening
In the end, misophonia and autism ask the same thing from the world:
Listen differently.
Not just to the sounds we make.
But to the bodies—human, fragile, miraculous—that hear them.
If we understood sound not as neutral, but as charged—capable of harming as well as healing—we might design not just better therapies, but a more merciful culture.
Maybe it's not the autistic misophonic body that needs fixing.
Maybe it's our inhospitable noise-blind world.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: Physiological investigations and case descriptions. Frontiers in Human Neuroscience, 7, 296. https://doi.org/10.3389/fnhum.2013.00296
Jastreboff, M. M., & Jastreboff, P. J. (2001). Components of decreased sound tolerance: Hyperacusis, misophonia, phonophobia. Ithaca: An Updated Book Chapter.
Kern, J. K., Trivedi, M. H., Garver, C. R., et al. (2007). The pattern of sensory processing abnormalities in autism. Autism, 11(2), 123–134. https://doi.org/10.1177/1362361307075703
Kumar, S., Tansley-Hancock, O., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology, 27(4), 527–533. https://doi.org/10.1016/j.cub.2016.12.048
O'Connor, K. (2012). Auditory processing in autism spectrum disorder: A review. Neuroscience & Biobehavioral Reviews, 36(2), 836–854. https://doi.org/10.1016/j.neubiorev.2011.11.008
Raymaker, D. M., Teo, A. R., Steckler, N. A., et al. (2020). "Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew": Defining Autistic Burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079
Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671–684. https://doi.org/10.1038/nrn.2017.112
Williams, Z. J., He, J. L., Cascio, C. J., & Woynaroski, T. G. (2021). A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms. Neuroscience & Biobehavioral Reviews, 121, 1–17. https://doi.org/10.1016/j.neubiorev.2020.12.024