Fresh Take: Dr. Thomas Phelan on What Parents Should Know About Misophonia

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0:17Hey, everybody. Welcome to Fresh Take from What Fresh Hell. This is Amy. Today, I am talking to Dr. Thomas W. Phelan. He is a clinical psychologist and the bestselling author of One, Two, Three Magic, the parenting program used by millions of families. Dr. Phelan's new book is called Stop That Chewing, When Ordinary Sounds Trigger Extraordinary Distress. It tackles misophonia, drawing on both Dr. Phelan's clinical expertise and his own lived experience with the condition. Welcome, Tom. Hi, Amy. Delighted to be here. Thank you. So as we like to say on the show, when you're the president of Hair Club for Men, you're also a client.

0:57Do you remember that old commercial? And in this case of misophonia, you bring both clinical training and lived experience. So let's start with your own lived experience of misophonia growing up. Well, I can remember, you know, the onset of misophonia is often ages 8 to 12. I can remember sitting at the dinner table and my father, who was a very nice fella, would finish his meal. and then he'd go get a bowl of ice cream. And he would sit there next to me and he would eat it, but he wouldn't eat it. He would slurp it and mush it around. And it would just, the sound was awful. But we lived in a family where you had to excuse yourself before you could leave the table.

1:37So I couldn't very well say to my mother, could I be excused because my father's eating like a pig? I was stuck. I was trapped and it was awful. And as you say, in that moment, you are filled with how could this person be doing this? And then also, how is this not bothering other people at the table like it's bothering me? Why is nobody else seeing this? Yes. And, you know, it's interesting you bring that up because that's often an assumption that's untrue. I found out later that some of the other people in the family did not like it as much as I did. But one of the problems with misophonia is you don't talk about it because you feel so stupid having the reaction.

2:12And that's one of the problems with misophonia. Treating it in general and broadening social awareness is it's so embarrassing to talk about. So let's start back at the beginning for people who are still catching up maybe. What is misophonia? Give us your best definition. Misophonia, well, the two words mean hatred of sound, but it's really a dislike or a hatred of certain particular sounds, often the soft sounds that are associated with eating. So it could be chewing, it could be crunching, it could be slurping, it could be drinking. The classics that we get arise out of people from are being in the movie theater and having somebody next to you either eating popcorn or chewing ice or both.

2:52You want to kill them, but you also want to see the movie. And so you're kind of stuck in that situation. It's a dislike of sounds most often related to eating. And it's stronger than dislike, right? It's a disgust that can even be rage. Whether or not you're expressing it, it is a huge reaction that you can have very quickly. You think of the emotions and you're absolutely correct. It's intense emotion, disgust, rage, and panic. And they often come in sequence. The panic often comes because you're in a social situation where now you don't want to act like a fool because you're having this idiotic reaction.

3:26And rage comes at the trigger producer, which is the person making the sound. And the disgust comes from that as well. And it has moralistic qualities to it. It's like, how could you be so rude? How could you be so disgusting? How could you do this in front of other people, whereas the trigger producer usually has absolutely no idea what they're doing. It is, as you say in the book, an inappropriate, involuntary adrenaline emergency for the person experiencing it. Yep. Just like having a panic attack in front of a group if you're giving a speech. I think this is important to underline because for me, I have something completely unrelated, but it's related in one way, which is I pass out at the sight of blood.

4:05It is involuntary. I have a lot of shame about it. I try to be a good patient and go without mentioning it, which does not lead to me not passing out. And instead, you know, I've had to learn to advocate over time. But the first thing I had to do was get over the shame that this is something that happens to me that I am not in control of, that I can't just tell myself, well, that's silly. I can't. My blood pressure just drops and I pass out. it's that similarly for misophonia you cannot say to somebody well it's silly it's just a little bit of ice well they don't mean to bother you well what's the big deal that is the opposite of useful to a person having this adrenaline emergency it's exactly true and you can't say to you it's just a little bit of blood you're going to still have the reaction and interesting people do say it's silly we do say it to ourselves and that's why we feel stupid and other people say to us well relax, you're just overreacting and all this kind of stuff.

5:00But it's triggering, I think, some primordial instincts. The blood thing is a good example, as well as the eating, some stuff in our brains and maybe some of the lower levels of our brains that gets triggered, it's set off and we're off and running. We love talking about that on this podcast, the sort of biological imperatives or evolutionary advantages that underpin things. So what is it about the chewing sounds you think that are particularly triggering? If we talk about evolutionary psychology, there's what I call sugar-fat-salt syndrome that we have now, a craving for sugar, fat, and salt.

5:33You know, six billion years ago when our ancestors were running around the African savanna and sugar, fat, and salt, you run into them, you eat them because they were pretty scarce. Maybe way back in those times, too, there was a shortage of food a lot of the time, maybe famine and stuff. So an instinct that we had and a skill was what I call competitive eating. We may go to a giraffe killing and try and get a few scraps away from who? The hyenas. So we throw rocks at them and try and get rid of them and all that. But our other competitors are our brothers, sisters, and family. And we may push them away.

6:07So what we learned was competitive eating was a skill. And also the sounds of other people eating were to us a sign of danger. I may not get enough. I got to get in there and scrap so I can stay alive by getting my calories. That makes a lot of sense. You make a joke in the book about people sometimes say that it's a sibling sound sensitivity, that that is often the first place it shows up. And might that be because we are sort of wired to be in competition with our siblings and to see them as threatening? I think so. And I think some of us get the genes that code for that more than others. Yes.

6:41But, you know, interesting, Amy, when we talk about family origins, a lot of the people that are kind of identified as the original triggers are fathers. And I used to have goats and my goat when I'd feed him, she had a baby. So I'd throw the hay there and mom ate first. Mom ate first. So imagine how babies feel. She's got to watch mom eat and listen to mom chew. How does baby feel? She might feel disgusted, angry, just like we do now. It's a theory. It's so interesting, though, that it makes sense that your one sibling who annoys you all the time might also annoy you when they chew or that just dad bothers you.

7:16But it is interesting to me seeing this play out in some homes that are very close to my own, let's just say. Like the dog chewing is fine, but this other person chewing is not. This person slurping goes without note, but this other person chewing is more triggering for some reason. So why do you think that is that it does tend to, once this is set in motion, it does seem to sort of accrue to one person in particular? It's interesting. It can do it to other people, but it seems to latch on. And it can spread. The triggers can spread to other people so you don't like anybody chewing. But I think the logic in line with the theory would be that these are the people that we're eating with.

7:52Usually the onset is a meal at home. Who are we eating with? The competitive eating theory would apply to families first because that's what it did six million years ago. So I think that's what's going to happen. And out of that, we have latching on to one person. Now, the father part of it could be the dad eats first and that bugs us. But siblings are natural competitors anyway. And parents really don't like it. They think their brothers and sisters should love each other the way mom and dad love them. I'm sorry, you got the wrong house, the wrong species. So siblings are sources of competition.

8:26And for them to fit into the misophonia thing is perfect because there are animals where the parents will actually help a sibling kill the other one when there's a shortage of food. There's a thing called the sand shark who the shark has two stomachs, lays hundreds of eggs in each stomach. Two fish come out, one out of each stomach. You know how they decide who lasts? They eat each other inside the mother's stomach. We think we have it rough in our houses, right? At least our kids aren't eating each other. Well, going back to this idea that misophonia is a neurophysiological thing that is happening to you or your kid, the sufferer, whoever it is, is really not in control of it.

9:03It still is perceived, as you say in the book, often as an anger management issue that can delay getting this the attention and treatment it needs because the family, the sufferer has shame about it. and the whole family has shame about it. The father is getting a lot of blowback that he chews wrong, feels bad about it and everybody feels bad about it, but they don't necessarily recognize the neurophysiological things that are underpinning it. So explain that to us, how that could delay treating the issue. If you have someone who's being triggered, the first thing you're gonna see often is gonna be anger or refusal to eat with the family or something like that, but you get a camouflaged symptomatic picture.

9:43You don't get the real thing. And because people feel stupid about it and they're just little kids, and this is so weird, they don't know how to describe it. So they can't say, you know, I'm having an inappropriate neurophysiological reaction and it involves my auditory sensation. They say, you idiot, you're chewing like a pig. And so that's what they do. Well, then that's no start. We just have family conflict with no insight whatsoever. And that's one of the problems. And when you go to a doctor, I talk to hundreds of pediatricians every year about this. families don't come in where the kid says, I can't stand somebody else's chewing.

10:14They'll often disguise it and say, I don't want to eat with the family. So you're left with a mystery, but we've got to train doctors say, if a kid says, I don't want to eat with the family, let's look for misophonia. I'm talking to Dr. Thomas Phelan, whose new book is called Stop That Chewing, and we'll be right back. Amy, you know that in our relationship, you have historically been the one to care about skincare. But let me tell you, Osea Skincare is an award-winning bestseller for a reason. Osea has been delivering results you can see and feel for 30 years. And after several months of using Osea's Dream Bioretinol Body Serum, I myself am a true believer.

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13:36Bada bing, bada boom, her dorm looks amazing. Find the fall pieces you'll reach for most at Quince. Download the Quince app for app-exclusive offers or go to quince.com slash fresh. Get free shipping on your order and 365-day returns. Now available in Canada and the UK, too. Gonna spell it. That's Q-U-I-N-C-E dot com slash fresh. Okay, in the book, Dr. Filling, you talk about misophonia as having a double curse for the sufferer. So let's talk a little more about how it has two problems. Yes. The first curse is the trigger incident where you're sitting there and you have to put up with this. You're with a bunch of friends at a Mexican restaurant.

14:16They're all eating chips and you're going crazy. That's no fun whatsoever. You panic. You feel trapped and all that. So now you go home, you get ready for bed and you're lying in bed at night. Now you get the second curse. The first curse was that incident at the restaurant. The second curse, I'm lying in bed and say, what does this say about me? Maybe I am crazy. Maybe I'm not a nice person. Maybe I'm a horrible person. As you lie there in bed thinking, I'm a mess. I'm an idiot. I'm a jerk. I'm not like these other people. Other people may have it. They don't talk about it, so you don't know that.

14:47So the second curse is the drop in self-esteem and self-perception that goes along with having this. And it can be horribly destructive to somebody, in addition to the restriction of life activities that goes with the first curse. And then there is what you call the fear of the fear, that dinner time. there's an anticipatory anxiety for everyone over, I hope this doesn't happen again tonight, and what if it does? That's exactly right. And any anxiety disorder, you know, all the phobias and stuff like that develop this fear of the fear. Once you've been through it, it's so unpleasant that you fear the next time the fear is going to occur, whether it's fear of driving or fear of public speaking or whatever.

15:26And now that's another curse in the sense, you fear the fear, and then on the back end where you disparage yourself, it's like you're getting whacked from both sides. You talk about the relief that families have once this has a name and for sufferers that, oh, this is a thing because you think you must be the only person who is this cuckoo about chewing ice, but it's way more prevalent than I think a lot of us have understood. It is. And one of the best things that people can do along these lines that you're talking about is my wife and I, we'd go out to dinner. We'll do a misophonia interviews with people and say, Here's the concept of misophonia.

16:03I've written a book on it. Do you know anybody who has it? Well, about a quarter of the people say I have it, but they'll almost always say I know other people that have it. So we ask people, if you have it, do your own misophonia interviews and you'll be reassured that you are not the only one. And you talk in the book about the possible connection to ARFID being something that's just starting to be understood. So tell us a little bit about that in particular. ARFID is a restriction of your food intake, but it's different from anorexia. Anorexia, you restrict your food intake because you think fat is disgusting.

16:36With ARFID, we don't know always why kids, it can happen to very young kids, why they eat less or don't want to eat and all this. What I'm suggesting is that you can have misophonia as kind of a screen for ARFID, where it causes kids to eat less and leave the table, but they don't explain it well to people. And so it's misophonia, but it looks like a version of ARFID. And since it's so awkward to talk about, it doesn't really get discussed in relaxed conversational tone. And so I'm thinking the misophonia could lead to either anorexia or ARFID. It's perfect for the genesis of eating disorders, especially in someone who might be predisposed anyway to ARFID or anorexia.

17:16It means that you could leave out certain categories of food. I can't eat ice cream or yogurt and nobody can eat it around me. and the ice flow of what feels safe to have eaten around you even can get smaller. And it might be because of misophonia. It might be. And it's interesting because the sounds are usually sounds coming, the triggers from other people. Usually we don't trigger ourselves. So chip eating by other people can drive you crazy. But if you're eating chips by yourself, it won't bother you usually. You can eat that stuff by yourself if you want. But if you're with other people, it's going to be a problem.

17:48And there is a psychiatric overlap with misophonia and lots of other psychiatric issues. So let's talk about that because it is sometimes not just ARFID, but other issues as well. Yeah. And I think the two biggest ones you're going to run into are anxiety and depression. We think that there's people who are anxious about other things may also be prone to misophonia because it is an anxiety. There's an anxiety component to it that I think bothers a lot of people. And of course, if you imagine a full-blown misophonia symptom, now your life is getting restricted. You don't have the relationship that you want.

18:21There are people who can't hold jobs because they can't stay in a job when they're in a cubicle. The next person next to them is chewing ice and stuff like that. Now your life is restricted. You're going to be depressed. And that isolation, I think it's important to underline we're going to get to treatment and how you approach this. But that isolation at the dinner table, if your child has misophonia and they really need to eat separately from the rest of the family, that's not something to be dismissed out of hand. But it can cause isolation. It can. And you want to be careful with that because you don't want a permanent strategy to be that the child eats separately.

18:57You want to try and work it through. So you really need to see a therapist or somebody who knows it who does some family counseling and educates both the trigger producers as well as the person who has the misophonia. And then you can experiment. When families say a child doesn't want to eat with us, my feeling is the first thing you do is you put on some background music, white noise, music, whatever. We're going to start experimenting with stuff. And we're going to have a couple of days a week where you don't eat together. You just get a break from it. But we don't want to permanently lock ourselves into this child eating alone.

19:28I know of one child who told his parents that neither one of them could say a word with an S in it anymore. And then everything was going to be fine. All they had to do was never make that sound again. Obviously, that's not possible. But to this eight-year-old, it was like, well, I have a solution. Just don't ever say that letter. It's not really possible. That's right. And it's interesting you mention that because we've had kids that the S sound will trigger them, but only from their parents and not from their teacher. And it's like, how does this happen? I don't know. Let's talk a little bit about what you call the interpersonal games that can come into play.

20:07In a family where this is happening every night at the dinner table and you haven't moved towards getting treatment yet, it can fall into a lot of blame games. Let's talk about how that can play out. There are two games I'm borrowing now from a guy named Eric Byrne, who wrote a book called Games People Play in the 1960s, I think. But the two games I think are most relevant to misophonia, I have to pardon my language for a second, are one which is an anger game. Now I've got you, you son of a bitch. the other game is poor me so they're complimentary games but somebody with misophonia can play them at different times so you have a misophonic and you have a trigger producer and trigger producer makes the crunching sound the misophonic what are you doing they're playing now i've got you you pig you know siblings do this very very well so that's now i've got you they're justifying their own anger in a very unthoughtful way they'll worry about it more later maybe but then later when they're worrying about it, they make it into the game of poor me.

21:03Why is my life being battered by this strange habit or this strange occurrence? And in the treatment for misophonia, what I recommend is that we have to deal with, in both the trigger producers and the people with misophonia, is we got to identify the games of now I've got you and poor me because they're a big part of the dynamic. You don't want to play those games on a regular basis because it's going to interfere with your therapy. You want to play now I've got you with the trigger producer, you're missing the point that it's your problem. You started it. They didn't start it. It's too bad you got it, but you got it and you got to deal with it.

21:35I think that can happen on the other end too. It's hard to be on the receiving end of your kid telling you never say a word with a letter S in it again, or never eat in front of me because you chew gross. I mean, it's hard to not play a little poor me or play a little, don't you see how put upon I am by these people around me? It's not bad. It's human nature. It's just not productive towards making the misophonia better. And it's a very common, you mentioned siblings before, those two games, siblings love to play with each other. Now I've got you and poor me. And then they love to present that to the parents.

22:09Look what he or she is doing to me. And then they love that feeling. So that sibling rivalry really complicates the treatment of misophonia if you have what we call sibling sound source trigger producer. It's such a good point that you make in this book, this idea that, but they should love each other like I love each of them. They're not wired that way. No. Let's talk about cognitive behavioral therapy because you said really the best approach for a family is to get some family therapy around this. But for people who are just figuring this out for the first time or who might not have access to CBT, let's talk about how that works and how that might be useful for reframing misophonia.

22:46Yeah. CBT is a great thing. It's been around for a while, and it's a way of just giving yourself a friendly slap in the face and say, look at reality calmly. So what do you see? And one of the examples is one we just talked about. If you want to bash yourself for being misophonic, it doesn't make any sense. I didn't come up with this. I don't even like it, but I've got it. So there's no point in criticizing myself about it. One of my things, my triggers, this may sound stupid, but that's part of the problem. That's what it is, right. is people doing either sirens or loud cars or motorcycles that go by me about 100 miles an hour.

23:22I'm playing now. I've got you. And so I need to do some cognitive therapy and think that through differently. Well, it's highly unlikely that Adolf Hitler just drove by me on a motorcycle and he deserves the hatred that I'm dishing toward him. And I will try to imagine myself, imagine this is a 31-year-old young man who's got a learning disability and he's really kind of lonely. And he's looking for a girlfriend and he thinks making noise with his motorcycle is going to attract girls. So that makes me more compassionate to him. And I get rid of my now I've got you thought or while I'm doing my relaxation.

23:57So CBT, it's cognitive and it's behavior therapy. So what I'm doing there is I'm altering my thought. So he's not really a SOB. And then I'm relaxing my stomach muscle, which is my favorite muscle to get tense when I'm into one of these things. That's cognitive behavior therapy. So the essence of it is learning how to do different with your body to get out of your sympathetic fight or flight arousal and also change your thoughts, the trigger your dad's chewing. Your dad's not trying to be a nasty person. You have to accept that. But you're not trying to be a nasty person by not liking his chewing either.