Misophonia in teens and children: Interview with Dr. Andrew Guzick
Dr. Andrew Guzick researches and works directly with young people who struggle with misophonia and their families.
Understanding misophonia:
In the 12 years Dr. Andrew Guzick has researched misofonía, he has observed how the scientific understanding of the condition has evolved significantly.
Guzick, a clinical psychologist and owner of a private practice specializing in misophonia, first became interested in the condition when it was introduced to him as a potential subtype of obsessive-compulsive disorder [OCD]. However, he believes few researchers now consider that an accurate way to view misophonia. Instead, it is increasingly viewed as its own unique condition as we move beyond the original limited and theoretical work being done.
He first learned about misophonia through a client during his training to become a psychologist at an OCD clinic. As a student, part of his job was to go through the research and figure out what is known about different conditions.
“There was nothing [about misophonia] and yet people were really suffering, and so that motivated me to try to contribute in both ways, you know, to get more expert at helping and to also try to contribute to growing the research,” said Guzick.
A lot more is now known about the neuroscience and psychology behind it; what it is like to live with it or be a loved one of someone living with it, and how it can develop from childhood into adulthood, Guzick said.
Defining and distinguishing misophonia:
When it comes to defining misophonia, he follows the expert consensus definition.
“It's a condition that's characterized by intense, negative emotional, physiological reactions to specific, sound, or sometimes visual triggers,” Guzick said.
Because emotion encapsulates relationships, psychological processes, and physiological changes, he also thinks of it as an emotional disorder.
Distinguishing misophonia from other conditions is often relatively straightforward because the response from trigger sounds is so distinctive.
“There's really no other condition where that very specific definition applies,” Guzick said.
Although misophonia can overlap with conditions such as OCD, he emphasizes they should still be understood separately because of how the misophonia experience in reaction to sounds is unique. Different treatments are also recommended for each condition. For example, while a specific type of exposure therapy is often helpful for OCD, helping people approach triggers in new, healthier ways is a different process in therapy for misophonia. However, an example of overlap could be how a person with OCD may follow specific rules in response to their triggers, Guzick said.
Official diagnosis?:
Misophonia is not currently included in many of the classification systems, such as International Classification of Diseases [ICD] or Diagnostic and Statistical Manual [DSM]. However, adding an ICD-10 and ICD-11 diagnostic code has been proposed by a collaborative team including people from soQuiet, Duke Center for Misophonia and Emotion Regulation, William and Mary, and University of Texas at Austin.
So when it comes to diagnosing a person with misophonia, mental health professionals or psychologists can compare someone's experiences to those consistent with the definition of misophonia.
“They do a big long interview where they get to know everything about you,” said Guzick. “Your history, your mental health, how things are going in school, what things are like in your family, medical problems that you have, and then they understand your experience with sound sensitivity in that big picture. And if in that big picture it sounds like your sound sensitivity issue is misophonia, based on that definition, then they can determine whether that's the case.”
That interview is done along with validated questionnaires or interview-based assessments. For children and adolescents, there are also two validated assessments that can break apart people with and without severe misophonia.
School support and accommodations:
Healthcare professionals and schools use different systems to define disabilities, so meeting the requirement for accommodations for misophonia often depends on the school district, as professionals working in the school typically have little or no training in misophonia. Because of this, although schools are required to accommodate disabilities, these decisions are usually handled case-by-case.
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“Schools do have their own psychologists who might help out in that [granting accommodations],” said Guzick. “But most school psychologists don't know [or] won't be familiar with misophonia and they might not know how to understand it very well.”
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Awareness:
Through interviews with kids and families impacted by misophonia, Guzick has observed how a lack of awareness can become one of the most harmful effects. For many many kids in his studies, misophonia causes strong and unbearable emotional pain on a daily basis. Yet when they find the courage to seek help, others may invalidate their experiences or say they will simply grow out of it. Such invalidation can be very impactful to kids, especially coming from professionals who are supposed to be able to help. As a result, kids try to manage the condition and keep their struggles internal, which can be harmful long term.
For a child beginning to develop misophonia, symptoms can often be missed or dismissed.
“I think part of what the challenges here is [that] it is a normal human experience to be bothered by certain sounds,” Guzick said.
As a result of this, many people may think they can relate to misophonia by saying it is not a big deal or just something you learn to deal with, and there is a risk of it being dismissed.
Researchers do not fully know how common misophonia is because it depends on its complex definition and various levels of severity. Guzick mentioned various studies done in different countries.
“One was done in the UK, and they define misophonia as someone who has these major reactions to specific repetitive noises, but they didn't have to be at the level where they're causing major problems or major emotional distress on a day-to-day level (a “disorder” level)," said Guzick. “When they looked at it that way, it was about 18% of people in the UK seem to have it.”
Gucick also mentioned a study done by Laura Dixon, a psychologist at the University of Mississippi. She surveyed a sample of Americans using a cutoff score on a misophonia assessment to determine who had clinically significant symptoms, Guzick said.
Clinically significant symptoms means misophonia causes major emotional distress and problems in day-to-day life, and her study found that percentage to be closer to 4.5 percent.
Guzick says creating a strong assessment to break apart severity takes a lot of time and research, and thinks we will have a better answer to that question in the next 5-10 years.
Kids vs. Adults:
As both a therapist and researcher, Guzick holds viewpoints of how misophonia can impact both kids and adults. Both groups tend to have triggers in common and describe them similarly. Feelings of anger, disgust, and panic are evoked, Guzick said. However, adults and children may have different responses to their triggers.
“A normal part of growing up is figuring out how to calm down, how to deal with intense emotions,” Guzick said.
Because children are still learning to regulate their emotions, misophonia can be especially challenging. Guzick explained that the feelings associated with the condition are difficult for even adults to manage. For children who are only beginning to handle emotion, misophonia can be expressed differently as it interacts with their ability to regulate and talk about their feelings, Guzick said.
Types and severity of triggers vary for everyone, but it is a common theme that family members are the biggest trigger producers for people with misophonia. Guzick said that a potential cause of this is because a person may be comfortable enough to be their true self and let their guard down when around family. They may also expect or hope to feel safest around family, so when they are triggered, it is especially painful as that expectation is broken.
“That can be the kindling for the cycle that can go on after that, where now the expectation is that it's going to be really bad with my parents,” Guzick said.
Other outside factors and family dynamics can also play a role, and there are many factors that can impact misophonia. Kids can also feel invalidated if their parent doesn’t understand misophonia, which can intensify the emotional reaction and make them more anxious the next time and contribute to the cycle, Guzick said.
Genes:
Guzick has observed that misophonia can tend to run in families.
“Almost every complicated emotional issue involves genes, and it involves the world that you live in, and it involves how you're growing up, and it involves the way you look at situations,” said Guzick “And so here, if the broader understanding of emotion holds true here, which it certainly should, then genes are a factor, but they're not the only factor.”
Progression of misophonia:
A person could develop misophonia as an adult, but the most common age of onset is between 10 and 12 years old. The way misophonia changes over time varies greatly from person to person.
In results from one of Guzick’s studies he is writing up now, he followed children and adolescents with misophonia over 6 months, and found that some people experienced worsening symptoms, while others improved and remained relatively constant for others. These different trajectories balanced each other out when analyzing data, and so results averaged to no change even though individuals had different experiences in the expression of their symptoms over time.
Treatment and strategies:
Guzick thinks the treatment of misophonia is an area where more research is needed, but did mention different types of effective therapies.
“Cognitive behavioral therapies [CBT] that have been adapted and tailored to people with misophonia, they have the most research supporting their effectiveness,” said Guzick. This type of therapy is centered on perspective, focus, and behavior change, and is applied to many mental and physical health problems.
Another factor that impacts misophonia is sleep.
“We studied about 100 kids with clinically significant misophonia and poorer sleep was correlated with more severe misophonia symptoms,” said Guzick. “Nutrition and sleep affect more or less every aspect of how you think and how you feel, and so again I think misophonia would be no exception.”
Context of a situation can also have an impact on misophonia and response to triggers, but the severity of its impact can vary person to person. Guzick thinks this is an idea that should continue to be studied.
“Why is it that for some people it's so much about seeing the situation and maybe the meaning of that situation, and for other people it's automatic regardless of the visual connected to the trigger?” said Guzick.
Treating misophonia is difficult because of the depth and variability the condition holds. There are many trends and similarities but treatment may still look slightly different for everyone. Guzick describes his approach in being a clinician.
“This is what we know tends to help typically, but we got to figure out how to apply it for you and the unique challenges that you face” said Guzick.
“One of the uniquely challenging aspects about misophonia is that anger is such a big part of that initial reaction, [and] it's hard to hide,” said Guzick. “ But the problem is when you express emotional distress like in the form of anger, it usually kind of brings up a defensive reaction from someone else.”
Guzick explains how this aspect of misophonia can contribute to a cycle of isolation, misunderstanding, and being unsure of how to find help. Beyond the anger that comes with the reaction, his advice is to try to channel other emotional components and communicate how they may be feeling overwhelmed or in need of support. He also wants to emphasize that it is nobody’s fault for communicating how they do, and part of misophonia is that it evokes overwhelming automatic reactions.
Advice and future:
Guzick says that communication is a two-way street, and his advice to parents or loved ones of people with misophonia is to try and lead with love and a desire to both understand the condition and learn how to support them.
He emphasized that there is still reason for hope, especially for young people.
“People experience real relief from how much triggers are bothering them, how strong those reactions are, how much it's messing up their life,” said Guzick.
He expects the understanding of the condition will continue to evolve in the years to come. In his personal work and private practice, he has also seen how very possible relief can be.
“It can [get better] for many people. It really can,” said Guzick. And a lot of people learn to live with it in ways that are where it's minimally impacting their life, and so there's hope.”
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Works cited:
Dixon, L. J., Schadegg, M. J., Clark, H. L., Sevier, C. J., & Witcraft, S. M. (2024). Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of U.S. adults. Revista de Psicopatología y Ciencias Clínicas, 133(5), 403–412. https://doi.org/10.1037/abn0000904
Rodriguez-Barajas, S., Sadek, S. J., Storch, E. A., Rast, C. E., & Guzick, A. G. (2026). A qualitative study of treatment experiences among youth with misophonia and their parents. Revista de Práctica Psiquiátrica, 32(1), 15–21. https://doi.org/10.1097/PRA.0000000000000905
Swedo, S. E., Baguley, D. M., Denys, D., Dixon, L. J., Erfanian, M., Fioretti, A., Jastreboff, P. J., Kumar, S., Rosenthal, M. Z., Rouw, R., Schiller, D., Simner, J., Storch, E. A., Taylor, S., Werff, K. R. V., Altimus, C. M., & Raver, S. M. (2022). Consensus definition of Misophonia: A delphi study. Fronteras en neurociencia, 16. https://doi.org/10.3389/fnins.2022.841816
Vitoratou, S., Hayes, C., Uglik-Marucha, N., Pearson, O., Graham, T., & Gregory, J. (2023). Misophonia in the UK: Prevalence and norms from the S-Five in a UK representative sample. PLOS One, 18(3), e0282777. https://doi.org/10.1371/journal.pone.0282777
Wagner, K. M., Cervin, M., & Rast, C. E. (2025). Examining Sleep-Related Problems in Youth With Misophonia. Revista de Psicología Clínica, 82, 330–337. https://doi.org/10.1002/jclp.70075
