What Happens when we're Triggered?
Upon being triggered, misophonics experience a powerful surge of bodily sensations, emotions, and other perceptions in quick succession. We might feel like our teeth are itching, or a rubber band is squeezing our head. We might feel rage, panic, or disgust. Almost all of us can relate to a visceral feeling of having been deeply transgressed against, however irrational that notion.
In this post I’m going to attempt to clarify the exact sequence of steps involved in the trigger response. In doing so I will advocate for a view that sees the emotional components as secondary, perhaps even irrelevant, to the aim of understanding and treating misophonia. That might sound odd for a condition that appears on the surface to consist of almost nothing but emotions. As we look closer, I hope this idea will start to make sense.
I subscribe to the construction view of emotion. This view holds that emotions are concepts constructed by the brain on the fly in order to categorise and predict our interoceptive sensations—mostly affect, which is the basic pleasant/unpleasant feeling—taking the entire context into account. A spike in heart rate and blood pressure along with negative affect can mean fear in one context and anger in another. The emotion is not intrinsic to the interoceptive state or other physiological variables; it is the brain’s best guess at the most appropriate disposition to take towards the situation as a whole.
The relevance of this idea to misophonia should be obvious: could it be that being triggered initially consists of only the core affective ingredients of the fight-or-flight response, and that the ensuing emotions and judgments—rage, panic, this person’s chewing is grossing me out, etc—are the brain’s attempt to construct an emotion-based narrative that best explains the fact that we just got our fight-or-flight response triggered by a sound or image?
If this is the case then many of the discussions and research studies focused on the emotional aspects of the misophonic response are barking up the wrong tree. It doesn’t matter what emotional narrative our brain comes up with in the moment to account for each instance of being triggered; what matters is the mechanism that allows a sound or image to trigger our fight-or-flight response in the first place.
To an unfamiliar reader it may appear that I am talking about the same thing when I talk about “the fight-or-flight response” and about “anger” and “fear”, and that the distinctions being made are therefore confused. The common view is that the fight-or-flight response simply is anger or fear. But the separateness of these things is exactly the counter-intuitive claim being made by the construction view: emotions are constructed by the brain after we feel a particular interoceptive state; they are not intrinsic to such states. If you’re still not convinced, I recommend reading the book or watching Lisa Feldman Barrett speak on the topic.
Before continuing, I will hedge my position slightly by acknowledging that higher-order emotions and related perceptions and judgments can feed back into lower-level interoceptive states. We can judge, for example, that we are being treated unfairly at work due to subtle social dynamics, and that can ultimately cause the raw affective ingredients of an intense emotional response. So it is not out of the question that a high-level judgment to do with, for example, table manners, could be behind the misophonic response—and such judgments almost certainly feed into the long-running interpersonal struggles that characterise the condition. But they are not where my money is in relation to the fundamental mechanism of the response: I think interoception, via some emotionally-agnostic neurological process, is the prime mover in misophonia. We feel a markedly negative interoceptive state, and then we start making emotions and judgments.
Here’s where I think we are in terms of understanding the basic steps of the response:
We perceive a sound or image with the necessary qualities, and in the necessary context, to be a trigger.
Some neural machinery takes the image and converts it into a negative interoceptive sensation.
We feel this as negative affect, and our brain constructs its best guess at an appropriate emotion based on a multitude of factors.
We feel the emotion, and possibly turn it into further high-level judgments, for example bad table manners.
Note that steps 3 and 4 above are normal, and can therefore be ignored, given the negative affect produced in step 2: everyone constructs emotions and makes judgments based on interoceptive sensation. The point is to figure out what’s going on between steps 1 and 2, to get from a trigger image to a markedly negative interoceptive sensation in the first place.
The most relevant research to this question so far seems to be the orofacial mirror neurons paper, which inspired my jaw dysfunction hypothesis. The context-dependent and person-specific nature of mirroring behaviour nicely accounts for the corresponding aspects of misophonia, and the health implications of jaw dysfunction provide a possible basis for negative interoceptive sensations and predictions.
Whether these theories turn out to be right or not, I hope that a closer look at misophonia with the observations of constructed emotion in mind will help to focus future research efforts and avoid wasting further time ruminating on the meanings of emotions—something we, as emotional beings, are of course bound to be biased towards.