Perimenopause Misophonia Misery

My poor husband.  He was just eating dinner.  But he was CHEWING.  SO.  LOUDLY.  I tried to suppress everything I was feeling and ignore it.  But the CHEWING was relentless.  Despite all my best attempts to suppress my feelings, bury contempt and give him grace, I snapped yelling “Oh my God! Can you please chew your food like a normal human being?”  Also because my face always gives away all of my feelings, I am sure that I looked horrified, disgusted and angry all at once.  My kids sat at the dinner table and stared at me in confusion.  My husband was even more confused.  And then you know what happened?  Instead of apologizing and owning my (robust?) reaction, I doubled down.  I proceeded to explain that he was chewing. so. loudly.  And that it was kind of gross.  And a little rude.  And seriously how could he not be aware that his chewing was that loud?  

Thankfully, my son (see “chained by expectation”) adeptly noticed the hurt on my husband’s face and took control of the situation.  “Mom, chill out.  He’s just eating dinner.  Are you ok?”  Ummmm, if you’re asking earnestly…prolly not.  But was I ready to acknowledge that I was the one with the problem, not my husband?  Ummmmmm…. that took a few more minutes, but I did eventually come around to realizing a few things.

1. Misophonia is real.  According to Merriam-Webster (and my husband), misophonia is “a condition in which one or more common sounds…cause an atypical emotional response (such as disgust, distress, panic, or anger) in the affected person hearing the sound.”  Well I’ll be darned.  Check. Check. Check and Check.
2. This visceral reaction to a sound is a classic, yet rarely discussed, hallmark of perimenopause.  In neurology, sensory gating is the process by which our brains tune out irrelevant noise and tune in to important or dangerous stimuli.  Estrogen (together with other hormones and neurotransmitters) helps to regulate this filter.  When estrogen drops, the prefrontal cortex (your logical “CEO”) loses its grip on the amygdala (your prehistoric “fight or flight” center) and with your prefrontal cortex now offline, the amygdala screams “Danger!” with every chew.  Similarly, Progesterone is also dropping during the perimenopause transition.  Progesterone acts on GABA receptors in your brain, and GABA is basically nature’s Xanax.  It helps you “keep calm and carry on.”  When progesterone drops, GABA levels drop and now what would normally be a small campfire becomes a raging forest fire with every bite of food.  
3. Our emotional reactions are complex constructs.  One of the tools in Cognitive Behavioral Therapy works by getting us to identify and understand the link between circumstances, thoughts, feelings and actions.  In CBT, the circumstance (or trigger) is neutral–neither good, nor bad.  We then assign a thought to the circumstance, feel an emotion related to our thought and then act on that emotion.  This is what it could look like for me at the dinner table that night:
   
   

Circumstance → Thought → Feeling → Action

Circumstance: chewing food (neutral)→ 

Thought: Wow!  That is really loud chewing!  OMG, does he not understand how loud it is? →

Feeling: disgust, anger, distress → 

Action: yell at my husband, shock the kids at the dinner table, and double down on how right I am to feel this way

One of the (many) benefits of CBT is our ability to identify and challenge “cognitive distortions” – those thoughts we assign to neutral circumstances.  If we can begin to understand that 1) our thoughts are flexible and shape our feelings and 2) our feelings lead to behavioral actions, then we can potentially learn to respond instead of react.  

That’s a tall order for any of us women working our way through the hormonal rollercoaster of perimenopause.  But when estrogen and progesterone are back on board, there is hope that we might be able to shift perspective and respond better the next time around.  

If you find yourself slinking away from the dinner table and apologizing for a version of yourself you barely recognize, let’s chat.  I am not a therapist, and won’t pretend to be one on this blog, but I do know you don’t have to white-knuckle your way through the hormonal rage.  There are options to get your sanity back, whether that be through hormone replacement, coaching or both (and a little therapy goes a long way in general).  

In good health,

Dr. Todd

(Pic of my hot husband included for reference.  And no, you cannot have him.  He’s taken.  xoxo )