Should sound sensitivities be treated like OCD?

It’s a pivotal question. Obsessive Compulsive Disorder is often treated with exposure therapy. The person is gradually and repeatedly exposed to the thing they fear so their brain can learn not to overreact. But what if the fear isn’t irrational? What if the threat is real?

Misophonia. Hyperacusis. Noxacusis. These aren’t just quirks of perception. They are sensory intrusions. They are real, painful, overwhelming. They don’t stem from obsession. They stem from a nervous system that has learned to protect itself from something harmful. When we treat them like OCD, we risk retraumatizing the person we’re trying to help.

Exposure therapy, in this case, can make things worse. Not because the person is unwilling, but because their system is already flooded. They are stuck in high-alert mode, scanning their surroundings for the next strike.

Imagine I followed you around with a thumbtack. Not constantly. Just often enough to keep you guessing. Sometimes I prick you. Sometimes I hide. But you know I’m out there. You’d flinch. You’d tense up. You might stop trusting people altogether. You’d wonder who was going to prick you next.

Now imagine I bring you into a clinic. I sit across from you, holding the same thumbtack, and I say, “Don’t worry. I’m going to keep pricking you until you get used to it.”

Could you relax?

Now take a child. Autistic. Highly sensitive. Brilliant at detecting patterns. Certain sounds hurt them, often high-pitched ones. A fire alarm. A scraping door. A classmate’s voice. These sounds don’t just annoy them. They cause pain. So the child begins to watch for patterns. They try to predict what’s coming. They avoid situations that have hurt them before.

For some, it stops there. But for others, especially those with more anxiety, it spreads. They start hearing those sounds in quieter and quieter environments. They begin to anticipate them, even when they’re not there.

If you’ve ever been pregnant, you might remember noticing how many other people seemed pregnant too. The brain is always tracking, always building associations. These children are no different. Their brains notice everything. And when their environment doesn’t feel safe, that gift becomes a trap.

So they start creating rituals. They try to regain control. It can look a lot like OCD. But it’s not quite the same.

Let me tell you about a boy I worked with. He was terrified of people sniffing or making certain mouth sounds. He’d been removed from the classroom and placed in a hallway, alone, for over a year. The hallway wasn’t quiet. It was full of unpredictable triggers. Doors. Voices. Sounds drifting from behind the walls. So he trained himself. He became a master listener, like a soldier in enemy territory. He could hear things no one else could. And in time, he began to imagine sounds that weren’t even real. His brain was so primed for threat that it filled in the blanks.

He wasn’t getting better. He was getting worse. Because he was never safe.

Now imagine if he had been given the right to silence. Imagine if he could control his soundscape. If he could turn it off when he needed to. If he could retreat and return on his own terms.

That is what I believe works. Safety. Control. Regulation. Not forcing someone to sit through pain until they surrender. Not poking them with metaphorical thumbtacks until they go numb.

People with sound sensitivities are not broken. Their brains are trying to protect them. If we respect that, and if we listen, they might finally begin to breathe. And only then, maybe, they’ll choose to come back to the world. Not because we pushed them, but because we made it safe enough to return.