Bridget Sharkey set down the letter on the couch. The words, written in the near-perfect handwriting of a 14-year-old who is serious about her studies, seemed alien coming from this soft-spoken girl.
"I sat there with my insides burning, hearing the sounds that bothered me the most: chewing and swallowing," she wrote. "More and more sounds bothered me, and this time it gave me a new reaction. It made me angry."
For Bridget, dinner with her family in their Schwenksville home was becoming a nightmare.
Her father, Michael, describes her as the "ideal, passive baby," he said. "She never cried. We never had an issue with her."
But two years ago, Bridget started morphing into a girl who was almost unrecognizable to her parents. A girl who said she wanted to hurt her younger sisters at dinner, a girl who had to quit the softball team she loved so much, a girl whose hopes of getting into the National Honor Society were slipping away as her grades plummeted.
Bridget learned through an Internet search that her condition had only recently been given a name. She called it the "m-word," but researchers in the field know it as misophonia, literally translated as "hatred of sounds."
Jennifer Jo Brout, a sufferer herself, directs the Sensation and Emotion Network and Misophonia International Research Network, both dedicated to understanding auditory over-responsivity. She said the disorder begins with a negative response to repetitive stimuli, called triggers. Usually the sounds are familiar at the dinner table, like chewing or lip-smacking, but repetitive visual cues can be triggers as well.
Zach Rosenthal, associate professor in the department of psychiatry and behavioral sciences at Duke University Medical Center, said the label for this condition is not ideal.
"It's suggestive of a hatred of sounds, and I think that hate is the wrong word," he said. Rather, he suspects the condition is a result of survival circuitry gone haywire.
The limited body of research on misophonia demonstrates that when people with it hear repetitive sounds, they enter into fight-or-flight mode - a heightened state of arousal in response to perceived harm.
But for sufferers, the experience is more living nightmare than "fight or flight."
Here's how Bridget described the experience: "It makes me immediately stop what I am doing. It makes me want to scream and yell, or physically make the person stop the trigger."
Jeff Gould, 55, a videographer from Long Branch, N.J., who has been suffering with misophonia for 48 years, described the feeling when he hears a trigger as "physical pain," although he said anticipating the sound is an even bigger ordeal.
"It's like a plane crash," he said. "Going down is worse than the actual moment."
And Kathy Reynolds, 58, a New Jersey resident who works in a clinical lab, describes it just as vividly: "Most people don't like nails on a chalkboard. It sends a shiver up your spine. Imagine that amplified a hundredfold. Imagine that happening for 10 to 15 minutes and you're trapped."
Previously, misophonia was lumped into a more general category of sensory processing disorder, Brout said, although neither condition is recognized by the Diagnostic and Statistical Manual of Mental Disorders. In the early 2000s, Pawel and Margaret Jastreboff of the Emory University School of Medicine, working with patients with hyperacusis, a disorder in the perceived volume of sounds, noticed there was a subset of patients with different symptoms. Those patients were reacting to repetitive triggers, not when sounds were merely too loud.
Misophonia could be a matter of the brain's failing to filter out unnecessary stimulation, Brout said.
When a sleeping dog hears a noise, it will prick up its ears in alert. But if the noise keeps repeating, there's less sense of danger and the dog will stop pricking up its ears.
"It's the same with people," Brout said. "The auditory stimuli travels the quickest to the fight-or-flight center."
Most people can filter sounds out, Gould said. "But when you have misophonia, you do the opposite. You zoom in on those sounds and filter everything else out."
This theory about the underlying basis of misophonia is not embraced by all, however; researchers are not sure what the underlying basis is.
Reynolds, who has dealt with misophonia since childhood, said it's getting worse with age. Gould agreed: "It's a progressive condition. I'm in the worst of it right now."
A recent study by researchers at Amsterdam University suggested the most frequent age of onset is the early teenage years.
Mercede Erfanian, lead author of the study, said it might be due to hormonal changes that happen at the beginning of puberty.
Katherine Dahlsgaard, a psychologist in the department of child and adolescent psychiatry and behavioral sciences at Children's Hospital of Philadelphia, said the patients with misophonia she sees in her clinic use poor coping strategies in an attempt to regulate their exposure to the sounds.
"This is not a good long-term strategy," she said. "Often those with misophonia misinterpret the intentions of whatever person is making the 'offending' noise. They then respond with anger and escape behaviors, which usually means storming away from the table in a huff or refusing to come sit at the table in the first place."
Misophonia likely has both a genetic and environmental component, Brout said. Perhaps environmental factors are merely a trigger for a genetic predisposition.
Rosenthal agreed. It's important "not to make false dichotomies - either nature or nurture," he said. No matter what the label, he said, the cause is fundamentally both.
Dahlsgaard said she tries to educate her patients about the brain's capacity to become less reactive to perceived threats. She teaches her patients "better coping strategies than escape, such as by refocusing their attention at the dinner table towards pleasant things and rewarding them for doing so."
Dean McKay, professor of psychology at Fordham University, agreed it was helpful to come up with a way to tolerate the sounds. His lab is developing a treatment program that would use recordings of certain trigger noises, such as chewing sounds, so patients can practice enduring the sounds at low volume and work their way up.
Those with misophonia say one of the most important things is to realize they have company.
"It's not a good feeling to think you're the only one," said Gould, who is making a documentary called Quiet Please . . . to help others feel less isolated.
Bridget once wrote that she "felt like an outcast."
But now that she's getting help, and with the support of her family, she feels ready to tackle a new challenge: starting high school in the fall.