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| '''Misophonia''', literally "hatred of sound", |
'''Misophonia''', literally "hatred of sound", describes a neurologically based disorder in which auditory stimuli (and sometimes visual) is misinterpreted within the central nervous system. Drs. Pawel and Margaret Jastreboff, who termed the the disorder in 2001, distinguished it from hyperacusis, although they are both considered disorders involving decreased tolerance for sound. Drs. Jasterboff and Jasterboff propose that while both hyperacusis and misophonia may share common neurology, they may be discriminated by the differing types of sounds the subgroups react to. In hyperacusis, loud sounds are highly aversive, whereas in misophonia pattern-based, repetitious sounds are aversive despite decibel level. The Jastreboff's more specifically describe a fight/flight reaction to auditory stimuli in misophonia, which corresponds to clinical observation of behavioral responses in affected individuals. Those with misophonia are triggered by specific, often patterned sounds, such as chewing, coughing, pencil tapping, etc. As the Jasterboff's describe, these particular groups of noises trigger an over reaction in the limbic system (where emotions are mediated in the brain). Therefore, auditory stimuli often causes an emotional response that is recognizable as anger, fear, disgust, or a general feeling of "lack of control" .<ref>{{cite web|title=Sensory modulation in misophonia|url=http://www.sfn.org/am2012/pdf/abstracts/MON_Poster_AM.pdf#page=1042|work=Program No. 367.07. 2012 Neuroscience Meeting Planner|publisher=New Orleans, LA: Society for Neuroscience|accessdate=27 January 2013|author=M. Edelstein, D. Brang, V. S. Ramachandran|page=1042|format=PDF|year=2012}}</ref> The sounds can be loud or soft.<ref>{{cite web |title=Decreased Sound Tolerance: Hypersensitivity of Hearing |author=Jonathan Hazell |publisher=Tinnitus and Hyperacusis Centre, London UK |url=http://www.tinnitus.org/home/frame/hyp1.htm |accessdate= February 5, 2012}}</ref> <ref>{{cite journal |title=Tinnitis retraining therapy for patients with tinnitus and decreased sound tolerance |authors=Pawel J. Jastreboff, Margaret M. Jastreboff |journal=Otolaryngologic Clinics of North America |date=April 2003 |volume=36 |pages=321�36 |pmid=12856300 |issue=2 |doi=10.1016/s0030-6665(02)00172-x}}</ref> and is sometimes referred to as '''selective sound sensitivity syndrome'''.<ref>{{cite journal | last1 = Neal | first1 = M. | last2 = Cavanna | first2 = A. E. | title = P3 Selective sound sensitivity syndrome (misophonia) and Tourette syndrome | journal = Journal of Neurology, Neurosurgery & Psychiatry | volume = 83 | issue = 10 | pages = e1 | year = 2012 | pmid = | pmc = | doi = 10.1136/jnnp-2012-303538.20 }}</ref> | ||
| Misophonia is not classified as a |
Misophonia is not classified as a disorder in ] or ]; in 2013, three psychiatrists at the Academic Medical Center in Amsterdam formulated diagnostic criteria for it and suggested that it be classified as a separate psychiatric disorder. In this study diagnostic confounds, or overlaps, were found with the following DSM-IV TR (still used in 2013) Disorders: 1) Post Traumatic Stress Disorder, 2) Autism and Aspergers, 3) Sensory Processing Disorder, 4) Obsessive Compulsive Personality Disorder and others. The authors noted, however, that despite the overlaps, misophonia was not described comprehensively by any of these other disorders and should be considered as for its own classification in the DSM-V. <ref name="plosone.org">{{cite journal | last1 = Schröder | first1 = A. | last2 = Vulink | first2 = N. | last3 = Denys | first3 = D. | title = Misophonia: Diagnostic Criteria for a New Psychiatric Disorder | journal = PLoS ONE | volume = 8 | pages = e54706 | year = 2013 | pmid = | pmc = | doi = 10.1371/journal.pone.0054706 | editor1-first = Leonardo | editor1-last = Fontenelle | url = http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0054706 }}</ref>Notably, this study has been criticized on the basis of its biased sample. That is, the researchers utilized only individuals with psychiatric disorders in the study. They did not have a control group, or a "pure misophonia group". | ||
| A 2013 review of neurological studies and fMRI studies of the brain as it relates to the disorder<ref name="Chalcedony Press, 210 pgs">{{cite book |title=Sound-Rage. A Primer of the Neurobiology and Psychology of a Little Known Anger Disorder |authors=Judith T. Krauthamer |year=2013 |publisher=Chalcedony Press, 210 pgs }}</ref> |
A 2013 review of neurological studies and fMRI studies of the brain as it relates to the disorder<ref name="Chalcedony Press, 210 pgs">{{cite book |title=Sound-Rage. A Primer of the Neurobiology and Psychology of a Little Known Anger Disorder |authors=Judith T. Krauthamer |year=2013 |publisher=Chalcedony Press, 210 pgs }}</ref> postulates that abnormal or dysfunctional assessment of neural signals occurs in the anterior cingulate cortex and insular cortex. These cortices are also implicated in ], and are the hub for processing anger, pain, and sensory information. Other researchers concur that the dysfunction is in ] structures.<ref>{{cite book |title=Hearing, Second Edition: Anatomy, Physiology, and Disorders of the Auditory System |author=Aage R. Møller |publisher=Academic Press |year=2006 |isbn=978-0-12-372519-6}}</ref> It has been speculated that the anatomical location may be more central than that involved in ].<ref>{{cite book |title=Textbook of Tinnitis, part 1 |author=Aage R. Møller |year=2001 |pages=25�27 |doi=10.1007/978-1-60761-145-5_4 |url=http://www.springerlink.com/content/gl87436l77336151/ |accessdate=February 5, 2012}}</ref> Notably, since circuitry and connectivity within in the brain system is abundant, complicated, and far from fully comprehended these ideas are speculative and need further research in order to understand the nature of misophonia. In addition, the central/peripheral feedback system is also of consideration in misophonia, as in many health/mental health disorders. | ||
| The Jasterboff's propose that one possible explanation of misophonia relates to the associations made between auditory stimuli and the limbic system, which are "governed by classical conditioning conditioning" rules. Unlike tinnitus, which can sometimes be "desensitized", treating misophonia,must involve a reconditioning of auditory stimuli and the limbic system reaction (beyond simple desensitization). The Jasterboff's offer four different protocols for treatment, one which recognizes multisensory issues (i.e. some people over respond to sensory information beyond that which is auditory). In their recent article, one demonstration of a multisensory trigger describes an individual who reacts to both the auditory and visual stimulatio, or trigger, of another person's chewing. While the rules of classical conditioning govern the Jastreboff's methodology, the descriptions of their four protocols are varied according to different types of misophonia and combinations of misophona and hyperacusis. In addition, all of their protocols include specific auditory/neural retraining. <ref name="plosone.org"/> <ref name="Jastreboff2014">Jastreboff, M.M., & Jastreboff, P.J. (2014). Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia). Seminars in Hearing 35(2), 105-120. doi: 10.1055/s-0034-1372527</ref> <ref name="Dozier2015b">Dozier, T. H. (2015). . Psychological Thought, Vol. 8(1), 114–129, doi:10.5964/psyct.v8i1.132</ref> Some misophonic individuals responded favorably to treatment protocols that included active extinction or counterconditioning, which are both conditioning processes that allow a conditioned reflex to decay. <ref name="Jastreboff2014"/> <ref name="Dozier2015b"/> <ref name="Dozier2015a"> Dozier, T. H. (2015). Counter-conditioning treatment for misophonia. Clinical Case Studies. Published online before print January 20, 2015. doi:10.1177/1534650114566924</ref> The anatomical location that has primary control of conditioned reflexes is the autonomic nervous system (ANS). | |||
| ==Symptoms== | ==Symptoms== | ||
| According to various types of surveys (some by established clinicians who have worked with this population, some done informally on social media and some done by media outlets), people who have misophonia are most commonly triggered by specific sounds, such as slurping, throat-clearing, nail-clipping, chewing, drinking, tooth-brushing, breathing, sniffing, talking, sneezing, yawning, walking, gum-chewing or popping, laughing, snoring, swallowing, gulping, typing, coughing, humming, whistling, singing, certain consonants, or repetitive sounds.<ref>{{cite news |newspaper=The New York Times |title=When a Chomp or a Slurp is a Trigger for Outrage |author=Joyce Cohen |date=September 5, 2011 |url=http://www.nytimes.com/2011/09/06/health/06annoy.html?_r=3 |accessdate=February 5, 2012}}</ref> Sufferers self report a physical experience of symptoms associated with fight/flight response, such as sweating, muscle tension, and rapid heartbeat. A small number of reports from individuals on social media groups have included unwanted sexual arousal. <ref>http://www.misophonia-uk.org/dealing-with-misophonia.html</ref> Consistent with other reports of aversive responses to multisensory cues, some sufferers are also affected by visual stimuli, such as repetitive foot or body movements, or fidgeting. Intense anxiety and avoidance behaviour often develops, which can lead to decreased socialization. Some individuals have reported that they feel the compulsion to mimic what they hear or see. The incidence of this symptom is unknown.<ref name=Hadjipavlou/> However, mimicry is an automatic, non-conscious, and social phenomenon. It has a palliative aspect, making the sufferer feel better. The act of mimicry can elicit compassion and empathy, which ameliorates and lessens hostility, competition, and opposition. There may be a biological basis for how mimicry reduces the suffering from a trigger, based on research related to tourettes syndrome and Obsessive Compulsive and Related Disorders .<ref name="Chalcedony Press, 210 pgs"/>. However, more research is needed to better understand this connection. In addition, validation of survey and measures of misophonia are needed and are underway. | |||
| ==Prevalence and comorbidity== | ==Prevalence and comorbidity== | ||
| The prevalence of misophonia is unknown, but groups of people identifying with the condition suggest it is more common than previously recognized.<ref name=Hadjipavlou>{{cite journal |title=Selective Sound Intolerance and Emotional Distress: What Every Clinician Should Hear |authors=George Hadjipavlou, MD, MA, Susan Baer, MD, PhD, Amanda Lau and Andrew Howard, MD |journal=Psychosomatic Medicine |volume=70 |pages=739/40 |publisher=American Psychosomatic Society |year=2008 |url=http://www.psychosomaticmedicine.org/content/70/6/739.short |accessdate=February 2012 |issue=6 |doi=10.1097/psy.0b013e318180edc2}}</ref> Among patients with ], which is found at clinically significant levels in between 4 and 5% of the general population,<ref>{{cite web |title=Components of decreased sound tolerance : hyperacusis, misophonia, phonophobia |author=Jastreboff, P., Jastreboff, M. |date=July 2, 2001 |url=http://www.tinnitus.org/home/frame/DST_NL2_PJMJ.pdf |archiveurl=https://web.archive.org/web/20060813132140/http://www.tinnitus.org/home/frame/DST_NL2_PJMJ.pdf |archivedate=August 13, 2006}}</ref> some surveys report prevalence as high as 60%,<ref name=Hadjipavlou/> while prevalence in a 2010 study was measured at 10%.<ref>{{cite journal |title=DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing. |authors=Sztuka A, Pospiech L, Gawron W, Dudek K. |journal=Auris Nasus Larynx |year=2010 |volume=37 |pages=55–60 |pmid=19560298 |doi=10.1016/j.anl.2009.05.001 |issue=1}}</ref> A 2014 study of students, conducted at the University of South Florida found that 20% of the almost 500 participants had misophonia-like symptoms.<ref name="Lewin, A. B. 2014">Wu, M. S., Lewin, A. B., Murphy, T. K. & Storch, E. A. (2014), Misophonia: Incidence, phenomenology, and clinical correlates in an undergraduate student ample. Journal of Clinical Psychology. Vol. 00(00), 1–14. doi: 10.1002/jclp.22098</ref> Misophonia may be associated with both depressive and anxiety (particularly obsessive-compulsive) disorders.<ref name="Lewin, A. B. 2014"/> | The prevalence of misophonia is unknown, but groups of people identifying with the condition suggest it is more common than previously recognized.<ref name=Hadjipavlou>{{cite journal |title=Selective Sound Intolerance and Emotional Distress: What Every Clinician Should Hear |authors=George Hadjipavlou, MD, MA, Susan Baer, MD, PhD, Amanda Lau and Andrew Howard, MD |journal=Psychosomatic Medicine |volume=70 |pages=739/40 |publisher=American Psychosomatic Society |year=2008 |url=http://www.psychosomaticmedicine.org/content/70/6/739.short |accessdate=February 2012 |issue=6 |doi=10.1097/psy.0b013e318180edc2}}</ref> Among patients with ], which is found at clinically significant levels in between 4 and 5% of the general population,<ref>{{cite web |title=Components of decreased sound tolerance : hyperacusis, misophonia, phonophobia |author=Jastreboff, P., Jastreboff, M. |date=July 2, 2001 |url=http://www.tinnitus.org/home/frame/DST_NL2_PJMJ.pdf |archiveurl=https://web.archive.org/web/20060813132140/http://www.tinnitus.org/home/frame/DST_NL2_PJMJ.pdf |archivedate=August 13, 2006}}</ref> some surveys report prevalence as high as 60%,<ref name=Hadjipavlou/> while prevalence in a 2010 study was measured at 10%.<ref>{{cite journal |title=DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing. |authors=Sztuka A, Pospiech L, Gawron W, Dudek K. |journal=Auris Nasus Larynx |year=2010 |volume=37 |pages=55–60 |pmid=19560298 |doi=10.1016/j.anl.2009.05.001 |issue=1}}</ref> A 2014 study of students, conducted at the University of South Florida found that 20% of the almost 500 participants had misophonia-like symptoms.<ref name="Lewin, A. B. 2014">Wu, M. S., Lewin, A. B., Murphy, T. K. & Storch, E. A. (2014), Misophonia: Incidence, phenomenology, and clinical correlates in an undergraduate student ample. Journal of Clinical Psychology. Vol. 00(00), 1–14. doi: 10.1002/jclp.22098</ref> Misophonia may be associated with both depressive and anxiety (particularly obsessive-compulsive) disorders.<ref name="Lewin, A. B. 2014"/> | ||
| The Dutch study published in 2013<ref name="plosone.org"/> of a sample of 42 patients with misophonia found a |
The Dutch study published in 2013<ref name="plosone.org"/> of a sample of 42 patients with misophonia found a symptom overlaps with numerous psychiatric disorders, with the highest statistic correlation with ] (52.4%). However, it is notable that this study only included psychiatric patients with no control group, and therefore may have been biased. | ||
| There has been some inquiry into the possible diagnostic similarity or neurologic etiology between misophonia and ], a neurological condition in which stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second sensory or cognitive pathway.<ref>Cytowic, Richard E. (2002). Synesthesia: A Union of the Senses (2nd edition). Cambridge, Massachusetts: MIT Press. ISBN 0-262-03296-1. OCLC 49395033</ref> One possibility relates to a pathological distortion of connections between various limbic structures and the auditory cortex, causing sound-emotion synesthesia.<ref>EDELSTEIN, M., D. BRANG, and V. S. RAMACHANDRAN. "Sensory Modulation in Misophonia." Poster. Neuroscience 2012 Conference of the Society for Neuroscience. New Orleans, LA. 15 Oct. 2012. Sensory Modulation in Misophonia: A Preliminary Examination via Galvanic Skin Response. UCLA. Web. 4 July 2013.</ref> If Misophonia were a sound-emotion association form of synesthesia, then there may be people with both misophonia and synesthesia, and many people with synesthesia have more than one form of synesthesia (there are over 60 reported types).<ref>Day, Sean, Types of synesthesia. (2009) Types of synesthesia. Online: http://home.comcast.net/~sean.day/html/types.htm, accessed 18 February 2009.</ref> | |||
| ==Treatment== | ==Treatment== | ||
| Line 21: | Line 21: | ||
| The Misophonia Management Protocol<ref>Johnson, M. (2014, February). 50 cases of misophonia using the MMP. Paper presented at the misophonia conference of the Tinnitus Practitioners Association, Atlanta, GA.</ref> uses the ear-level noise generator and recommends 6-12 weeks of cognitive behavioural therapy or similar therapy for dealing with misophonia as a chronic condition. On average this treatment reduces the perceived severity of misophonia from severe to moderate or moderate to mild, according to patient report. | The Misophonia Management Protocol<ref>Johnson, M. (2014, February). 50 cases of misophonia using the MMP. Paper presented at the misophonia conference of the Tinnitus Practitioners Association, Atlanta, GA.</ref> uses the ear-level noise generator and recommends 6-12 weeks of cognitive behavioural therapy or similar therapy for dealing with misophonia as a chronic condition. On average this treatment reduces the perceived severity of misophonia from severe to moderate or moderate to mild, according to patient report. | ||
| The second treatment that uses sound is Tinnitus Retraining Therapy.<ref>Jastreboff, M.M., & Jastreboff, P.J. (2014). Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia). Seminars in Hearing 35(2), 105-120. doi: 10.1055/s-0034-1372527</ref> This treatment uses ear-level noise generators, |
The second treatment that uses sound is Tinnitus Retraining Therapy.<ref>Jastreboff, M.M., & Jastreboff, P.J. (2014). Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia). Seminars in Hearing 35(2), 105-120. doi: 10.1055/s-0034-1372527</ref> This treatment uses ear-level noise generators, counseling, and gradual exposure to triggers.This treatment is based on making new associations between the limbic system and the auditory triggers. This was reported to have produced significant reduction in the severity of misophonia in 83% of the 182 patients treated. However, since associations to auditory stimuli is very difficult to extinguish it is very important to follow up to see if results of these reconditioning treatments <ref>http://cogsci.stackexchange.com/questions/1081/what-salient-features-of-a-conditioned-stimulus-unconditioned-stimulus-pair-ar</ref> | ||
| There are two case-study journal articles that report successful reduction of misophonia using cognitive behavioural therapy (CBT). One case was an adult woman whose symptoms were reduced so there was no impairment of social functioning at the end of treatment and for four months post-treatment.<ref>Bernstein, R.E., Angell, K.L., & Dehle, C.M. (2013). A brief course of cognitive behavioural therapy for the treatment of misophonia: A case example. The Cognitive Behaviour Therapist, 6 (10), 1-13. doi:10.1017/S1754470X13000172</ref> Another was two adolescents who were successfully treated with CBT, but no follow-up data was provided.<ref>McGuire, J.F., Wu, M.S., & Storch, E.A. (in press). Cognitive Behavioral Therapy for Two Youth with Misophonia. Journal of Clinical Psychiatry.</ref> | There are two case-study journal articles that report successful reduction of misophonia using cognitive behavioural therapy (CBT). One case was an adult woman whose symptoms were reduced so there was no impairment of social functioning at the end of treatment and for four months post-treatment.<ref>Bernstein, R.E., Angell, K.L., & Dehle, C.M. (2013). A brief course of cognitive behavioural therapy for the treatment of misophonia: A case example. The Cognitive Behaviour Therapist, 6 (10), 1-13. doi:10.1017/S1754470X13000172</ref> Another was two adolescents who were successfully treated with CBT, but no follow-up data was provided.<ref>McGuire, J.F., Wu, M.S., & Storch, E.A. (in press). Cognitive Behavioral Therapy for Two Youth with Misophonia. Journal of Clinical Psychiatry.</ref> | ||
| Line 27: | Line 27: | ||
| A case study of a counter-conditioning treatment called the Neural Repatterning Technique reported a drastic reduction in the severity of misophonia in a middle-aged woman by individually counter-conditioning three auditory triggers and a visual trigger.<ref>Dozier, T. H. (2015). Counter-conditioning treatment for misophonia. Clinical Case Studies. Published online before print January 20, 2015. doi:10.1177/1534650114566924</ref> This treatment used an intermittent, reduced-intensity (short and quiet) trigger stimulus while talking about positive life experiences, listening to music, and dancing. This treatment is effective only for people who have a small number of triggers from a single person or in a single setting. | A case study of a counter-conditioning treatment called the Neural Repatterning Technique reported a drastic reduction in the severity of misophonia in a middle-aged woman by individually counter-conditioning three auditory triggers and a visual trigger.<ref>Dozier, T. H. (2015). Counter-conditioning treatment for misophonia. Clinical Case Studies. Published online before print January 20, 2015. doi:10.1177/1534650114566924</ref> This treatment used an intermittent, reduced-intensity (short and quiet) trigger stimulus while talking about positive life experiences, listening to music, and dancing. This treatment is effective only for people who have a small number of triggers from a single person or in a single setting. | ||
| There are anecdotal reports of reduction of misophonia symptoms with other treatment methods, but so far no peer-reviewed articles on other methods. | There are anecdotal reports of reduction of misophonia symptoms with other treatment methods, but so far no peer-reviewed articles on other methods. | ||
| ==See also== | ==See also== | ||
Revision as of 22:55, 20 June 2015
Misophonia, literally "hatred of sound", describes a neurologically based disorder in which auditory stimuli (and sometimes visual) is misinterpreted within the central nervous system. Drs. Pawel and Margaret Jastreboff, who termed the the disorder in 2001, distinguished it from hyperacusis, although they are both considered disorders involving decreased tolerance for sound. Drs. Jasterboff and Jasterboff propose that while both hyperacusis and misophonia may share common neurology, they may be discriminated by the differing types of sounds the subgroups react to. In hyperacusis, loud sounds are highly aversive, whereas in misophonia pattern-based, repetitious sounds are aversive despite decibel level. The Jastreboff's more specifically describe a fight/flight reaction to auditory stimuli in misophonia, which corresponds to clinical observation of behavioral responses in affected individuals. Those with misophonia are triggered by specific, often patterned sounds, such as chewing, coughing, pencil tapping, etc. As the Jasterboff's describe, these particular groups of noises trigger an over reaction in the limbic system (where emotions are mediated in the brain). Therefore, auditory stimuli often causes an emotional response that is recognizable as anger, fear, disgust, or a general feeling of "lack of control" . The sounds can be loud or soft. and is sometimes referred to as selective sound sensitivity syndrome.
Misophonia is not classified as a disorder in DSM-5 or ICD-10; in 2013, three psychiatrists at the Academic Medical Center in Amsterdam formulated diagnostic criteria for it and suggested that it be classified as a separate psychiatric disorder. In this study diagnostic confounds, or overlaps, were found with the following DSM-IV TR (still used in 2013) Disorders: 1) Post Traumatic Stress Disorder, 2) Autism and Aspergers, 3) Sensory Processing Disorder, 4) Obsessive Compulsive Personality Disorder and others. The authors noted, however, that despite the overlaps, misophonia was not described comprehensively by any of these other disorders and should be considered as for its own classification in the DSM-V. Notably, this study has been criticized on the basis of its biased sample. That is, the researchers utilized only individuals with psychiatric disorders in the study. They did not have a control group, or a "pure misophonia group".
A 2013 review of neurological studies and fMRI studies of the brain as it relates to the disorder postulates that abnormal or dysfunctional assessment of neural signals occurs in the anterior cingulate cortex and insular cortex. These cortices are also implicated in Tourette Syndrome, and are the hub for processing anger, pain, and sensory information. Other researchers concur that the dysfunction is in central nervous system structures. It has been speculated that the anatomical location may be more central than that involved in hyperacusis. Notably, since circuitry and connectivity within in the brain system is abundant, complicated, and far from fully comprehended these ideas are speculative and need further research in order to understand the nature of misophonia. In addition, the central/peripheral feedback system is also of consideration in misophonia, as in many health/mental health disorders.
The Jasterboff's propose that one possible explanation of misophonia relates to the associations made between auditory stimuli and the limbic system, which are "governed by classical conditioning conditioning" rules. Unlike tinnitus, which can sometimes be "desensitized", treating misophonia,must involve a reconditioning of auditory stimuli and the limbic system reaction (beyond simple desensitization). The Jasterboff's offer four different protocols for treatment, one which recognizes multisensory issues (i.e. some people over respond to sensory information beyond that which is auditory). In their recent article, one demonstration of a multisensory trigger describes an individual who reacts to both the auditory and visual stimulatio, or trigger, of another person's chewing. While the rules of classical conditioning govern the Jastreboff's methodology, the descriptions of their four protocols are varied according to different types of misophonia and combinations of misophona and hyperacusis. In addition, all of their protocols include specific auditory/neural retraining. Some misophonic individuals responded favorably to treatment protocols that included active extinction or counterconditioning, which are both conditioning processes that allow a conditioned reflex to decay. The anatomical location that has primary control of conditioned reflexes is the autonomic nervous system (ANS).
Symptoms
According to various types of surveys (some by established clinicians who have worked with this population, some done informally on social media and some done by media outlets), people who have misophonia are most commonly triggered by specific sounds, such as slurping, throat-clearing, nail-clipping, chewing, drinking, tooth-brushing, breathing, sniffing, talking, sneezing, yawning, walking, gum-chewing or popping, laughing, snoring, swallowing, gulping, typing, coughing, humming, whistling, singing, certain consonants, or repetitive sounds. Sufferers self report a physical experience of symptoms associated with fight/flight response, such as sweating, muscle tension, and rapid heartbeat. A small number of reports from individuals on social media groups have included unwanted sexual arousal. Consistent with other reports of aversive responses to multisensory cues, some sufferers are also affected by visual stimuli, such as repetitive foot or body movements, or fidgeting. Intense anxiety and avoidance behaviour often develops, which can lead to decreased socialization. Some individuals have reported that they feel the compulsion to mimic what they hear or see. The incidence of this symptom is unknown. However, mimicry is an automatic, non-conscious, and social phenomenon. It has a palliative aspect, making the sufferer feel better. The act of mimicry can elicit compassion and empathy, which ameliorates and lessens hostility, competition, and opposition. There may be a biological basis for how mimicry reduces the suffering from a trigger, based on research related to tourettes syndrome and Obsessive Compulsive and Related Disorders .. However, more research is needed to better understand this connection. In addition, validation of survey and measures of misophonia are needed and are underway.
Prevalence and comorbidity
The prevalence of misophonia is unknown, but groups of people identifying with the condition suggest it is more common than previously recognized. Among patients with tinnitus, which is found at clinically significant levels in between 4 and 5% of the general population, some surveys report prevalence as high as 60%, while prevalence in a 2010 study was measured at 10%. A 2014 study of students, conducted at the University of South Florida found that 20% of the almost 500 participants had misophonia-like symptoms. Misophonia may be associated with both depressive and anxiety (particularly obsessive-compulsive) disorders.
The Dutch study published in 2013 of a sample of 42 patients with misophonia found a symptom overlaps with numerous psychiatric disorders, with the highest statistic correlation with obsessive–compulsive personality disorder (52.4%). However, it is notable that this study only included psychiatric patients with no control group, and therefore may have been biased.
There has been some inquiry into the possible diagnostic similarity or neurologic etiology between misophonia and synesthesia, a neurological condition in which stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second sensory or cognitive pathway. One possibility relates to a pathological distortion of connections between various limbic structures and the auditory cortex, causing sound-emotion synesthesia. If Misophonia were a sound-emotion association form of synesthesia, then there may be people with both misophonia and synesthesia, and many people with synesthesia have more than one form of synesthesia (there are over 60 reported types).
Treatment
There are a limited number of journal articles and conference reports on treatment for misophonia, none of which involve controlled studies. The most widely used treatment is to add noise to the patient’s environment. With increased ambient noise, many misophonia sufferers have a greatly reduced response to triggers. Noise can be added to an environment with a sound generator or fan, or directly to the ear with a behind-the-ear sound generator that looks like a small hearing aid. There are two treatment protocols that use sound generators.
The Misophonia Management Protocol uses the ear-level noise generator and recommends 6-12 weeks of cognitive behavioural therapy or similar therapy for dealing with misophonia as a chronic condition. On average this treatment reduces the perceived severity of misophonia from severe to moderate or moderate to mild, according to patient report.
The second treatment that uses sound is Tinnitus Retraining Therapy. This treatment uses ear-level noise generators, counseling, and gradual exposure to triggers.This treatment is based on making new associations between the limbic system and the auditory triggers. This was reported to have produced significant reduction in the severity of misophonia in 83% of the 182 patients treated. However, since associations to auditory stimuli is very difficult to extinguish it is very important to follow up to see if results of these reconditioning treatments
There are two case-study journal articles that report successful reduction of misophonia using cognitive behavioural therapy (CBT). One case was an adult woman whose symptoms were reduced so there was no impairment of social functioning at the end of treatment and for four months post-treatment. Another was two adolescents who were successfully treated with CBT, but no follow-up data was provided.
A case study of a counter-conditioning treatment called the Neural Repatterning Technique reported a drastic reduction in the severity of misophonia in a middle-aged woman by individually counter-conditioning three auditory triggers and a visual trigger. This treatment used an intermittent, reduced-intensity (short and quiet) trigger stimulus while talking about positive life experiences, listening to music, and dancing. This treatment is effective only for people who have a small number of triggers from a single person or in a single setting.
There are anecdotal reports of reduction of misophonia symptoms with other treatment methods, but so far no peer-reviewed articles on other methods.
See also
References
- M. Edelstein, D. Brang, V. S. Ramachandran (2012). "Sensory modulation in misophonia" (PDF). Program No. 367.07. 2012 Neuroscience Meeting Planner. New Orleans, LA: Society for Neuroscience. p. 1042. Retrieved 27 January 2013.
{{cite web}}: CS1 maint: multiple names: authors list (link) - Jonathan Hazell. "Decreased Sound Tolerance: Hypersensitivity of Hearing". Tinnitus and Hyperacusis Centre, London UK. Retrieved February 5, 2012.
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