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Misophonia, literally "hatred of sound," is a presumed disorder of uncertain classification in which negative emotions, thoughts, and physical reactions are triggered by specific sounds. It is also called "soft sound sensitivity syndrome," "select sound sensitivity syndrome" ("4S"), "decreased sound tolerance," and "sound-rage." Misophonia is not recognized as a disorder by standard diagnostic criteria in the DSM-5 or the ICD-10, and there is little research on its prevalence or treatment. Misophonia can adversely affect ability to achieve life goals and to enjoy social situations.

Classification

The diagnosis of misophonia is not recognized in the DSM-5 or the ICD 10, and it is not classified as a hearing, neurological, or psychiatric disorder. It may be a form of sound–emotion synesthesia, and has parallels with some anxiety disorders.

Signs and symptoms

There is little evidence-based research available on misophonia, though some studies are now being conducted. Misophonia is an unpleasant reaction to a small number of specific sounds. Some small studies show that people with misophonia generally have strong negative feelings, thoughts, and physical reactions to specific sounds, which the literature calls "trigger sounds." These sounds are apparently usually soft, but can be loud. One study found that around 80% of the sounds were related to the mouth (eating, yawning, etc.), and around 60% were repetitive. A visual trigger may develop related to the trigger sound. It also appears that a misophonic reaction can occur in the absence of an actual sound.

Reactions to the triggers can include aggression toward the origin of the sound, leaving, or remaining in its presence but suffering, trying to block it, or trying to mimic the sound.

The first misophonic reaction may occur when a person is young and can originate from someone in a close relationship, or a pet. Common noises that have been reported as triggers include: other people chewing, throat clearing, slurping, finger tapping, foot shuffling, keyboard tapping, and pen clicking.

People with misophonia are aware they experience it and that it is not normal; the disruption it causes to their lives ranges from mild to severe. Avoidance and other behaviors can make it harder for people with this condition to achieve their goals and enjoy interpersonal interactions.

Mechanism

The mechanism of misophonia is not known, but it appears that, like tinnitus and hyperacusis, it is a dysfunction of the central auditory system in the brain and not of the ears. The perceived origin and context of the sound appears to be essential to triggering a reaction.

Diagnosis

There is no standard diagnostic criteria. Misophonia is distinguished from hyperacusis, which is not specific to a given sound and does not involve a similar strong reaction, and from phonophobia, which is a fear of a specific sound, but it may occur with either.

It is not clear whether people with misophonia usually have comorbid conditions, nor whether there is a genetic component.

Misophonia appears to be a chronic condition.

Management

There are no evidence-based treatments for the condition; health care providers generally try to help people cope with it by recognizing what the person is experiencing, and by working on coping strategies with the person. Some small studies have been published on the use of sound therapy similar to tinnitus retraining therapy and on cognitive behavioral therapy and particularly exposure therapy, to help people become less aware of the trigger sound. None of these studies have undergone extensive testing and therefore require further testing to determine their effeciveness for Misophonia.

Epidemiology

The prevalence is not known; it is not known whether men or women, or older or younger people, tend to have misophonia. It appears that people who experience misophonia may also have anxiety disorders or mood disorders.

History

Misophonia was first coined by audiologists Pawel and Margaret Jastreboff in a publication in 2000.

Research Directions

The role of the amygalda and aversive reactions to auditory stimuli has been studied. When faced with aversive sounds, "subjects consistently reported musculoskeletal tension in response to the sounds and likely experienced significant autonomic responses as well". There has also been research as to whether or not the auditory and visual components are related to a single disorder. The amygdala may be responsible for improper filtering of sensory stimuli in the brain. There is evidence that the amygdala responds to "aversive sensory stimula" such as auditory stimuli. Studies have not only shown the response of the amygdala to aversive reaction, but also a decrease in amygdala activity when exposed to pleasurable noises such as music. This has even been associated with a 'reward' response or an intense reaction such as 'chills down the spine'.

It has been proposed by the Sensory Processing Disorder Foundation that there may be an over-lap between Misophonia and Sensory Processing Disorder, more specifically its sub-set SPD SOR (Sensory over-responsivity). Differences in tactile and auditory over-responsivity show moderate genetic influences, with tactile over responsivity demonstrating greater heritability. Bivariate genetic analysis suggested different genetic factors for individual differences in auditory and tactile SOR.

Society and culture

People who experience misophonia have formed online support groups.

There are complaints that due to misophonia being unknown, false providers have exploited sufferers. Misophonia has been widely misrepresented in the press. While the media has examined an extreme reaction in children it has not provided proper context and has often exaggerated the rage attributed to chewing in particular. There is also a question as to whether or not researchers have the best interests of sufferers in mind. Some sufferers have called for a cross-disciplinary approach and for preliminary research to be conducted before treatments and widespread opinions are formed.

In 2009 the Sensory Processing and Emotion Regulation Program held a conference to address auditory over-responsivity and other connections between sensory stimuli and emotions. The conference addressed Sensory Processing Disorder as well as other sensory afflictions. Since 2013 there has been a conference that connects Misophonia sufferers and explores topics related to the subject. The conference is usually held in October but was postponed until the new year due to scheduling and vendor complications.

A crowdfunded documentary film on misophonia, "Quiet Please...", has been made in the US. The film focuses on the impact misophonia has on sufferers. As of October 20, 2016 $43,246 has been raised via IndieGoGo to support the project. The film premiered in the United States on June 18th 2016 at the Anthology Archives in New York City.

Notable cases

• Barron Lerner
• Kelly Ripa
• Kelly Osbourne

References

1. "Misophonia". MediLexicon. Retrieved 21 October 2016.
2. ^ Bruxner, G (2016), "'Mastication rage': a review of misophonia - an under-recognised symptom of psychiatric relevance?", Australasian Psychiatry: Bulletin Of Royal Australian And New Zealand College Of Psychiatrists, 24 (2): 195–197, doi:10.1177/1039856215613010, PMID 26508801
3. ^ Cavanna AE, Seri S (Aug 2015). "Misophonia: current perspectives". Neuropsychiatr Dis Treat. 11: 2117–23. doi:10.2147/NDT.S81438. PMC 4547634. PMID 26316758.{{cite journal}}: CS1 maint: unflagged free DOI (link)
4. ^ Duddy DF, Oeding KA (2014). "Misophonia: An Overview". Semin Hear. 35 (02): 084–091. doi:10.1055/s-0034-1372525.
5. ^ "Why the sound of chewing fills some people with rage". STAT. 2016-06-17. Retrieved 2016-10-21.
6. ^ Aage R. Møller (2006). Hearing, Second Edition: Anatomy, Physiology, and Disorders of the Auditory System. Academic Press. ISBN 978-0-12-372519-6.{{cite book}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
7. Wu, Monica S. "Misophonia: Incidence, Phenomenology, and Clinical Correlates in an Undergraduate Student Sample". Journal of Clinical Psychology. v70 n10 (October 2014): 994-1007.
8. Jastreboff PJ, Jastreboff MM (2015). "Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis". Handb Clin Neurol. 129: 375–87. doi:10.1016/B978-0-444-62630-1.00021-4. PMID 25726280.
9. Edelstein, Miren; Brang, David; Rouw, Romke; Ramachandran, Vilayanur S. (2013-06-25). "Misophonia: physiological investigations and case descriptions". Frontiers in Human Neuroscience. 7. doi:10.3389/fnhum.2013.00296. ISSN 1662-5161. PMC 3691507. PMID 23805089.{{cite journal}}: CS1 maint: unflagged free DOI (link)
10. ^ Cavanna, Andrea E. (2014-04-01). "What is misophonia and how can we treat it?". Expert Review of Neurotherapeutics. 14 (4): 357–359. doi:10.1586/14737175.2014.892418. ISSN 1744-8360. PMID 24552574.
11. Kumar, Sukhbinder; Kriegstein, Katharina von; Friston, Karl; Griffiths, Timothy D. (2012-10-10). "Features versus Feelings: Dissociable Representations of the Acoustic Features and Valence of Aversive Sounds". Journal of Neuroscience. 32 (41): 14184–14192. doi:10.1523/JNEUROSCI.1759-12.2012. ISSN 0270-6474. PMC 3505833. PMID 23055488.
12. LeDoux, Joseph; Bordi, F. "Sensory tuning beyond the sensory system: An initial analysis of auditory response properties of neurons in the lateral amygdaloid nucleus and overlying areas of the striatum". Journal of Neuroscience. Volume 12, Issue 7, 1992, Pages 2493-2503. {{cite journal}}: |volume= has extra text (help)
13. ^ David H. Zald, José V. Pardo, The Neural Correlates of Aversive Auditory Stimulation, NeuroImage, Volume 16, Issue 3, Part A, July 2002, Pages 746-753, ISSN 1053-8119, http://dx.doi.org/10.1006/nimg.2002.1115.
14. Mormann, Florian; Dubois, Julien; Kornblith, Simon; Milosavljevic, Milica; Cerf, Moran; Ison, Matias; Tsuchiya, Naotsugu; Kraskov, Alexander; Quiroga, Rodrigo Quian (2011-10-01). "A category-specific response to animals in the right human amygdala". Nature Neuroscience. 14 (10): 1247–1249. doi:10.1038/nn.2899. ISSN 1097-6256. PMC 3505687. PMID 21874014.
15. LeDoux, J. E.; Cicchetti, P.; Xagoraris, A.; Romanski, L. M. (1990-04-01). "The lateral amygdaloid nucleus: sensory interface of the amygdala in fear conditioning". Journal of Neuroscience. 10 (4): 1062–1069. ISSN 0270-6474. PMID 2329367.
16. Blood, Anne J.; Zatorre, Robert J. (2001-09-25). "Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion". Proceedings of the National Academy of Sciences. 98 (20): 11818–11823. doi:10.1073/pnas.191355898. ISSN 0027-8424. PMC 58814. PMID 11573015.
17. "Misophonia | STAR Institute". www.spdstar.org. Retrieved 2016-10-19.
18. Goldsmith, H. H.; Van Hulle, C. A.; Arneson, C. L.; Schreiber, J. E.; Gernsbacher, M. A. (2006-06-01). "A population-based twin study of parentally reported tactile and auditory defensiveness in young children". Journal of Abnormal Child Psychology. 34 (3): 393–407. doi:10.1007/s10802-006-9024-0. ISSN 0091-0627. PMC 4301432. PMID 16649001.
19. Cohen, Joyce (September 5, 2011). "When a Chomp or a Slurp is a Trigger for Outrage". The New York Times. Retrieved February 5, 2012.
20. Hayes, Shaylynn (2016-07-16). "I Have Misophonia, And We're Being Exploited". The Huffington Post. Retrieved 2016-10-18.
21. "General Problems in the Misophonia Research: The Abyss of Misperception We Are All Creating - Allergic to Sound". Allergic to Sound. Retrieved 2016-02-12.
22. Brout, Jennifer (2016-06-21). "Misophonia: When Everyday Noises Can Make Your Life Unbearable". Observer. Retrieved 2016-10-19.
23. "What is Misophonia? | Misophonia International". Misophonia International. 2016-07-22. Retrieved 2016-10-20.
24. "SENetwork/Duke 2009 Conference". SENetwork. Retrieved 2016-10-21.
25. "2016 Misophonia Conference – Misophonia Association". misophonia-association.org. Retrieved 2016-10-21.
26. "Quiet Please". Quiet Please. Retrieved 2016-10-20.
27. "Quiet Please..." Indiegogo. Retrieved 2016-10-20.
28. Gould, Jeffrey S. (2016-06-18), Quiet Please..., retrieved 2016-10-20
29. Lerner, Barron H. (2015-03-02). "Please Stop Making That Noise". Well. New York Times. Retrieved 2016-10-18.
30. Misophonia: Kelly Ripa Has Rare Disorder. 20/20. ABC News. 2012-05-18. Retrieved 2016-10-18.
31. "Kelly Osbourne goes queasy at sounds of eating". Mail Online. Retrieved 2016-10-19.

• Diseases of the ear and mastoid process
• Central nervous system disorders
• Synesthesia