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Misophonia, literally "hatred of sound",[1] is a rarely diagnosed disorder, commonly thought to be of neurological origin, in which negative emotions (anger, fright, hatred, disgust) are triggered by specific sounds. The sounds can be loud or soft.[2] The term was coined by neuroscientist Pawel Jastreboff and biological scientist Margaret Jastreboff[3] and is sometimes referred to as selective sound sensitivity syndrome.[4]

Misophonia is not classified as a discrete 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.[5]

A 2013 review of neurological studies and fMRI studies of the brain as it relates to the disorder[6] postulated 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.[7] It has been speculated that the anatomical location may be more central than that involved in hyperacusis.[8]

It has been proposed that misophonia develops through classical conditioning rather than brain dysfunction[5][9][10] although there is no clinical evidence to support this idea. 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.[9][10][11][12]


People who have misophonia are most commonly angered by specific sounds, such as lip-smacking, slurping, throat-clearing, nail-clipping, chewing, drinking, tooth-brushing, breathing, sniffing, talking, sneezing, yawning, walking, gum-chewing or popping, laughing, snoring, swallowing, gulping, burping, clicking dentures, typing, coughing, humming, whistling, singing, certain consonants, or repetitive sounds.[13][14] Sufferers experience fight/flight symptoms such as sweating, muscle tension, and quickened heartbeat. Some are also affected by visual stimuli, such as repetitive foot or body movements, fidgeting, or movement they observe out of the corners of their eyes. Intense anxiety and avoidance behaviour often develops, which can lead to decreased socialization. Some people feel the compulsion to mimic what they hear or see.[15] 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 is also a biological basis for how mimicry reduces the suffering from a trigger.[6]

Individual reports of extreme emotions in response to triggers have been empirically validated by measuring the skin conductance of misophonic individuals exposed to sustained trigger stimuli.[1] Skin conductance began increasing 2 seconds after trigger onset and continued to increase for the duration of the trigger.

Prevalence and comorbidity[edit]

The prevalence of misophonia is unknown, but groups of people identifying with the condition suggest it is more common than previously recognized.[15] Among patients with tinnitus, which is found at clinically significant levels in between 4 and 5% of the general population,[16] some surveys report prevalence as high as 60%,[15] while prevalence in a 2010 study was measured at 10%.[17] A 2014 study of students, conducted at the University of South Florida found that 20% of the almost 500 participants had misophonia-like symptoms.[18] Misophonia may be associated with both depressive and anxiety (particularly obsessive-compulsive) disorders.[18]

The Dutch study published in 2013[5] of a sample of 42 patients with misophonia found a low incidence of [co-morbid] psychiatric disorders, with the exception of obsessive–compulsive personality disorder (52.4%).

It has been suggested that there is a connection 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.[19] The basic problem may be a pathological distortion of connections between various limbic structures and the auditory cortex, causing sound-emotion synesthesia.[20] There are people with both misophonia and synesthesia.


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.[9][21] With increased ambient noise, many misophonia sufferers hear fewer trigger sounds and thus have fewer trigger responses. 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[21] 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. There is no follow-up data.

The second treatment that uses sound is Tinnitus Retraining Therapy.[9] This treatment uses ear-level noise generators, counselling, and gradual exposure to triggers. This was reported to have produced significant short-term reduction in the severity of misophonia in 83% of the 182 patients treated.

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.[22] Another was two adolescents who were successfully treated with CBT, but no follow-up data was provided.[23]

Two case studies of a counter-conditioning treatment reported a reduction in the severity of misophonia.[11] 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[edit]


  1. ^ a b Edelstein, Miren; Brang, David; Rouw, Romke; Ramachandran, Vilayanur S. (2013-01-01). "Misophonia: physiological investigations and case descriptions". Frontiers in Human Neuroscience 7: 296. doi:10.3389/fnhum.2013.00296. PMC 3691507. PMID 23805089. 
  2. ^ Jonathan Hazell. "Decreased Sound Tolerance: Hypersensitivity of Hearing". Tinnitus and Hyperacusis Centre, London UK. Retrieved February 5, 2012. 
  3. ^ Pawel J. Jastreboff, Margaret M. Jastreboff (April 2003). "Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance". Otolaryngologic Clinics of North America 36 (2): 321–36. doi:10.1016/s0030-6665(02)00172-x. PMID 12856300. 
  4. ^ Neal, M.; Cavanna, A. E. (2012). "P3 Selective sound sensitivity syndrome (misophonia) and Tourette syndrome". Journal of Neurology, Neurosurgery & Psychiatry 83 (10): e1. doi:10.1136/jnnp-2012-303538.20. 
  5. ^ a b c Schröder, A.; Vulink, N.; Denys, D. (2013). Fontenelle, Leonardo, ed. "Misophonia: Diagnostic Criteria for a New Psychiatric Disorder". PLoS ONE 8: e54706. doi:10.1371/journal.pone.0054706. 
  6. ^ a b Judith T. Krauthamer (2013). Sound-Rage. A Primer of the Neurobiology and Psychology of a Little Known Anger Disorder. Chalcedony Press, 210 pgs. 
  7. ^ Aage R. Møller (2006). Hearing, Second Edition: Anatomy, Physiology, and Disorders of the Auditory System. Academic Press. ISBN 978-0-12-372519-6. 
  8. ^ Aage R. Møller (2001). Textbook of Tinnitis, part 1. pp. 25–27. doi:10.1007/978-1-60761-145-5_4. Retrieved February 5, 2012. 
  9. ^ a b c d 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. 
  10. ^ a b Dozier T. H. (2015). "Etiology, composition, development and maintenance of misophonia: A conditioned aversive reflex disorder". Psychological Thought 8 (1): 114–129. doi:10.5964/psyct.v8i1.132. 
  11. ^ a b Dozier T. H. (2015). "Counter-conditioning treatment for misophonia". Clinical Case Studies 14: 374–387. doi:10.1177/1534650114566924. 
  12. ^ Dozier, T. H. (2015). "Treating the initial physical reflex of misophonia with the neural repatterning technique: A counterconditioning procedure". Psychological Thought 8: 189–210. doi:10.5964/psyct.v8i2.138. 
  13. ^ Krauthamer, Judith T. (April 2014) Descriptive Statistics of Misophonia.Retrieved online from: https://www.academia.edu/7074008/Descriptive_Statistics_of_Misophonia.
  14. ^ Joyce Cohen (September 5, 2011). "When a Chomp or a Slurp is a Trigger for Outrage". The New York Times. Retrieved February 5, 2012. 
  15. ^ a b c George Hadjipavlou, MD, MA, Susan Baer, MD, PhD, Amanda Lau and Andrew Howard, MD (2008). "Selective Sound Intolerance and Emotional Distress: What Every Clinician Should Hear". Psychosomatic Medicine (American Psychosomatic Society) 70 (6): 739/40. doi:10.1097/psy.0b013e318180edc2. Retrieved February 2012. 
  16. ^ Jastreboff, P., Jastreboff, M. (July 2, 2001). "Components of decreased sound tolerance : hyperacusis, misophonia, phonophobia" (PDF). Archived from the original (PDF) on August 13, 2006. 
  17. ^ Sztuka A, Pospiech L, Gawron W, Dudek K. (2010). "DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing.". Auris Nasus Larynx 37 (1): 55–60. doi:10.1016/j.anl.2009.05.001. PMID 19560298. 
  18. ^ a b 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 70: 1–14. doi:10.1002/jclp.22098. 
  19. ^ Cytowic, Richard E. (2002). Synesthesia: A Union of the Senses (2nd edition). Cambridge, Massachusetts: MIT Press. ISBN 0-262-03296-1. OCLC 49395033
  20. ^ 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.
  21. ^ a b Johnson, M. (2014, February). 50 cases of misophonia using the MMP. Paper presented at the misophonia conference of the Tinnitus Practitioners Association, Atlanta, GA.
  22. ^ 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. 
  23. ^ McGuire, J.F., Wu, M.S., & Storch, E.A. (in press). Cognitive Behavioral Therapy for Two Youth with Misophonia. Journal of Clinical Psychiatry