Misophonia

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Misophonia
Other namesselective sound sensitivity syndrome,[1] select sound sensitivity syndrome, sound-rage[2][3]
SpecialtyAudiology, Neurology, Psychiatry

Misophonia (or selective sound sensitivity syndrome, sound-rage) is a neurobehavioral phenomenon associated with an intolerance of specific sounds or their associated stimuli, whose medical name and assessment vary over authors and methods. It can adversely affect the ability to achieve life goals and enjoy social situations. It was first recognized in 2001,[4] though it is still not in the DSM-5 or any similar manual.[5][6][7][8][9]

Reactions to sounds range from annoyance to anger, with possible activations of the fight-or-flight response. Common triggers include oral sounds (loud breathing, chewing, swallowing), clicking sounds (keyboard tapping, finger tapping, windshield wipers), and sounds associated with movement (fidgeting).[8] Hated sounds are often repetitive in nature. Misophonia is not an auditory or psychiatric disorder. It also differs from phonophobia (fear of sound). There are no standard criteria for diagnosing misophonia. As of 2019, there were still no evidence-based methods to efficiently treat the condition.[8]

Origin of term[edit]

The term was coined in 2001 by professor Pawel Jastreboff and doctor Margaret M. Jastreboff, with the assistance of the classicist Guy Lee,[10][11] introducing it in their article "Hyperacusis",[12] with further explanation in the International Tinnitus and Hyperacusis Society's ITHS Newsletter.[13]

The term was first used in a peer-reviewed journal in 2002.[14]

"Misophonia" comes from the Ancient Greek words μῖσος (IPA: /mîː.sos/), meaning "hate", and φωνή (IPA: /pʰɔː.nɛ̌ː/), meaning "voice" or "sound", loosely translating to "hate of sound", and was coined to differentiate the condition from other forms of decreased sound tolerance such as hyperacusis (hypersensitivity to certain frequencies and volume ranges) and phonophobia (fear of sounds).[3][15][9]

Signs and symptoms[edit]

As of 2016, the literature on misophonia was limited.[8] 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 usually appear quiet to others, but can seem loud to the person with misophonia, as if they can't hear anything except the sound. One study found that around 80% of the sounds were related to the mouth (e.g., eating, slurping, chewing or popping gum, whispering, whistling) and around 60% were repetitive. A visual trigger may develop related to the trigger sound,[8][16] and a misophonic reaction can occur in the absence of an actual sound.[2]

Reactions to triggers can range from mild (anxiety, discomfort, and/or disgust) to severe (rage, anger, hatred, panic, fear, and/or emotional distress).[7] Reactions to the triggers can include aggression toward the origin of the sound, leaving, remaining in its presence but suffering, trying to block it or trying to mimic the sound.[16] In extreme cases, sufferers may become physically violent toward the source of the sound.[17]

The first misophonic reaction may occur when a person is young, often between the ages of 9 and 13,[7] and can originate from someone in a close relationship, or a pet.[16]

People with misophonia are aware they experience it and some consider it abnormal; the disruption it causes in their lives ranges from mild to severe.[8][16] Avoidance and other behaviors can make it harder for people with this condition to achieve their goals and enjoy interpersonal interactions.[3]

Mechanism[edit]

Misophonia's mechanism is not known, but it appears that it may be caused by a dysfunction of the central auditory system in the brain and not of the ears.[8][2] The perceived origin and context of the sound appears to be essential to trigger a reaction.[2]

A 2017 study[18] found that the anterior insular cortex (which plays a role both in emotions like anger and in integrating outside input, such as sound, with input from organs such as the heart and lungs) causes more activity in other parts of the brain in response to triggers, particularly in the parts responsible for long-term memories, fear, and other emotions. It also found that people with misophonia have higher amounts of myelin (a fatty substance that wraps around nerve cells in the brain to provide electrical insulation). It is not clear whether myelin is a cause or an effect of misophonia and its triggering of other brain areas.[19]

A 2021 study found that the orofacial motor cortex, a part of the brain representing lip, jaw, and mouth movement, has enhanced activation for typical trigger sounds much more than for aversive or neutral sounds in misophonia sufferers. It also found enhanced functional connectivity between orofacial motor cortex and secondary auditory cortex during sound perception for any sound. It further reported resting state fMRI functional connectivity between orofacial motor cortex and secondary auditory and visual brain areas as well as secondary interoceptive cortex (left anterior insula). This suggests that misophonia, which is typically thought of as a disorder of sound emotion processing, is a result of overactivation of the motor mirror neuron system involved in producing the movements associated with these trigger sounds or images.[20]

Diagnosis[edit]

There are no standard diagnostic criteria,[8][16] and many doctors are unaware of this condition.[7] 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 loud sounds,[16] but it may occur with either.[21]

It is not clear whether people with misophonia usually have comorbid conditions, nor whether there is a genetic component.[8][16] It appears that misophonia can occur on its own or along with other health, developmental and psychiatric problems.[7] When attempting to diagnose a patient with misophonia, doctors sometimes mistake its symptoms for an anxiety disorder, bipolar disorder or obsessive-compulsive disorder.[7]

Classification[edit]

The diagnosis of misophonia is not recognized in the DSM-IV or the ICD-11, and it is not classified as a hearing or psychiatric disorder.[16] It may be a form of sound–emotion synesthesia, and has parallels with some anxiety disorders.[8] A 2022 survey of prominent researchers determined that misophonia should be classified as a disorder, and not a symptom, syndrome, or a condition.[7]

Management[edit]

As of 2018, there are no evidence-based treatments[8] for the condition and no randomized clinical trial has been published; health care providers generally try to help people cope with misophonia by recognizing what the person is experiencing and working on coping strategies.[16] 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.[3] None of these approaches has been sufficiently studied to determine its effectiveness.[3][15]

Epidemiology[edit]

Misophonia's prevalence is not known; nor is it known whether sex, gender, or age affect the likelihood of having misophonia.[8][2][16]

The existence of several online support groups with thousands of members has been cited as possibly indicative of its prevalence.[22]

Associated symptoms[edit]

Some people[who?] have sought to relate misophonia to autonomous sensory meridian response, or auto-sensory meridian response (ASMR), a pleasant form of paresthesia, a tingling sensation that typically begins on the scalp and moves down the back of the neck and upper spine. ASMR is described as the opposite of what can be observed in reactions to specific audio stimuli in misophonia.[23] There are plentiful anecdotal reports of people who claim to have both misophonia and ASMR. Common to these reports is the experience of ASMR in response to some sounds and misophonia in response to others.[23][24][25]

Society and culture[edit]

People who experience misophonia have formed online support groups.[26][22]

In 2016, a documentary about the condition, Quiet Please, was released.[27]

In 2020, a team of misophonia researchers[28] received the Ig Nobel Prize in medicine "for diagnosing a long-unrecognized medical condition".[29]

Notable cases[edit]

See also[edit]

References[edit]

  1. ^ Sanchez TG, Silva FE (2017). "Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?". Brazilian Journal of Otorhinolaryngology. 84 (5): 553–559. doi:10.1016/j.bjorl.2017.06.014. PMC 9452240. PMID 28823694.
  2. ^ a b c d e Bruxner G (April 2016). "'Mastication rage': a review of misophonia - an under-recognised symptom of psychiatric relevance?". Australasian Psychiatry. 24 (2): 195–7. doi:10.1177/1039856215613010. PMID 26508801. S2CID 7106232.
  3. ^ a b c d e Cavanna AE, Seri S (August 2015). "Misophonia: current perspectives". Neuropsychiatric Disease and Treatment. 11: 2117–23. doi:10.2147/NDT.S81438. PMC 4547634. PMID 26316758.
  4. ^ Jastreboff, MM; Jastreboff, PJ (2001). "Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia" (PDF). ITHS News: 5–7.
  5. ^ Brout, Jennifer J.; Edelstein, Miren; Erfanian, Mercede; Mannino, Michael; Miller, Lucy J.; Rouw, Romke; Kumar, Sukhbinder; Rosenthal, M. Zachary (2018). "Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda". Frontiers in Neuroscience. 12: 36. doi:10.3389/fnins.2018.00036. ISSN 1662-453X. PMC 5808324. PMID 29467604.
  6. ^ Taylor, Steven (June 2017). "Misophonia: A new mental disorder?". Medical Hypotheses. 103: 109–117. doi:10.1016/j.mehy.2017.05.003. ISSN 1532-2777. PMID 28571795.
  7. ^ a b c d e f g Swedo S, Baguley DM, Denys D, Dixon LJ, Erfanian M, Fioretti A, Jastreboff PJ, Kumar S, Rosenthal MZ, Rouw R, Schiller D (2021). "A Consensus Definition of Misophonia: Using a Delphi Process to Reach Expert Agreement". medRxiv. doi:10.1101/2021.04.05.21254951. S2CID 233152520. Retrieved 11 April 2021.
  8. ^ a b c d e f g h i j k l Brout JJ, Edelstein M, Erfanian M, Mannino M, Miller LJ, Rouw R, et al. (2018). "Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda". Frontiers in Neuroscience. 12: 36. doi:10.3389/fnins.2018.00036. PMC 5808324. PMID 29467604.
  9. ^ a b Jastreboff MM, Jastreboff PJ (2001). "Components of decreased sound tolerance : hyperacusis, misophonia, phonophobia" (PDF).
  10. ^ "Misophonia". Tinnitus & Hyperacusis Center. Retrieved 8 October 2022.
  11. ^ Freytas-Tamura, Kimiko de (3 February 2017). "Misophonia Sufferers: Scientists May Have Found the Root of Your Pain". The New York Times. Retrieved 6 October 2022.
  12. ^ Jastreboff, Margaret M. Jastreboff,Pawel J. "Hyperacusis". AudiologyOnline. Retrieved 8 October 2022.
  13. ^ Jastreboff MM, Jastreboff PJ (2001). "Components of decreased sound tolerance : hyperacusis, misophonia, phonophobia" (PDF).
  14. ^ Jastreboff, Margaret M.; Jastreboff, Pawel J. (1 November 2002). "Decreased Sound Tolerance and Tinnitus Retraining Therapy (TRT)". Australian and New Zealand Journal of Audiology. 24 (2): 74–84. doi:10.1375/audi.24.2.74.31105.
  15. ^ a b Cavanna AE (April 2014). "What is misophonia and how can we treat it?". Expert Review of Neurotherapeutics. 14 (4): 357–9. doi:10.1586/14737175.2014.892418. PMID 24552574. S2CID 36026220.
  16. ^ a b c d e f g h i j Duddy DF, Oeding KA (2014). "Misophonia: An Overview". Semin Hear. 35 (2): 084–091. doi:10.1055/s-0034-1372525. S2CID 76090599.
  17. ^ Tunç, Serhat; Başbuğ, Hamit Serdar (2 October 2017). "An extreme physical reaction in misophonia: stop smacking your mouth!". Psychiatry and Clinical Psychopharmacology. 27 (4): 416–418. doi:10.1080/24750573.2017.1354656. ISSN 2475-0573. S2CID 148603011.
  18. ^ Kumar S, Tansley-Hancock O, Sedley W, Winston JS, Callaghan MF, Allen M, et al. (February 2017). "The Brain Basis for Misophonia". Current Biology. 27 (4): 527–533. doi:10.1016/j.cub.2016.12.048. PMC 5321671. PMID 28162895.
  19. ^ Cartreine J (21 April 2017). "Misophonia: When sounds really do make you "crazy"". Harvard Health Blog.
  20. ^ Kumar S, Dheerendra P, Erfanian M, Benzaquén E, Sedley W, Gander PE, et al. (May 2021). "The Motor Basis for Misophonia". Journal of Neuroscience. 41 (26): 5762–5770. doi:10.1523/JNEUROSCI.0261-21.2021. PMC 8244967. PMID 34021042.
  21. ^ Jastreboff PJ, Jastreboff MM (2015). Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis. Handb Clin Neurol. Handbook of Clinical Neurology. Vol. 129. pp. 375–87. doi:10.1016/B978-0-444-62630-1.00021-4. ISBN 9780444626301. PMID 25726280.
  22. ^ a b Schröder A, Vulink N, Denys D (23 January 2013). "Misophonia: diagnostic criteria for a new psychiatric disorder". PLOS ONE. 8 (1): e54706. Bibcode:2013PLoSO...854706S. doi:10.1371/journal.pone.0054706. PMC 3553052. PMID 23372758.
  23. ^ a b Rouw R, Erfanian M (March 2018). "A Large-Scale Study of Misophonia". Journal of Clinical Psychology. 74 (3): 453–479. doi:10.1002/jclp.22500. hdl:11245.1/c9c45e84-3c70-407e-aa2f-782ccdb79791. PMID 28561277.
  24. ^ "ASMR and Misophonia: Sounds-Crazy!". Science in our world: certainty and controversy. Pennsylvania State University. 16 September 2015.
  25. ^ Higa K (11 June 2015). "Technicalities of the Tingles: The science of sounds that feel good. #ASMR". Neuwrite. Retrieved 20 January 2016.
  26. ^ Cohen J (5 September 2011). "When a Chomp or a Slurp is a Trigger for Outrage". The New York Times. Retrieved 5 February 2012.
  27. ^ Jeffries A (17 June 2016). "There's a New Film About Misophonia, Where People Get Enraged by Certain Sounds". Motherboard. Retrieved 18 September 2020.
  28. ^ Schröder A, Vulink N, Denys D (2013) "Misophonia: Diagnostic Criteria for a New Psychiatric Disorder". PLOS ONE 8(1): e54706. https://doi.org/10.1371/journal.pone.0054706
  29. ^ "Past Ig Winners". improbable.com. 1 August 2006.
  30. ^ Lerner BH (2 March 2015). "Please Stop Making That Noise". Well. New York Times. Retrieved 18 October 2016.
  31. ^ Bisley A (10 March 2015). "Melanie Lynskey on Togetherness, realism and 'radical' nudity". The Guardian. ISSN 0261-3077. Retrieved 30 June 2017.
  32. ^ Misophonia: Kelly Ripa Has Rare Disorder. 20/20. ABC News. 18 May 2012. Retrieved 18 October 2016.
  33. ^ Dogshit, Comedy and Pain (YouTube video). The Sarah Silverman Podcast. 17 March 2022. Retrieved 8 February 2023.

Further reading[edit]

External links[edit]

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