Misophonia

Updated on June 3rd, 2019

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    People with misophonia find simple things aggravating. They may, for example, find it irritating to eat in restaurants or even at home with their family because hearing the sound of people eating creates an over-the-top emotional charge.

    Often normal, everyday sounds can infuriate them. These frayed nerves can lead to a variety of irrational behavior.

    A misophonia sufferer may verbally attack someone laughing at a TV sitcom joke, assault someone for chewing gum, or run out of the room if a baby cries. We examine the real scientific finding behind this little-known disorder.

    What Is Misophonia?

    Misophonia, also called Selective Sound Sensitivity Syndrome, is a little-known disorder that is not formally recognized as a mental disorder and included in the DSM-5, the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders.”

    Etymologically, misophonia derives from two Greek words 1 —misos, meaning “hate,” and “phónè” meaning, voice. In essence, then, it means “hatred of sound.”

    In 2000, two audiologists coined this neologism because they wanted to distinguish it from other disorders for sound intolerance. Pawel and Margaret Jastreboff sought to differentiate misophonia from hyperacusis and phonophobia.

    Hyperacusis is hypersensitivity to sound frequencies and volume while phonophobia is fear of sounds. Misophonia does not meet the criteria for either of these two disorders.

    Hyperacusis is not specific to a certain sound and it does not cause a strong emotional reaction. Phonophobia is limited to a fear of a certain sound.

    Nomenclature

    The specific names for different types of misophonic disorders describe the specific sounds a person hates. For example:

    • If someone hates the sound of breathing, their condition is called “misophonia breathing.”
    • If someone hates the sound of a baby crying, it is called “misophonia baby crying.”
    • If someone hates the sound of coughing, it is “misophonia coughing.”

    Symptomology

    The most noticeable feature of misophonia is emotional and physiological over-reaction to certain sounds. These are sounds other people rarely notice because they are neither loud nor unusual.

    Someone with misophonia does not react to all sounds, only certain ones drive them crazy and stir up visceral feelings. They feel the urge to fight or flee and feel extreme emotions like anger or panic.

    The sounds can be subtle — like someone chewing or sighing or breathing heavily. They may also be repetitive sounds like the sound of fingers clicking on a keyboard.

    Often, too, anticipating a sound can be a source of considerable stress. Visual stimuli alone may be enough to make someone tense up. For instance, they may cringe watching someone about to open up a paper package, anticipating the sounds of paper shredding.

    Researchers speculate that misophonic-like sounds are those with a repetitive pattern. The brains of those with misophonia may filter repetitive sounds in an unusual way, amplifying their auditory qualities.

    Range of Intensity

    Misophonic reactions range from mild to severe.

    A mild reaction might be anxiety, discomfort, or revulsion. A strong reaction might be anger, fear, or panic.

    Relation to OCD

    Although there has been speculation that misophonia is a form of OCD 2, obsessive-compulsive disorders, this idea is still being debated. While some researchers think that it is a new disorder within the OCD spectrum, others think misophonia should be grouped with sensory intolerance disorders.

    The Genetic Link

    Is misophonia genetic? Although there have been claims by a few genetic testing websites that the genes for misophonia have been identified, these have yet to be scientifically validated.

    One claim, for instance, is that the TENM2 gene is associated with misophonia. This assertion rests on the fact that this is the gene for neural development and nervous system connectivity.

    It is even claimed that specific markers on these genes have been identified. For example, if someone has misophonia chewing, it is supposed to be linked to rs2937573 misophonia, a marker on TENM2 gene associated with TENM2 Gene.

    But, according to an article in Frontiers in Neuroscience 3, “Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda,” there is no clearly identified genetic link to misophonia.

    After examining the empirical literature, the authors pointed out, “Since we do not have sufficient evidence to make conclusions about the role of genetics in misophonia, or to firmly conclude how this condition develops in regards to conditioning and associated neurobiological processes, we suggest avoiding language suggestive of a false dichotomy between nature and nurture.”

    What Causes Misophonia?

    Scientists have not been able to identify misophonia causes and are still puzzling over its effects. It is not merely a hearing ailment.

    One speculation is that it could be a physical reaction — the brain triggers an automatic response to a particular sound. Since the brain consists of 100 billion neurons using trillions of synaptic connections, it’s possible that in the misophonia brain, certain parts have specialized and are now working together.

    They theorize that there could be a connection between the part of the brain that processes sound and the part that focuses on the fight, freeze, or flight response. It could also be that part of the brain codes certain sounds as more significant (and threatening) than other sounds.

    Another speculation is that it is a psychological issue because misophonia shows some symptoms of anxiety, some symptoms of bipolar disorder, and some symptoms of obsessive-compulsive disorder. But, since there is insufficient evidence to either establish it as part of the spectrum of an existing disorder or an entirely new disorder, the DSM-5 does not include it.

    It’s not surprising then, because so little is known about it, that doctors and psychiatrists tend to misdiagnose it.

    The meaning of correlations about misophonia is also not clear. It appears more common among girls but not for any clear reason.

    It also may or may not be accompanied by developmental, health, or psychological problems. Overall, it’s hard to interpret the meaning of these findings. Is the age of onset 9 years old? Does it affect the developing female brain more than the male? Is it related or unrelated to other pre-existing conditions? Only more misophonia research can answer such questions.

    Is My Misophonia Genetic?

    Misophonia does not appear to have a genetic component. An inherited disorder is identified by an abnormality in a person’s DNA.

    This could be a one base mutation of a gene or the addition or deletion of many chromosomes. In the case of misophonia, none of these conditions apply.

    Who Does Misophonia Typically Affect?

    Misophonic triggers appear to vary between different demographics and environmental influences.

    Misophonia in Women vs. Men

    While more men report experiencing misophonic symptoms, more women report severe symptoms.

    What Percent of the Population Has Misophonia?

    Since little is known about misophonia, it is easy to assume that it’s a rare disease, but instances of misophonia may be higher than most people assume. It may affect as many as 15% of adults.

    It might be more accurate to say that it’s more common than most people assume, but it’s a little-known disorder.

    What Is the Age of Onset for Misophonia?

    Cases have been reported in children as young as nine years of age, but it is too early to tell if this is also the age of onset or if these are just outliers.

    Diagnosis of Misophonia

    Doctor’s cannot diagnose misophonia because it is unclear whether this is a physical disorder or a psychological one.

    Consequently, it is not recognized as a disorder by either medical or psychiatric authorities.

    How Do You Diagnose Misophonia?

    It is difficult to diagnose misophonia for several reasons:

    • Science does not understand it well enough to create a diagnostic criterion.
    • It is under-reported or only reported to a doctor or psychologist after many years.
    • When reported, it is often misdiagnosed as something else.
    • Third-party insurance agencies will only to pay for treatment if it is officially recognized as either a medical or psychological disorder.

    Researchers are now working to find out what they can about this disorder. Many questions remained unanswered.

    For instance:

    • What is the correlation between misophonia and intelligence?
    • What are some identifiable misophonia causes?
    • What do all the diverse misophonia symptoms have in common with each other?

    How Do Doctors Test for Misophonia?

    There is no standard procedure for doctors to diagnose or test for misophonia. But, there are a few organizations that provide information and resources.

    Here are three examples:

    1. Misophonia.com has a misophonia blog and social media channels to support those with the disorder
    2. In 2015, Dr. Jennifer Jo Brout established The International Misophonia Research Network (IMRN) to encourage misophonia research and community networking. She also wanted to provide evidence-based information to professionals and patients who want to know more about misophonia.
    3. While there is no recognized misophonia treatment institute, an online resource called the Misophonia Institute does point sufferers to possible treatment options.

    Genetic Tests for Misophonia – Are They Available?

    No misophonia test is available because medical and psychiatric authorities have not agreed on misophonia diagnosis criteria.

    What’s more, misophonia does not meet the criteria of a genetic condition. A genetic condition will turn on like a switch at a certain age in childhood.

    With misophonia, some people only report experiencing it when they are adults.

    Misophonia and Autism

    Misophonia shares a few similarities with autism. For instance, many influences create these disorders.

    They both also show an over-response to an ordinary auditory stimulus. But, these similarities are not strong enough to link the two diseases.

    They are not co-morbid — one is not accompanied by the other — nor are they disorders on the same spectrum.

    It is also not clear if the auditory symptoms of over-responsivity involve the same brain mechanisms and functions. In essence, then, there are no conditions that could be classified as misophonia autism.

    Is Misophonia Treatable?

    Despite the lack of diagnostic criteria, there are some effective misophonia treatments.

    Currently, treatment options depend on the health care system in a country. In the UK’s National Health Services (NHS), for example, one misophonia treatment NHS approach is to refer the patient to an occupational therapist specializing in auditory processing disorders.

    Treatments for Misophonia

    Some effective for misophonia treatment options include:

    • Tinnitus retraining therapy (TRT)
    • Cognitive behavior therapy
    • Adding background noise in a personal environment
    • Deconditioning strong negative reactions to certain sounds

    Certain medications may also work. Lyrica for misophonia has helped some people with the disorder.

    These treatments are effective for all types of misophonia triggers.

    Misophonia Coping Strategies

    Here are six strategies on how to deal with misophonia:

    1. Use a multidisciplinary approach. Work with an audiologist and a counselor, as well as join a misophonia support group.
    2. Try devices that reduce or distract from sounds that trigger a strong reaction. For instance, the use of a hearing aid that creates the sound of a waterfall or the use of misophonia earplugs.
    3. Get emotional support through talk therapy.
    4. Make positive lifestyle choices. A good diet, exercise, and enough sleep will increase vitality and reduce stress.
    5. Create a safe space at home free from upsetting noises.
    6. Increase your education about misophonia.

    The Prognosis for Misophonia

    Although there is no misophonia cure, there are some effective treatments and coping strategies to improve outcomes.

    Does Misophonia Go Away?

    There are no case histories that suggest misophonia goes away on its own or with treatment.

    Does Misophonia Get Worse?

    If left untreated, misophonia will probably get worse because triggers may become more overwhelming due to an increased sensitivity to them.

    Is There a Cure for Misophonia?

    There is no misophonia cure yet. Effective treatments only reduce the intensity and coping skills help make life easier.

    Conclusion

    A practical misophonia definition is to describe it as a disorder that involves hatred of specific sounds. When strong emotions overcome a sufferer, they may react irrationally. They may fight, freeze, or flee.

    These sounds are not unusual in themselves. They may, for instance, be speaking, tapping, or lip smacking.

    They may be swallowing, breathing, or chewing. The only thing these sounds have in common is that they are usually repetitive.

    The disorder does not feature in the DSM-5 because of insufficient research to justify an entry. As a result, there is no known diagnosis nor prognosis.

    Still, despite these obstacles, some effective treatment and coping strategies are emerging and more scientists are now researching the disorder. For now, doctors, counselors, and patients must rely on private organizations and support groups for guidance.

    Referenced Sources

    1. Misophonia and Potential Underlying Mechanisms: A Perspective.
      Palumbo, Devon B., Ola Alsalman, Dirk De Ridder, Jae-Jin Song, and Sven Vanneste. 2018.
      Frontiers in Psychology 9 (June).
    2. Misophonia: A new mental disorder?
      Taylor, Steven. 2017 Med Hypotheses. June, 2017; 103:109-117.
    3. Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda.” Frontiers in Neuroscience 12 (February).
      Brout, Jennifer J., Miren Edelstein, Mercede Erfanian, Michael Mannino, Lucy J. Miller, Romke Rouw, Sukhbinder Kumar, and M. Zachary Rosenthal. 2018.