Phenomenology of Misophonia: Initial Physical and Emotional Responses

Abstract

Objective: Misophonia is typically characterized as an extreme emotional response to auditory and visual stimuli. In several case studies, physical responses have also been reported. This study sought to determine whether adults with misophonia experience physical responses in addition to emotional responses in the presence of triggering stimuli. Method: Twenty-seven adults with misophonia were interviewed via teleconferencing. Participants self-reported the presence of physical and emotional responses to triggers (i.e., two auditory and one visual). Results: All participants reported physical responses to at least one of their triggers. There was great variation in the region of the physical responses across participants. Approximately half of the sample reported region consistency across triggers. Likewise, all participants reported emotional responses to at least one of their triggers. Conclusion: These results suggest including an immediate physical response as part of the conceptualization of misophonia. They also support classical conditioning of a physical response as a possible contributing mechanism for the etiology of misophonia.

Full text

American Journal of Psychology
Winter 2017, Vol. 130, No. 4 pp. 431–438 • ©2017 by the Board of Trustees of the University of Illinois
Phenomenology of Misophonia:
Initial Physical and Emotional Responses
THOMAS H. DOZIER
Misophonia Treatment Institute
KATE L. MORRISON
Utah State University
Misophonia is typically characterized as an extreme emotional response to auditory and visual
stimuli. In several case studies, physical responses have also been reported. This study sought to
determine whether adults with misophonia experience physical responses in addition to emo-
tional responses in the presence of triggering stimuli. Twenty- seven adults with misophonia
were interviewed via teleconferencing. Participants self- reported the presence of physical and
emotional responses to triggers (i.e., two auditory and one visual). All participants reported
physical responses to at least 1 of their triggers. There was great variation in the region of
the physical responses across participants. Approximately half of the sample reported region
consistency across triggers. Likewise, all participants reported emotional responses to at least 1
of their triggers. These results suggest including an immediate physical response as part of the
conceptualization of misophonia. They also support classical conditioning of a physical response
as a possible contributing mechanism for the etiology of misophonia.
KEYWORDS: misophonia, classical conditioning, reflex, selective sound sensitivity syndrome,
neurodevelopmental disorders, Pavlovian conditioning, sound sensitivity
other sensory modalities (e.g., tactile, olfactory, low-
frequency vibration; Dozier, 2015d).
The etiology of misophonia is unknown, with
onset occurring predominantly in childhood or the
early teens (Claiborn, Dozier, Hart, & Jaehoon, 2017;
Edelstein et al., 2015; Schröder et al., 2013; Wu et
al., 2014). Onset also occurs in adulthood, but at
much lower rates (Claiborn et al., 2017). It has been
hypothesized that misophonia may originate from a
defective structure in the inferior part of the temporal
lobe (Møller, 2011), as part of a general hyperreactivity
syndrome (Schröder et al., 2013), or through classi-
Misophonia is commonly characterized as an extreme
emotional response of anger or disgust to common-
ly occurring innocuous auditory and visual stimuli
(Edelstein, Brang, Rouw, & Ramachandran, 2013;
Jastrebo & Jastrebo, 2014; Schröder, Vulink, &
Denys, 2013; Wu, Lewin, Murphy, & Storch, 2014).
Misophonia is a newly identied condition and may
be surprisingly common. One study of psychology
undergraduate students reported that 19.9% had
clinically significant misophonia symptoms (Wu
et al., 2014). Stimuli that cause such a response are
commonly referred to as triggers and can include
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432 • DOZIER AND MORRISON
cal conditioning (Dozier, 2015b, 2015c; Jastrebo &
Jastrebo, 2002, 2014; Schröder et al., 2013).
Several studies have reported physiological
arousal in response to trigger stimuli, including in-
creased skin conductance, heart rate, blood pressure,
and a feeling of pressure in the body, as an accompa-
nying stress response to misophonic triggers (Clai-
born et al., 2017; Edelstein et al., 2013; Jastrebo &
Jastrebo, 2014; Schröder et al., 2013). Edelstein et al.
(2013) empirically validated the autonomic arousal by
measuring the skin conductance response (SCR) to
prolonged exposure to misophonic auditory stimuli.
SCR began rising 2 s after onset of the trigger stimulus
and continued to rise for the duration of the stimulus.
The stress response is illustrated in Figure 1a, which
displays the prevalent conception of misophonia.
Several case studies and one survey have reported
a physical response, typically a skeletal muscle con-
traction (e.g., inch, various muscle contractions), to
trigger stimuli (Claiborn et al., 2017; Dozier, 2015a,
2015b, 2015c; Pearson, 2015). Dozier (2015b, 2015c,
2015d) proposed an alternative model of the miso-
phonic response that includes this physical response
elicited by the trigger stimulus (Figure 1b). In the pro-
posed model, the misophonic emotional response is
elicited primarily by the sensation of the initial physi-
cal response. The dashed line in Figure 1b shows
a secondary path whereby the trigger stimulus may
directly contribute to the strength of the emotional
response. The proposed response paths are similar
to the James–Lange and Cannon–Bard theories of
emotion, which discuss the order and processing
of physiological and emotional responses to stimuli
(Cannon, 1987). Though similar, the model put forth
by Dozier (2015b, 2015c, 2015d) includes a sometimes
visible muscle inch or ticlike movement beyond
the emotional and physiological responses in those
models. Dozier’s model proposes that misophonia
is an aversive physical and emotional reex disor-
der. Moreover, Dozier (2015b) posits that misophonia
includes a classically conditioned aversive physical
response to selective stimuli, which does not extin-
guish with in vivo exposure.
Aversive stimuli have been shown to evoke anger
in humans (Berkowitz, 1983; Berkowitz, Cochran, &
Embree, 1981). Neuroimaging studies have shown
increased activity in the limbic system of humans
in response to aversive gustatory stimuli (Zald, Lee,
Fluegel, & Pardo, 1998), aversive odorants (Zald &
Pardo, 1997), and aversive auditory stimuli (Zald &
Pardo, 2002). The physical response to misophonic
trigger stimuli has been reported as severe by some
people and very mild by others (Dozier, 2015b). Even
in cases where the physical response is weak, it is
intrusive and may therefore be aversive.
The existence of an initial physical response is
an important consideration in elucidating misopho-
nia, but the emotional response to real- life trigger
stimuli may mask the perception of that response
(Dozier, 2015c, 2015d). This study sought to deter-
mine whether physical sensations could be identied
when misophonic people were presented with weak
trigger stimuli. Providing evidence of an initial physi-
cal response in a controlled study may lead to in-
creased awareness and recognition of this previously
reported characteristic of the misophonic response.
It may also identify a widespread example where a
physical response contributes to extreme emotional
responses.
FIGURE 1. (a) Prevalent conception of misophonia emotional and physical
response to trigger stimuli. The trigger stimulus elicits the misophonic extreme
emotions and the accompanying stress response. (b) Alternative conception of
misophonia response chain, including the initial physical response. The trigger
stimulus elicits a physical response, and the sensation of the physical response
elicits the extreme emotions and accompanying stress response
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MISOPhONIA AND RESPONSE • 433
EXPERIMENT
METHOD
Participants
Invitations were sent to 194 people (31 men and 163
women) randomly selected from those who, as part
of an online survey of adults with misophonia symp-
toms, indicated a willingness to participate in further
study phases. The high rate of female participation
in the survey is consistent with other self- selection
misophonia studies (Cash, 2015; Wu et al., 2014),
even though those studies found no signicant gen-
der dierence for prevalence. Eligibility required that
participants be 18 years of age or older and report
at least two misophonic trigger stimuli. Of the 194
contacted, 27 people returned the informed consent
form and completed the study interview (7 men and
20 women, mean age = 38.3 years; range = 18–63
years). The responses of one person were excluded
from analysis because responses intermixed thoughts,
emotions, and physical sensations for both the physi-
cal and emotional questions. Based on the Amster-
dam Misophonia Scale (range 0–24; Schröder et al.,
2013), which was administered as part of a previous
study, the misophonia severity ratings of participants
ranged from subclinical to extreme, with the mean
between moderate and severe (M = 14.38, SD = 3.81,
range = 4–21).
Procedure
This study was approved by the Sterling Institutional
Review Board. After being invited to participate in
the interview, participants returned the completed
informed consent, a form that designated the types
of triggers that would be used in the interview and, if
necessary, any recording of those triggers via e- mail.
The trigger form requested identification of one
visual and two auditory triggers. Each trigger was
designated as either “trigger made by investigator”
or “recording will be provided.” At that time, a one-
time appointment was scheduled to meet via VSee
(a Health Insurance Portability and Accountability
Act–compliant telehealth videoconferencing plat-
form). Interviews were conducted by both authors.
Before the interview, the interviewer veried that
recorded trigger les played properly and prepared
the materials to produce triggers (e.g., chips, gum,
video of kissing). The interviews lasted approxi-
mately 20–30 min. At the start of the interview, the
informed consent was reviewed for participant clari-
cation. Once assured it was fully understood, the
interviewer read the following script:
The purpose of this meeting is to help you
identify the physical sensations that you have
when you are triggered. In real life, the emo-
tions are so overpowering that almost no one
can accurately identify the physical sensations
that occur immediately after a trigger. The
research on reexes indicates that the smaller
a trigger stimulus, the smaller the response. I
will attempt to make the trigger so tiny that it
does not cause any reex response. Then I will
slowly increase the trigger until you start to be
triggered. At that point, I will ask you to report
the strength of the trigger (on a scale of 0–10),
any physical sensation you have, and any emo-
tions you experience.
Each trigger was tested several times. For each
auditory trigger test, participants were asked to close
their eyes and relax their muscles. The interviewer
produced a very low- level trigger (i.e., low volume
and short duration), and the participant was asked
whether it triggered them. The trigger was slowly
increased until the participant was triggered. The
participant then reported the strength of the trig-
ger, physical sensations, and emotions experienced.
The interviewer prompted for clarication of the
responses when needed. For subsequent tests of
the same trigger, the interviewer attempted to ad-
just the trigger to have a “trigger strength” of 2 to
4, as reported by the participant. This procedure
was repeated several times until a consistent physi-
cal response was reported (dened as two matching
consecutive responses) or a maximum of 10 tests were
completed. The procedure for visual triggers was the
same as for auditory triggers, except participants were
asked to relax their muscles with their eyes open and
close their eyes as soon as they were triggered. The
researcher produced the trigger, attempting to start
with a nontriggering stimulus and slowly increase
the trigger strength until participants closed their
eyes. The strength of the visual trigger was adjusted
by the size of the image on the screen and topology.
For example, if the trigger was open mouth chewing,
the interviewer started chewing with a closed mouth
and progressively increased the separation of the lips
until the participant closed his or her eyes. With this
method, the trigger strength rating was maintained
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434 • DOZIER AND MORRISON
in the same range for visual and auditory triggers.
The interviewer’s microphone was muted during the
test for a visual trigger to ensure that the misophonic
response was elicited solely by the visual image. The
two auditory and one visual triggers were tested using
this format, with the exception of two participants
who had only auditory triggers. Participant responses
were recorded on a data collection form by the re-
searcher and later entered into a data le.
Interviewer Interrater Reliability
To ensure interviewer interrater reliability, 6 of the
27 interviews (22%) were observed by the other au-
thor. The observer was blocked visually and audibly
from both the participant and interviewer after mak-
ing the participant aware of his or her presence. The
observer completed the same data collection form
and entered the data into a separate data le for later
comparisons. Interrater agreement was calculated
for the physical and emotional response data. The
percentage agreement was calculated as the number
of responses that completely matched, divided by to-
tal responses. Interrater agreement was 91.1%, which
suggests high agreement between the observer and
interviewer.
Data Analysis Techniques
The physical response was determined according
to three rules. First, if two consecutive responses
were identical, those responses were reported (57 of
76 tests, 75.0%). Second, if a set of responses did
not meet the rst rule but were reported in three
consecutive tests, and each response was reported
at least twice, then all the responses were reported
(9 of 76 tests, 11.8%). Third, if the rst and second
rules were not met, responses that occurred two or
more times were reported, and any further responses
were reported as various (10 of 76 tests, 13.2%). All
emotional responses reported were included in the
data summary. The second author reviewed 19.2%
(randomly selected) of the total participant responses
to ensure accuracy of the data summary. The data
summary interrater agreement was 100%.
RESULTS
Physical Responses
Each participant was tested with two dierent audi-
tory triggers and one visual trigger, except for the two
participants who did not have any visual misophonic
triggers. The physical and emotional responses for all
triggers tested are shown in the supplemental table.
The physical responses for each person are summa-
rized in Table 1. Responses are grouped into major
categories. For example, responses of upper arms,
forearms, hands, and ngers are grouped into arms
and hands. A response of trapezius (e.g., participant
reporting shoulders at the neck or pointing to this
location) is included in the shoulders and neck groups.
Three participants (11.5%) had one or two trig-
gers wherein they consistently reported no physical
response. One participant (3.8%) reported a physi-
cal response but intermittently reported no physical
response from two triggers. The responses to many
TAbLE 1. Summary of Physical Responses to Trigger Stimuli
Physical
response
Number of
participants
(
n
= 26)
% of
Participants
Number
of trigger
tests
(
n
= 76)
% of
Trigger
tests
Shoulders 13 50.0% 26 34.2%
Arms and
hands
11 42.3% 24 31.6%
Neck 9 34.6% 17 22.4%
Chest 5 19.2% 8 10.5%
Back 5 19.2% 8 10.5%
Abdomen 4 15.4% 8 10.5%
Jaw 3 11.5% 5 6.6%
Thighs 2 7.7% 4 5.3%
General
tensing
2 7.7% 3 3.9%
Sexual
(e.g., clitoral,
vaginal)
2 7.7% 2 2.6%
Warmth 2 7.7% 5 6.6%
Toes 2 7.7% 3 3.9%
Stomach or
nausea
2 7.7% 2 2.6%
Breath 2 7.7% 2 2.6%
Torso 2 7.7% 3 3.9%
Head 2 7.7% 2 2.6%
Face 1 3.8% 1 1.3%
Numb
sensation
1 3.8% 1 1.3%
Various 8 30.8% 10 13.2%
None 4 15.4% 7 9.2%
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MISOPhONIA AND RESPONSE • 435
of the triggers included more than one muscle group;
therefore, the sum of the percentages in Table 1 is
greater than 100%. Table 2 shows the number of par-
ticipants with same, similar, dierent, and no physical
responses. All participants (100%) reported a physical
response to at least one of their tested triggers. Table
3 provides examples of the consistency of responses
to dierent trigger stimuli.
It was dicult for some participants to determine
the location of the response. For example, one par-
ticipant reported feeling panic and fear in the rst
instance of the trigger and a physical sensation in the
gut and shoulders in the second instance. After sev-
eral more exposures to weak triggers, the participant
consistently reported a slight tensing of the abdomen
as the physical response to triggers. Therefore, in
many cases the exact location of the physical response
should not be considered reliable (e.g., whether the
response was in the neck versus the neck, shoulders,
and chest).
Emotional Responses
Emotional responses were recorded for each trigger
test. Actual responses from each trigger tested are
listed in the supplemental table. Four participants
(15.4%) had one or two triggers wherein they con-
sistently reported no emotional response. The only
emotion that one of these participants reported in all
the individual trigger tests was that he “wanted them
to go away.” Another four participants (15.4%) report-
ed emotional responses but intermittently reported
no emotional response for one or more triggers. A
summary of the emotional responses to triggers is
shown in Table 4, as a percentage of participants and
of triggers tested. As with the physical responses, the
sum of the percentages is greater than 100% because
multiple emotions were often reported for each trig-
TAbLE 2. Within- Participant Similarities and
Differences of Responses to Triggers
Responses to different
triggers
Number
participants
(
n
= 26) %
Same (all) 6 23.1%
Same or similar (all) 15 57.7%
Same (2 or more) 13 50.0%
Same or similar (2 or more) 19 73.1%
Different (1 or more) 11 42.3%
No response (1 or more) 4 15.4%
Physical response (1 or more) 26 100%
TABLE 3. Examples of Physical Responses Consistency to Triggers
Responses
to different
triggers
Example of physical response of participant
Auditory
trigger 1
Auditory
trigger 2
Visual
trigger
Same (all) Hand clench,
jaw
Hand clench,
jaw
Hand clench,
jaw
Same or similar
(all)
Neck,
shoulders,
upper back,
upper arms
Shoulder,
upper back
Neck,
shoulders,
head tilt to
left
Same (2 or more) Shoulders,
chest
Varied Shoulders,
chest
Same or similar
(2 or more)
Shoulders,
upper arms,
chest
Shoulders,
upper body,
abdomen
Whole arms
Different
(1 or more)
Neck,
shoulders
Chest Neck,
shoulders
No response
(1 or 2)
Arms, hands Arms, hands None
Physical response
(1 or more)
None None Shoulders
TAbLE 4. Summary of Emotional Responses to Trigger Stimuli
Emotional
response
Number of
participants
(
n
= 26)
% of
Participants
Number
of trigger
tests
(
n
= 76)
% of
Trigger
tests
Anger 24 92.3% 57 75.0%
Anxiety 24 92.3% 32 42.1%
Desire for
escape
14 53.8% 23 30.3%
Disgust 12 46.2% 17 22.4%
Fear 6 23.1% 9 11.8%
Sadness 4 15.4% 5 6.6%
Other 9 34.6% 9 11.8%
None 8 30.8% 15 19.7%
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436 • DOZIER AND MORRISON
ger. The categories of emotion are aggregations of
similar emotions. For example, aggravation, irritation,
annoyance, frustration, anger, and rage are combined
into the anger category. All participants (100%) re-
ported an emotional response to at least one of their
tested triggers.
DISCUSSION
Although other studies have reported general physi-
ological arousal in response to strong or prolonged
trigger stimuli including muscle tension (Edelstein et
al., 2013; Schröder et al., 2013; Wu et al., 2014), this is
the rst research study to report a physical response
to trigger stimuli that often included specic skeletal
muscle contraction and movement. Edelstein et al.
(2013) concluded that their misophonic participants
“reported physical symptoms synonymous with au-
tonomic arousal” (p. 8). In the current study, par-
ticipants reported their perceived physical response
after weak auditory stimuli. Weak stimuli and time
between tests were intended to prevent general
physiological arousal, so that the participants could
be aware of their physical sensations in response to
trigger stimuli. We posit that the reported physical
sensation was an immediate elicited response from
the stimulus and not autonomic arousal, as reported
in other studies. Although there were some trigger
tests in this study wherein the participant reported
experiencing no physical response, most participants
reported a physical response to each trigger stimulus,
and every participant reported a physical response to
at least one of their tested triggers.
The physical responses were highly varied, with
reports of skeletal muscle responses predominating.
Some participants reported a response in a single
area, such as hands or abdomen, and many reported
multiple muscles (e.g., hands and shoulders). The
non–skeletal muscle responses included a feeling of
warmth, stomach contraction, nausea, clitoral sensa-
tion, and contraction of the vagina. More than half
of participants reported the same or similar physical
response for all triggers tested. Most reported the
same or similar physical response for two or more
triggers, and 42% of participants had distinctly dier-
ent physical responses to at least one of their triggers.
The most important nding is that the misophonic
response to triggers includes a physical response that
may be unique to each participant. Thus, the recom-
mendation would not be to categorize misophonia by
specic physical responses but rather incorporate
the general presence of these automatic physical re-
sponses into the understanding of this phenomenon.
Anger (and lesser precursors), anxiety, disgust,
and avoidance were the most common emotions re-
ported by participants in response to a single weak
instance of a trigger, with anger being the dominant
emotion. This was consistent with emotional reports
in other studies in response to typical trigger stimuli
(Edelstein et al., 2013; Wu et al., 2014). However, the
reported fear response was novel because it is gener-
ally not reported in misophonia studies (Edelstein et
al., 2013; Schröder et al., 2013; Wu et al., 2014).
Weak trigger stimuli were used in this study to
limit the emotional responses and allow percep-
tion of the physical response. The severity of the
responses reported by the participant appeared to
be directly related to the volume and duration of the
trigger stimulus, and these parameters were varied
based on the participant rating of severity. The mild
emotional responses (e.g., irritation, frustration, mild
anger, mild disgust) were probably a function of the
weak trigger stimuli. It may be more appropriate to
say that the weak trigger stimuli limited the physical
and emotional responses, because the strength of a
conditioned physical response is related to condi-
tioned stimulus intensity (Kessen, 1953). It is posited
that strong trigger stimuli, especially those in real-
life situations, would produce stronger physical and
emotional responses. About a third of participants
(30.8%) had instances where they did not experience
an emotional response, and half as many (15.4%) had
instances where they did not experience a physical
response. The trigger stimuli were intentionally weak.
Each participant had several instances where the au-
ditory stimulus did not elicit a physical or emotional
response (i.e., participant did not have a misophonic
response to the stimulus). It seems plausible that a
physical and an emotional response will almost al-
ways be elicited by stronger, real- life trigger stimuli.
The occasional lack of emotional response should
not alter the conceptualization of misophonia as a
condition in which innocuous stimuli elicit or evoke
extreme emotional responses.
The variation in physical responses of partici-
pants supports an individual learning history to
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MISOPhONIA AND RESPONSE • 437
account for the variety of responses. Classical con-
ditioning is a possible mechanism as part of the etiol-
ogy of misophonia, in which each person develops
unique physical responses to repeating stimuli in
their environment. Classical conditioning is typically
conceptualized as an association between a condi-
tioned stimulus (CS) and an unconditioned stimulus
(US), and when the intermittent temporal relation-
ship between the CS and US stimuli is eliminated, the
response extinguishes. However, with misophonia
there is no identiable US for conditioning the miso-
phonic stimulus response, and the response generally
does not extinguish (Dozier, 2015b). Donahoe and
Vegas (2004) reported that conditioning occurred
based on the temporal pairing of a neutral stimulus
(NS) and an unconditioned response. Dozier (2015b)
provides case study examples of people whose condi-
tioning may have occurred with the pairing of an NS
(e.g., chewing sound) and an unconscious behavior.
Schroder et al. (2013) hypothesized that recurrent
conditioning may occur when a child is exposed to
repetitive annoying events related to eating sounds.
Such events could pair an NS (chewing sound) and a
behavioral response (e.g., st clench, shoulder shrug)
unique to the child. This pairing of NS and response
would meet the criteria for conditioning reported by
Donahoe and Vegas (2004). Further basic research
on stimulus–response conditioning may provide
valuable insight and inform future misophonia re-
search. Such basic research may also provide insight
into other potential physical–emotional interactions
such as hating a portable chemotherapy infusion
pump (J. Theobald, personal communication, De-
cember 16, 2015; http://newccboard.colonclub.com/
viewtopic.php?t=11244) or an aversive muscle re-
sponse to phone ringtones that have been paired
with stressful problems (Dozier, 2015b).
Although the nature of this study is insucient to
determine the relationship of the physical and emo-
tional responses, the presence of physical responses
suggests a dierent denition of misophonia than the
prevalent conception of misophonia. Thus, a deni-
tion that includes the presence of physical responses
is recommended based on the findings from this
study: Misophonia is a condition in which a person
experiences an immediate physical response and an
immediate negative emotional response to auditory,
visual, or other modality trigger stimuli.
Limitations
This study has inherent limitations due to its reliance
on self- report of participants. The stimuli were low
intensity and elicited only mildly aversive responses.
The stimuli for each person were dierent based on
their individual misophonic triggers. Many of the
participants had diculty identifying a consistent
physical response, especially at the start of their in-
terviews, and so the repetitions were dierent for
each participant. Continued practice or exposure
to the stimuli could have led to diering responses.
Additionally, there is a lack of accuracy in specifying
the location of the physical response. Although there
may be a lack of precision regarding the location of
the physical response, this does not diminish the fact
that participants experienced a physical response to
exposure of a trigger stimulus.
The method of this study does not provide con-
crete information about timing of the physical or
emotional responses in relation to the trigger stimulus
or each other. Additional testing is needed to pro-
vide empirical data on the temporal relationship of
the stimulus, physical responses, and emotional re-
sponses. The relationship between the stimulus and
physical response might be measured with electromy-
ography, and the temporal relationship between the
stimulus and emotional response might be measured
with brain imaging technology. This study supports
the existence of a distinct physical response but does
not provide information on the priority of the physi-
cal response as hypothesized in Figure 1b. The eects
of self- selection to participate in this study, the high
percentage of female participants, and conducting
the study via webcam are unknown.
Conclusion
This study provides insight into the composition of
misophonia, indicating that misophonia consists of
both involuntary physical and emotional responses
to trigger stimuli. It also documents that auditory
and visual trigger stimuli produce similar physical
responses, demonstrating that misophonia may be
a general sensory condition rather than an auditory
condition. The existence of a physical response has
important implications for understanding the origin,
maintenance, and treatment of misophonia. The re-
sults from this study may suggest conceptualizing
misophonia as an aversive physical and emotional
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438 • DOZIER AND MORRISON
reex disorder in order to highlight the characteris-
tics of misophonia. Furthermore, this study illustrates
a potentially fundamental psychological process, in
which a physical response may be the maintaining el-
ement of what supercially appears to be a condition
in which typically innocuous stimuli elect extreme
negative emotional responses.
NOTES
Thomas Dozier is a misophonia treatment provider and the
owner of several misophonia apps.
Address correspondence about this article to Thomas
H. Dozier, Misophonia Treatment Institute, 5801 Arlene Way,
Livermore, CA 94550 (e- mail: tom@misophoniatreatment.
com).
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