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Abstract

Misophonia is a new and relatively under-explored condition characterized by experiencing strong emotions (mainly anger and disgust) and a physical response (such as muscle constriction, increased heart rate) when exposed to specific sounds. Among the most frequent aversive triggers are the sounds of eating, breathing, or typing. The experience of misophonia is associated with suffering and a significant decrease in quality of life. The phenomenon was first described in 2002. Since then, numerous case studies and data from psychophysiological and neurological and survey research on this phenomenon have been published. These data indicate that misophonia is a consistent phenomenon and preliminary identification is possible. The most recent results show that misophonia occurs independently of other disorders. There are still, however, many questions regarding the definition and diagnostic criteria to be answered. The most important diagnostic issues that are faced during clinical work with people with misophonia are described in this article. Furthermore, the main theoretical concepts and research on misophonia are reviewed and analyzed.
Psychiatr. Pol. 2019; 53(2): 447–458
PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE)
www.psychiatriapolska.pl
DOI: https://doi.org/10.12740/PP/92023
Misophonia – a review of research results
and theoretical concepts
Marta Siepsiak, Wojciech Dragan
University of Warsaw, Faculty of Psychology,
Department of Psychology of Individual Dierences
Summary
Misophonia is a new and relatively under-explored condition characterized by experienc-
ing strong emotions (mainly anger and disgust) and a physical response (such as muscle
constriction, increased heart rate) when exposed to specic sounds. Among the most frequent
aversive triggers are the sounds of eating, breathing, or typing. The experience of misophonia
is associated with suering and a signicant decrease in quality of life. The phenomenon was
rst described in 2002. Since then, numerous case studies and data from psychophysiological
and neurological and survey research on this phenomenon have been published. These data
indicate that misophonia is a consistent phenomenon and preliminary identication is pos-
sible. The most recent results show that misophonia occurs independent of other disorders.
There are still, however, many questions regarding the denition and diagnostic criteria to be
answered. The most important diagnostic issues that are faced during clinical work with people
with misophonia are described in this article. Furthermore, the main theoretical concepts and
research on misophonia are reviewed and analyzed.
Key words: misophonia, decreased sound tolerance
Introduction
Misophonia (from the Greek misos‛hate’, phonia – ‛sound’) is a form of de-
creased sound tolerance [1, 2]. Its literal translation is misleading, because the essence
of the condition is selective sound aversion, not a hypersensitivity to all kinds of sounds.
Some authors [3] include reactions evoked by visual triggers in misophonia. However,
because of the predominance of data on sound triggers and sparse evidence for other
triggers, this article will be consistent with the main subject literature and assume that
misophonic reactions are related to sounds.
Misophonia was rst described in 2002 by Paweł Jastrebo, who, when working
with patients with tinnitus, noticed a group of people displaying a set of symptoms
Marta Siepsiak, Wojciech Dragan
448
that did not t any previously described disorders [2]. In 1990, Marsha Johnson,
an audiologist, observed the same specic intolerance for certain sounds during her
clinical work, calling it 4 SSelective Sound Sensitivity Syndrome [4]. Both terms
for this condition are present in the literature, however, ‛misophonia’ is more common.
In recent years, a growing interest in this condition among researchers has con-
tributed to new knowledge and awareness of this extremely disruptive aiction.
The scientic work performed to date has identied new areas for future research and
provided clinicians with the fundamentals to take into consideration this currently
marginalized phenomenon. Though the problem of misophonia has already been
addressed by Polish authors [5, 6], there has been no systematic theoretical review on
this phenomenon in the Polish language.
Misophonia – general characteristics
Misophonia is a set of symptoms which some people experience when exposed
to certain sounds. Strong emotions such as anger, irritation, disgust, or anxiety are
evoked immediately when people with misophonia hear particular sounds [7–11].
Somatic responses are also present – pressure in the chest, arms, head, or the whole
body, as well as increased heart rate, increased body temperature, physical pain, or
diculties with breathing [8]. Dozier [3, 12], based on research conducted by his
group, postulates the inclusion of muscle constriction (varying between individuals)
as one of the main symptoms of misophonia, in addition to unpleasant emotional
reactions. Suerers consider these dicult emotions to be unwanted, uncontrolled,
and excessive [10]. These feelings are often accompanied by a desire to violate the
‛source’ of the sound and various thoughts such as “I hate this person” [8]. Sometimes,
a strong uncontrolled emotional experience leads to verbal and physically aggressive
outbursts [8, 10]. These are, however, rare cases. Jastrebo and Jastrebo [7] claim
that the reaction is inuenced by one’s history, subjective assessment of the sound,
beliefs about possible danger, psychological prole, and the context in which the sound
appears. This opinion is consistent with the results of Edelstein et al. [8] which found
that the majority of subjects said that their reactions tend to be limited to members of
their family or coworkers, and that they do not experience misophonic reactions if the
sound is made by a child or an animal.
It is not known what fraction of the population suers from misophonia (all the
more so, given that there is no agreement on what misophonia really is), but it is
possible to infer that the number is signicant. An estimate based on data gathered
by the Emory Tinnitus and Hyperacusis Center shows that around 3% can have
misophonia [2]. It is possible, however, that the numbers are even higher. The data
on decreased sound tolerance (including misophonia) shows a prevalence of up to
15% [13]. Additionally, according to Jastrebo and Jastrebo [2], 92% of people
with decreased sound tolerance have misophonia. The suggestion that there is
a large number of people with misophonia is supported by data from research on
449
Misophonia – a review of research results and theoretical concepts
this phenomenon. Over the course of 5 years, almost 500 people with misophonia
contacted a clinic in Amsterdam [9]. Almost 20% of 483 American students of psy-
chology [14] and 17% of 415 Chinese students [15] declared they suered negative
consequences from misophonic symptoms in their daily lives (the questionnaire used
in this research is described below). Therefore, it seems that misophonia might be
a signicant social problem.
Dierential diagnosis and comorbidity with other disorders
Despite the disagreements among researchers about the specics of misophonia,
preliminary identication is possible in both research as well as in clinical practice as
the dierences in the proposed diagnostic criteria are not very signicant. Misophonia
is not included in any diagnostic classication and in spite of growing knowledge
on this phenomenon it is still not dened enough to include it soon in any of them.
In 2013, based on the available research data, Schröder et al. [10] dened misophonia
as follows:
A. The presence or anticipation of a specic sound, produced by a human be-
ing (e.g., eating sounds, breathing sounds) provokes an impulsive aversive
physical reaction which starts with irritation or disgust that instantaneously
becomes anger.
B. This anger initiates a profound sense of loss of self-control with rare but po-
tentially aggressive outbursts.
C. The person recognizes that the anger or disgust is excessive, unreasonable, or
out of proportion to the circumstances or the provoking stressor.
D. The individual tends to avoid the misophonic situation, or if he/she does not
avoid it, endures encounters with the misophonic sound situation with intense
discomfort, anger or disgust.
E. The individual’s anger, disgust or avoidance causes signicant distress (i.e.,
it bothers the person that he or she has the anger or disgust) or signicant
interference in the person’s day-to-day life. For example, the anger or disgust
may make it dicult for the person to perform important tasks at work, meet
new friends, attend classes, or interact with others.
F. The person’s anger, disgust, and avoidance are not better explained by another
disorder, such as obsessive-compulsive disorder (e.g., disgust in someone
with an obsession about contamination) or post-traumatic stress disorder (e.g.,
avoidance of stimuli associated with a trauma related to threatened death,
serious injury or threat to the physical integrity of self or others).
In 2017, Dozier et al. [12] proposed another set of criteria for misophonia:
A. The presence or anticipation of a specic sensory experience such as a sound,
sight, or other stimulus (e.g., eating sounds, breathing sounds, machine
sounds, leg movement, vibration), provokes an impulsive, aversive physical
Marta Siepsiak, Wojciech Dragan
450
and emotional response which typically begins with irritation or disgust that
quickly becomes anger.
B. The stimulus elicits an immediate physical reex response (skeletal or internal
muscle action, sexual response, warmth, pain, or other physical sensation).
Note the physical response cannot always be identied, but the presence of
an immediate physical response may be used to more clearly identify the
condition as misophonia.
C. A moderate duration of the stimulus (e.g., 15 s) elicits general physiological
arousal (e.g., sweating, increased heart rate, muscle tension).
D. Dysregulation of thoughts and emotions with rare but potentially aggressive
outbursts. Aggressive outbursts may be frequent in children.
E. The negative emotional experience is later recognized as excessive, unrea-
sonable, or disproportionate to the circumstances or the provoking stressor.
F. The individual tends to avoid the misophonic situation, or if he/she does
not avoid it, endures the misophonic stimulus situation with discomfort or
distress.
G. The individual’s emotional and physical experience, avoidance, and eorts
to avoid cause signicant distress or signicant interference in the person’s
life. For example, it is dicult for the person to perform tasks at work, attend
classes, participate in routine activities, or interact with specic individuals.
Although both suggested criteria were based on research results and case studies
of people with misophonia, neither was entirely veried empirically. The criteria
proposed by Dozier undoubtedly indicate a new perspective in misophonia research.
Dozier emphasizes that misophonia should be seen as a multi-sensory phenomenon,
as the trigger stimuli are not necessarily sounds but can also be, for example, another
person’s movement or a vibration. However, because of limited data, these suggestions
should be treated as a hypothesis to verify.
There are currently no published, validated questionnaires for detecting misophonia
based on the proposed criteria. There are, however, some other unvalidated scales and
questionnaires for assessing it.
Schröder’s research group [10] created a scale to measure the intensity of miso-
phonia, the Amsterdam Misophonia Scale (A-MISO-S), which was adapted from the
obsessive-compulsive disorders assessment scale (Yale-Brown Obsessive-Compulsive
Scale – Y-BOCS). It consists of 6 questions related to time taken up by misophonia
during the day, inuence on social functioning, anger intensity, eorts to inhibit the
impulse, control over the anger, as well as thoughts and time spent on avoiding miso-
phonia-related situations. There are 5 levels of misophonia intensity, based on score.
Another questionnaire (Misophonia Questionnaire – MQ) for identifying miso-
phonia and assessing its intensity was created by Wu et al. [14]. It consists of 3 scales:
1) the Misophonia Symptom Scale, which includes sounds made by people, sounds
from one’s surroundings as well as repetitive and once-o sounds;
451
Misophonia – a review of research results and theoretical concepts
2) the Misophonia Emotions and Behaviors Scale;
3) the Misophonia Severity Scale, adapted from a questionnaire that assesses the
intensity of obsessive-compulsive disorder (the National Institute of Mental
Health Global Obsessive-Compulsive Scale NIMH-GOCS).
As in the NIMH-GOCS, the cut-o point for clinical symptoms was dened as
at least 7 points (out of 15) on the MQ. Psychometric analysis showed that the tool
has high internal consistency. The questionnaire has some limitations. The authors as-
sessed its psychometric properties on the research group and the external validity was
correlated with questionnaires that assess general sensory sensitivity (including sound
sensitivity), but not misophonia. However, better assessment of the external validity
was not possible as the study had been performed before the rst paper with criteria
for misophonia was published. Moreover, among the sounds classied as misophonic
were repetitive sounds (repeated many times over a longer period of time), which are
not included in either criteria proposed by Schröder et al. [10] or Dozier et al. [12]
(the misophonic reaction should be immediate, impulsive, and not evoked only if the
sound does not fade). The analysis also included sounds made by things (non-human
sounds), which are still a controversial issue. Additionally, some people with hypera-
cusis might be misclassied as having misophonia.
Misophonic reaction is selective and is not related to hearing impairment [7].
It should be dierentiated from hyperacusis, however, those two condition can exist
together. People with hyperacusis exhibit aversive reactions towards sounds character-
ized by certain physical properties, such as volume or frequencies, and their emotional
responses are consistent, not dependant on social situations. Audiological assessment
shows that these patients usually have a lower loudness discomfort level (LDD) [16].
In misophonia, there is an unnaturally strong, negative emotional reaction to specic
sounds, unique to each individual. The acoustic features of the triggers may vary, but
they tend to be rather soft and low [7]. Therefore misophonia is not an intolerance
of loud sounds or noise. It is critical to assess what kind of sounds are aversive to
the individual and what kind of sounds are tolerated. Importantly, misophonia and
hyperacusis can be present together [2, 7]. Jastrebo and Jastrebo [2] claim that the
emotions which are experienced by individuals when exposed to aversive triggers
are identical in both misophonia and hyperacusis. However, this has not yet been
conrmed empirically.
Since research began on misophonia, one of the main areas of interest has been its
comorbidity with other disorders. In 2013, Schröder et al. [10] suggested that misopho-
nia could be included in the obsessive-compulsive disorder spectrum because of the
characteristic obsessionality, impulsivity and compulsivity associated with misophonia.
Some comorbid disorders were identied among the patients examined by Schröder
– obsessive-compulsive personality (over 50%), mood disorders, Tourette syndrome,
ADHD, trichotillomania, obsessive-compulsive disorder, and hypochondria. One ob-
jection against the data gathered by Schröder is the recruitment of an unrepresentative
group of patients with psychiatric disorders [2]. In 2014, Wu [14] assessed 483 students
Marta Siepsiak, Wojciech Dragan
452
of psychology using the MQ described above, of whom almost 20% showed clinical
symptoms of misophonia. Analysis of the data showed moderate, signicant correla-
tion of the intensity of misophonia with OCD and depression. Interestingly, anxiety
(assessed with the Depression Anxiety Stress Scale-21 – DASS-21) was a mediator
between misophonia (measured with the Misophonia Symptom Scale) and aggressive
outbursts (assessed with the Rage Outbursts and Anger Rating Scale – ROARS) evoked
by exposure to aversive triggers.
A recent study by Rouw and Erfanian [18], on the other hand, did not show
an increased occurrence of any particular disorder among people with misophonia.
Instead, a higher intensity of symptoms of misophonia in people with post-traumatic
stress disorder was found in comparison to people with other disorders. McKay et al.
[19] assessed a non-clinical group with a battery of many tests to measure various
psychological disorders and traits potentially related to misophonia. They found three
distinct proles, of which only one dierentiated between people with and without
misophonia (barely accounting for 11% of the total variance). The prole was related
to lower results on the scales of neutralizing, washing, and general symptoms of OCD
(the Obsessive Compulsive Inventory–Revised was used [20]) as well as higher results
on ordering and harm avoidance scales (the Obsessive-Compulsive Trait Core Dimen-
sions Questionnaire was used [21]). The authors came to the conclusion that in spite of
the previously mentioned relations with OCD, 70% of the variance in the model was
explained by two proles that did not dierentiate between people with and without
misophonia; therefore it is reasonable to claim that misophonia is not unambiguously
bound to any other pathology, but is rather a unique set of symptoms.
It is characteristic for people with misophonia to experience sudden, uncontrol-
lable, strong emotions together with a tendency to avoidance. Therefore, it could be
misdiagnosed with a specic phobia. Nevertheless, the reaction cannot be classied as
a phobia because the dominant emotion in misophonia is anger, rather than fear [10].
The term ‛phonophobia’ describes the condition where one is afraid of certain sounds
[17]. However, this phenomenon is not well documented yet. Symptoms of people with
misophonia may also be similar to symptoms of social phobia. However, the reason
for avoiding other people by people with misophonia is not fear of judgment, but the
desire to protect themselves from the sounds that they make. It is important to take
into account the fact that no particular cognitive issues are reported among people with
misophonia, which dierentiates it from dissociative and somatomorphic disorders.
People with misophonia are aware of the fact that their reactions are exaggerated [10].
Research shows [26] that people with misophonia process aversive sounds dierently
in their neurological connections. Despite the fact that it is not known whether this is
a cause or consequence of misophonia, for the purposes of research we can discuss
it as a neurological correlates of the specic emotional reaction in people with miso-
phonia. However, as already said, it is not unusual for misophonia to be present with
other disorders [10, 14, 19]. It is worth mentioning that the literature also contains
case studies of people with misophonia and eating disorders [22].
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Misophonia – a review of research results and theoretical concepts
The lack of diagnostic criteria for misophonia and validated questionnaires
to detect and measure its intensity makes it dicult to compare the results from
the various research groups and make diagnoses in clinical work. The participants
who took part in published studies were recruited according to dierent theoretical
approaches, and mostly did not go through a full psychiatric and audiological as-
sessment. In many works only the self-report of the symptoms was used, therefore
the conclusions drawn from this data might have limited credibility and the results
cannot be generalized to the whole population of people with a potential diagnosis
of misophonia [23, 24].
Dispute about the nature of the aversive sounds
In the literature, there is disagreement over what kind of sounds should be cate-
gorized as misophonic, a point which can impact the validity of a diagnosis and lead
to dierent diagnoses being made by dierent specialists. Some authors [7, 25] claim
that any sound can be misophonic, regardless of its source – therefore including sounds
made by people, such as eating sounds, breathing, or snoring, and other sounds, for
example, a clock ticking, a toilet ushing, a vacuum cleaner working, a school bell
ringing, a pen tapping, or typing on a keyboard, etc. Other researchers consider only
sounds made by people to be misophonic.
In an experiment conducted by Edelstein et al. [8] that measured skin galvanic
reaction, among other things, the most aversive sounds were found to be those made by
people, e.g., eating and crunching sounds as well as snoring (11 people). Only 2 people
indicated that the sounds they found most aversive were a pen clicking and a clock
ticking. Among the other subjects, the most common (but less unpleasant) aversive
sounds were pen clicking, the sound of steps, typing, the sound of plastic bags, and
repetitive dog barking. For 6 people, the ‛s’ sound was unpleasant.
The results of Kumar’s work [26] also indicate that the strongest negative reactions
are evoked by specic soft sounds made by humans. The analysis showed statistically
signicant dierences in emotional arousal (measured with a galvanometer) and in
heart rate (HR) between the following conditions: sounds of breathing and eating,
a woman screaming and a baby crying, and sounds made by non-humans – raining
and a kettle whistling. The most aversive triggers were the sounds of breathing and
eating. The analysis of functional Magnetic Resonance Imaging (fMRI) data showed
that the sounds of eating and breathing greatly activated the anterior insular cortex,
which is related to emotional regulation and the detection of signals that are important
for the individual from the surroundings.
Describing the characteristics of misophonic sounds seems to be crucial to un-
derstanding the mechanism of misophonia, the data is increasingly showing that
misophonic trigger sounds are very individualized and dependent on personal history
and social context.
Marta Siepsiak, Wojciech Dragan
454
Determinants of misophonia
The mechanisms underlying misophonia are still unknown [27]. That there is
a greater prevalence of decreased sound tolerance among people with genetic disorders
suggests the possibility of it having a genetic basis. In the study of Levitin et al. [28],
including 118 people with Williams syndrome, 90.6% showed increased sensitivity
to certain sounds, of which 14% were aversive towards the sounds made by people
or animals. The same kind of sound intolerance was present in 27% of people with
autism, 7% of people with Down syndrome, and 2% of people in the control group.
The authors, in order to distinguish aversiveness towards particular, selective sounds
from the category of general sensitivity to sounds, created a category that they called
‛auditory allodynia’. It was not named misophonia, maybe because at this time the
term ‛misophonia’ was not yet widely used, and apart from theoretical papers (e.g.,
Jastrebo and Jastrebo [1]), no empirical studies on misophonia existed. The existence
of decreased sound tolerance in the population of people with Williams syndrome is
indicated, for example, by the results of the study conducted by Bloomberg et al. [29].
To date, no genetic analyses concerning decreased sound tolerance have been conducted
on a population of people without additional disorders and illnesses.
Jastrebo and Jastrebo [7] claim that misophonia is related to a dysfunction of
the central auditory pathways. According to these authors, people with misophonia
have enhanced neural connections between the auditory and limbic systems for certain
sounds. The previously mentioned research by Kumar et al. [26], published in 2017,
seems to conrm the theory postulated by Jastrebo and Jastrebo [7]. It showed a dif-
ference in the processing of certain aversive sounds in functional neural connections
between the anterior insular cortex and the regions related to emotional regulation as
well as greater myelination in the prefrontal cortex among people with misophonia.
Earlier, Schröder et al. [30] published a study where they were the rst to show the
neurobiological mechanisms of misophonia. Using the event-related potential (ERP) in
the oddball paradigm, they showed a dierence in N1 mean peak amplitude, a bioelec-
trical brain response related to early processing. People with misophonia had a lower
average mean peak than people from the control group.
Edelstein et al. [8] notice a similarity between misophonia and synesthesia. They
postulate that in the same way that sound can be associated with color, in misophonia,
certain sounds could be associated with a certain emotional reaction. Dozier instead
proposed a theory saying that misophonia is formed by a process of classical condi-
tioning [25], suggesting in the case studies that this reex reaction might have been
created, for example, by a quarrel while eating, or issues with sleeplessness which
were accompanied by a breathing sound. However, this has yet to be demonstrated.
The data on the causes of misophonia are still insucient to determine whether it is
innate or acquired and the role of neurobiological and cognitive factors.
455
Misophonia – a review of research results and theoretical concepts
Social functioning, mental hygiene, and misophonia
According to the current state of knowledge on misophonia, its intensity can
vary from symptoms causing discomfort or irritation with some inuence on social
life to extreme cases where the individual can experience decreased mood or even
have suicidal thoughts [2, 8]. Comments on misophonia-related websites and forums
indicate that misophonia often leads to social isolation, family conicts, absconding
from family meals and interactions with friends, or even separations and divorces.
One of the most frequently mentioned problems on internet forums is the lack of
support among those closest to the person suering from misophonia – their parents
or partner. People with misophonia describe experiencing psychological abuse from
family members – being called ‛mentally ill’, ‛crazy’, accusations of manipulation
and ‘making up’ problems in order to attract attention or to distress other family
members. Some people with misophonia also mention a fear of having children (they
are afraid that their child might make aversive sounds). The experience of miso-
phonia is linked to suering and a signicant decrease in quality of life [8, 10, 12].
It is also known that the phenomenon is not a particularly rare problem [2, 14, 15].
Therefore, it seems that the issue of exploration of misophonia by both researchers
and practitioners is a big challenge for contemporary psychology, psychiatry, audi-
ology, and other disciplines.
Directions for further research
Misophonia has become a more active area of research in recent years. However,
this phenomenon is still little known in the Polish scientic literature. Taylor [31]
prioritizes the analysis of misophonia in the context of other sensory sensitivities, not
only auditory ones. Further exploration of its comorbidity with other disorders seems
to be important as well. Rare reactions to trigger sounds, such as the experience of
warmth, pain, and sexual arousal [12], are another interesting avenue of investigation.
One of the lesser known, but more controversial, aspects are the mechanisms underlying
misophonia. Brout et al. [27] suggest avoiding preliminary classication of misophonia
as a phenomenon dependent on genetics vs. a conditioned one. According to them,
this attitude can have a negative impact on the diagnosis and therapy of misophonia.
It seems important that tools for the diagnosis and measurement of the severity of miso-
phonia be developed and validated. Detailed multidisciplinary diagnoses of research
participants and the use of objective measurement tools (in contrast to self-descriptive
questionnaires) in our opinion is crucial for further research on misophonia. Only this
will allow the comparison of analyses from dierent research groups.
Conclusions
In spite of the lack of ocial diagnostic criteria for misophonia and the conten-
tion around its denition, in light of the discussed research results it is reasonable to
Marta Siepsiak, Wojciech Dragan
456
agree on the existence of a specic, uniform construct. Misophonia is related to many
aspects of functioning – hearing, emotions, physiology, and social functioning. There-
fore, diagnosis of misophonia should involve various specialists such as psychiatrists,
audiologists, and psychologists. Because there is no evidence of the eectiveness of
any therapy for misophonia, apart from limited data from research [9, 32, 33] and
clinical work [2], patients should be informed about the current, not denite state of
knowledge concerning their condition.
The work was carried out within the framework of grant DSM 119300-24/2018, Psychological
and psychophysiological determinants of misophonia
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Marta Siepsiak, Wojciech Dragan
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components to treat misophonia. Journal of Contextual Behavioral Science 2017; 6(2): 221–225.
Address: Marta Siepsiak
Department of Psychology of Individual Dierences
Faculty of Psychology
University of Warsaw
00-183 Warszawa, Stawki Street 5/7
e-mail: marta.siepsiak@gmail.com
... This lack of identification not only prevents health care providers from classifying the disorder officially but also prevents the affected individuals from seeking professional help. In addition, there are still no universally agreed-upon clinical practice guidelines for the management of this situation (Schröder et al., 2013). ...
... The A-MISO-S is a tool used to determine the presence and severity of misophonia and is the instrument from which the revised scale (AMISOS-R) was derived. It was inspired by the Yale-Brown Obsessive-Compulsive Scale (Jager et al., 2020;Schröder et al., 2013), which was originally designed to evaluate the severity of OCD (Naylor et al., 2021;Schröder et al., 2013). The A-MISO-S, which consisted of 6 items, was revised, and the AMISOS-R, which consisted of 10 items, was developed (Daniels et al., Cakiroglu et al. 2020;Jager et al., 2020;Wiese et al., 2021). ...
... The A-MISO-S is a tool used to determine the presence and severity of misophonia and is the instrument from which the revised scale (AMISOS-R) was derived. It was inspired by the Yale-Brown Obsessive-Compulsive Scale (Jager et al., 2020;Schröder et al., 2013), which was originally designed to evaluate the severity of OCD (Naylor et al., 2021;Schröder et al., 2013). The A-MISO-S, which consisted of 6 items, was revised, and the AMISOS-R, which consisted of 10 items, was developed (Daniels et al., Cakiroglu et al. 2020;Jager et al., 2020;Wiese et al., 2021). ...
Article
The Amsterdam Misophonia Scale-Revised (AMISOS-R) is a self-report scale that measures the presence and severity of symptoms experienced in response to specific auditory stimuli. This cross-sectional, descriptive study aims to evaluate psychometric properties of the AMISOS-R in the Turkish language and to examine psychosocial factors associated with misophonia. A total of 374 individuals (female/male: 154/220) between 15 and 45 years of age were included in the study. Confirmatory factor analysis showed that the fit indices were at a good level, and they supported the single-factor structure. Test-retest results and Cronbach's alpha coefficient showed that the scale had high reliability. Misophonia scores were also found to be moderately correlated with obsessive-compulsive disorder and neuroticism. The AMISOS-R was found to be a valid and reliable tool to evaluate misophonia in the Turkish language.
... Misophonia is a complex neurophysiological and behavioral disorder of multifactorial origin and is characterized by an increased physiological and emotional response produced by intolerance to specific auditory stimuli [1][2][3][4][5]. It has also been described as a form of sound intolerance, in which hyper-reactivity and selective aversion to one type of sound are present [6]. Additionally, misophonia has been considered a new mental disorder [7,8]. ...
... Res. Public Health 2022, 19, 6790 2 of 26 their maladaptive and avoidant behaviors interfere with the performance of work or academic tasks and cause significant impairment in their interpersonal relationships [1,6]. In response to exposure to the triggering stimulus, the individual experiences a series of physical and emotional reactions of such intensity that they affect their functionality and well-being (see Figure 1). ...
... so the percentage of affected individuals may be higher [4,[12][13][14], with it being considered an underdiagnosed disorder. Misophonia has a significant impact on the sufferer's life, as their maladaptive and avoidant behaviors interfere with the performance of work or academic tasks and cause significant impairment in their interpersonal relationships [1,6]. In response to exposure to the triggering stimulus, the individual experiences a series of physical and emotional reactions of such intensity that they affect their functionality and well-being (see Figure 1). ...
Article
Full-text available
Misophonia is a scarcely known disorder. This systematic review (1) offers a quantitative and qualitative analysis of the literature since 2001, (2) identifies the most relevant aspects but also controversies, (3) identifies the theoretical and methodological approaches, and (4) highlights the outstanding advances until May 2022 as well as aspects that remain unknown and deserve future research efforts. Misophonia is characterized by strong physiological, emotional, and behavioral reactions to auditory, visual, and/or kinesthetic stimuli of different nature regardless of their physical characteristics. These misophonic responses include anger, general discomfort, disgust, anxiety, and avoidance and escape behaviors, and decrease the quality of life of the people with the disorder and their relatives. There is no consensus on the diagnostic criteria yet. High comorbidity between misophonia and other psychiatric and auditory disorders is reported. Importantly, the confusion with other disorders contributes to its underdiagnosis. In recent years, assessment systems with good psychometric properties have increased considerably, as have treatment proposals. Although misophonia is not yet included in international classification systems, it is an emerging field of growing scientific and clinical interest.
... Since there is no consensus on the definition of misophonia, its true incidence is unclear. However, some authors have claimed that its true prevalence in the society is underestimated (Siepsiak and Dragan, 2019). Jastreboff et al. (2014) reported that 92% of individuals with decreased sound tolerance might suffer from misophonia with an overall incidence of 3% in the general population. ...
... Of note, misophonic reaction is selective and is not associated with hearing impairment . However, individuals with hyperacusis usually exhibit a lower loudness discomfort level based on audiological examinations (Siepsiak et al., 2019). Phonophobia characterized by decreased sound tolerance is also considered a subcategory of misophonia. ...
Article
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Misophonia is defined as a disproportionate emotional response to everyday sounds created by other people and sometimes to animal sounds. It can be severe enough to disrupt people's professional and social functionality. The risk factors and etiology of the disease are not fully known. It can be seen together with some neurodevelopmental diseases and psychiatric disorders. Amsterdam Misophonia Scale and Misophonia Scale are scales developed to evaluate misophonia. Diagnostic criteria have not been fully determined and are not included in the current diagnostic classifications. In its treatment, methods such as cognitive behavioral therapy, mindfullnes, dialectical behavioral therapy and exposure are used, and no specific pharmacological treatment has been defined. Öz Mizofoni, diğer insanların oluşturduğu günlük seslere ve bazen hayvan seslerine orantısız şekilde duygusal tepki vermek olarak tanımlanmaktadır. Kişilerin mesleki ve sosyal işlevselliklerini bozabilecek kadar şiddetli olabilir. Hastalığın risk faktörleri ve etiyolojisi tam olarak bilinmemektedir. Bazı nörogelişimsel hastalıklar ve psikiyatrik bozukluklarla birlikte görülebilmektedir. Amsterdam Mizofoni Ölçeği ve Mizofoni Ölçeği mizofoniyi değerlendirmek için geliştirilmiş ölçeklerdir. Tanı kriteleri tam olarak belirlenmemiştir ve güncel tanı sınıflamalarında yer almamaktadır. Tedavisinde, bilişsel davranışçı terapi, farkındalık (mindfullnes), diyalektik davranış terapisi ve maruz bırakma gibi yöntemler kullanılmakta olup belirli bir farmakolojik tedavi tanımlanmamıştır. Anahtar sözcükler: Mizofoni, azalmış ses toleransı, fenomenoloji, tanı Yılmaz and Hocaoğlu Misophonia Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
... A reação típica, consequência da ativação do sistema nervoso simpático, inclui uma resposta neurofisiológica (taquicardia, sudorese, tensão muscular e dor física) e uma resposta comportamental e emocional (irritação, raiva, nojo) (Potgieter et al., 2019). Sugere-se a classificação como nova condição psiquiátrica e estima-se um maior número de pessoas afetadas em relação aos casos reportados Potgieter et al., 2019;Schröder et al., 2013;Siepsiak et al., 2019;Taylor, 2017). ...
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Livro de ATAS da 1ª Conferência Lusófona de Terapia Ocupacional - 2021. Organizada pelo Núcleo Académico de Terapia Ocupacional da Rede Académica de Ciências da Saúde da Lusofonia
... Once triggered, children and adults with misophonia experience intense distress and have difficulty disengaging from the stimulus (Brout et al., 2018). While triggers may vary from person to person, the typical response involves increased autonomic arousal (muscle tension, increased heart rate, and skin conductance) and self-reported experience of anger, disgust, and anxiety (Siepsiak and Dragan, 2019). This discomfort may translate into behavioral or verbal aggression in the moment, and extreme avoidance behaviors outside of the moment (Swedo et al., 2021). ...
Article
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Decreased tolerance in response to specific every-day sounds (misophonia) is a serious, debilitating disorder that is gaining rapid recognition within the mental health community. Emerging research findings suggest that misophonia may have a unique neural signature. Specifically, when examining responses to misophonic trigger sounds, differences emerge at a physiological and neural level from potentially overlapping psychopathologies. While these findings are preliminary and in need of replication, they support the hypothesis that misophonia is a unique disorder. In this theoretical paper, we begin by reviewing the candidate networks that may be at play in this complex disorder (e.g., regulatory, sensory, and auditory). We then summarize current neuroimaging findings in misophonia and present areas of overlap and divergence from other mental health disorders that are hypothesized to co-occur with misophonia (e.g., obsessive compulsive disorder). Future studies needed to further our understanding of the neuroscience of misophonia will also be discussed. Next, we introduce the potential of neurostimulation as a tool to treat neural dysfunction in misophonia. We describe how neurostimulation research has led to novel interventions in psychiatric disorders, targeting regions that may also be relevant to misophonia. The paper is concluded by presenting several options for how neurostimulation interventions for misophonia could be crafted.
... Die genaue Ätiologie der Misophonie ist derzeit noch nicht ausreichend untersucht (Siepsiak & Dragan, 2019). Jastreboff und Jastreboff gingen zum einen von einer Dysfunktion in den zentralen auditorischen neuronalen Bahnen aus, zum anderen gingen sie von einem konditionierten Reflex aus, im Sinne der klassischen Konditionierung nach Pavlov, bei welcher ein misophonisches Geräusch (konditionierter Reiz) eine konditionierte Reaktion (extreme Emotion und "Fight-Flight"-Reaktion als physiologische Reaktion) auslöst (Jastreboff & Jastreboff, 2014). ...
Article
Full-text available
Zusammenfassung. Die Misophonie beschreibt ein Phänomen, bei welchem betroffene Kinder und Jugendliche eine starke negative physiologische und emotionale Reaktion bei Konfrontation mit speziellen auditiven (misophonischen) Reizen zeigen (am häufigsten Ess- oder Atemgeräusche). Einzelne Studien mit Erwachsenen liefern bereits Prävalenzen zwischen 6 und 20 % in verschiedenen (klinischen) Stichproben, wobei eine Repräsentativität der Stichproben in den meisten Studien nur sehr eingeschränkt gegeben war. Die Erstmanifestation der Symptomatik liegt jedoch bei über 80 % der Fälle im Kindes- und Jugendalter, weshalb diese Altersgruppe besonders betrachtet werden sollte. Hinsichtlich komorbider Störungen zeigt sich auch eine große Heterogenität mit Schätzungen zwischen 28 bis 76 % an komorbiden psychischen Störungen und etwa 25 % mit komorbiden körperlichen Erkrankungen. Die genaue Ätiologie ist derzeit noch nicht ausreichend untersucht. Erste neurophysiologische Erklärungsansätze und Bildgebungsstudien weisen auf eine spezifische physiologische Reaktion bei Misophoniepatient_innen hin. Obwohl mittlerweile eine Vielzahl von Fallberichten vorliegt, Diagnosekriterien und Messinstrumente entwickelt und erste kognitiv-behaviorale Behandlungsansätze evaluiert wurden, stellt die Misophonie weiterhin keine eigenständige neurologische, audiologische oder psychiatrische Störung im DSM-5 oder der ICD-11 dar.
... Diese Kriterien sind nicht unbestritten, weil u. a. das Kriterium "Zorn" nicht immer zuträfe und dies in der Diagnose der Misophonie berücksichtigt werden müsste [41]. Sowohl der Begriff "selektive Geräuschempfindlichkeit" als auch "Misophonie" sind in der Literatur präsent [63], Letzterer ist jedoch gebräuchlicher geworden [61]. ...
Article
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Zusammenfassung Die Misophonie ist eine Intoleranz auf bestimmte Alltagsgeräusche. Hierbei fungieren als „Trigger“ „menschliche Körpergeräusche“, z. B. Schlucken/Schmatzen/Atemgeräusche oder Geräusche, die von Menschen, aber nicht vom menschlichen Körper erzeugt werden (z. B. Klicken Kugelschreiberknopf), ferner Tier‑/Maschinengeräusche. Die Betroffenen verspüren sofort eine negativ-emotionale Reaktion wie Wut, Aggression, Ekel u.a. Objektivierbare Veränderungen sind Herzfrequenzerhöhung und Blutdruckveränderungen. Die emotionale Reaktion ist individuell und hängt z. B. von Geräuschart, persönlicher Vorerfahrung, sozialem Kontext oder psychologischem Profil ab. Die Misophonie ist bisher als Krankheit nicht definiert und keinem offiziellen Diagnosesystem zugeordnet, sie scheint eine eigenständige Störung zu sein: Assoziationen bestehen u. a. mit Aufmerksamkeits‑/Zwangsstörungen, Tinnitus, Hyperakusis, Autismus-Spektrum-Krankheiten. Definitionskriterien wurden 2013 veröffentlicht; verschiedene, validierte Fragebögen wurden bisher zur Misophonieausprägung entwickelt. Studien mit funktionellen MRT-Untersuchungen des Kopfes zeigten eine übermäßige Aktivierung des anterioren Inselkortex (AIC) und seiner benachbarten Regionen, die für Emotionsverarbeitung/-regulation verantwortlich sind. Bisher gibt es keine randomisierten kontrollierten Studien zur Therapie. Einzelne Publikationen beschreiben kognitive Verhaltensinterventionen, Retrainingtherapien und Schallmaskierungssysteme. Zur Triggerreduktion werden Ohrstöpsel/Musikkopfhörer verwendet. Auch HNO-Ärzte können mit Misophoniepatienten konfrontiert werden, z. B. zur Klärung des Hörvermögens oder Beratung von Therapiemöglichkeiten. Der Bericht stellt eine Übersicht des aktuellen Wissensstands zur Misophonie sowie ihrer Diagnostik und Therapie dar.
... As indicated in different works, this syndrome can generate severe daily dysfunction (for example, occupational, interpersonal, academic), resulting in isolation, social, family, and couple conflicts. It can also contribute to the development of behavioral health problems (18), influence social life to extreme cases in which the individual may experience a decrease in mood or even have suicidal thoughts (10,14,18,33)]. New preliminary studies also refer to the need to study misophonia and screen for comorbid psychiatric symptoms (34). In their work, PTSD (15.8%), ...
Article
Full-text available
Forced strict confinement to hamper the COVID-19 pandemic seriously affected people suffering from misophonia (M+) and those living with them. Misophonia is a complex neurophysiological and behavioral disorder of multifactorial origin, characterized by an intense physiological and emotional response produced by intolerance to auditory stimuli of the same pattern, regardless of physical properties. The present work studied the secondary impact that strict confinement caused in 342 adults (224 women: 118 men) regularly attending a medical psychological center in Barcelona. Misophonia, usually underdiagnosed, showed a prevalence of 35%, the same for women (37%) than men (31%). A retrospective analysis using a physical-psychological-social inventory of 10 variables evaluated the number of individuals that during confinement and self-confinement (March 11 - June 29, 2020) canceled (mostly M-) and/or requested a therapeutic intervention, the reasons for their request, and the strategies they used to self-manage the situation. Ten main variables indicated that the confinement exponentially increased the effects of misophonia compared with results from the same individuals during the last quarter of 2019. Most people diagnosed with misophonia continued with tele-assistance during the confinement because of this impact's self-concern. Besides the impacts as part of the general population, M+ also developed different symptoms causing significant personal, social, and job/occupational imbalance, as compared to M-. Health, fears, conflicts with neighbors, study-related difficulties were outstanding reasons for consultations. The LSB-50 test for ‘Psychological and Psychosomatic Symptoms’ applied to M+ revealed the increase of 8 of 9 items of this psychopathological test. Sleep disorders (coronasomnia), hostility, depression, and somatization were more severe than in previous assessments. Women presented the worst psychological and psychosomatic states (eight out of nine, as compared to one out of nine in males). The study unveiled the complex physical-psychological-social burden, the need for dissemination and a gender perspective to understand the secondary impact of COVID-19 pandemic on the mental health of the population with misophonia. The results also show that in this new COVID era people suffering from misophonia need to develop coping strategies addressing modifiable risk and protective factors. They deserve familial/social comprehension, stronger clinical support and a gender medicine perspective.
Article
Misophonia is a complex syndrome in which selective auditory stimuli, such as sounds of breathing, sniffing or eating, trigger an intense, negative emotional response. Previous studies have shown that the symptoms of misophonia coexist with a number of mental disorders, such as OCD, depression and anxiety. However, still little is known about other mental states that may be present in this context. A total of 312 people from the non-clinical sample participated in an online correlational study, which aimed at investigating whether there is a significant association between misophonia symptoms and paranoia-like thoughts, as well as to examine what factors might underlie this potential relationship. The results revealed that misophonia positively correlates with paranoia-like thoughts. A serial mediation analysis showed that difficulties in regulating emotions, anxiety and hostile attributions are significant mediators in the relationship between misophonia and paranoia-like thoughts. Importantly, these mediators, above all, form a potential coherent explanatory mechanism underlying this association. Hence, our results highlight the important role of socio-cognitive factors in the conceptualization of misophonia and its relation to paranoia-like thoughts.
Article
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Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.
Article
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Misophonia is an underinvestigated condition often typified as an extreme sensitivity to specific, low volume sounds and images that elicit an intense physiological and emotional response. Diagnostic criteria was proposed in 2013 by Schroder et al. specifying misophonia as a distinct auditory/psychiatric disorder. Subsequent research identifies several areas of clarification of misophonia which should be incorporated. These include trigger stimuli of all sensory modalities, stimuli from any source, exclusion of anger responses to unconditioned stimuli, dysregulation of thoughts and emotions, and the inclusion of an immediate physical conditioned reflex.
Article
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Misophonia is characterized by extreme aversive reactions to certain classes of sounds. It has recently been recognized as a condition associated with significant disability. Research has begun to evaluate psychopathological correlates of misophonia. This study sought to identify profiles of psychopathology that characterize misophonia in a large community sample. A total of N = 628 adult participants completed a battery of measures assessing anxiety and anxiety sensitivity, depression, stress responses, anger, dissociative experiences, obsessive-compulsive symptoms and beliefs, distress tolerance, bodily perceptions, as well as misophonia severity. Profile Analysis via Multidimensional Scaling (PAMS) was employed to evaluate profiles associated with elevated misophonia and those without symptoms. Three profiles were extracted. The first two accounted for 70% total variance and did not show distinctions between groups. The third profile accounted for eleven percent total variance, and showed that misophonia is associated with lower obsessive compulsive symptoms for neutralizing, obsessions generally, and washing compared to those not endorsing misophonia, and higher levels of obsessive-compulsive symptoms associated with ordering and harm avoidance. This third profile extracted also showed significant differences between those with and without misophonia on the scale assessing physical concerns (that is, sensitivity to interoceptive sensations) as assessed with the ASI-3. Further research is called for involving diagnostic interviewing and experimental methods to clarify these putative mechanisms associated with misophonia.
Article
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Misophonia is an affective sound-processing disorder characterized by the experience of strong negative emotions (anger and anxiety) in response to everyday sounds, such as those generated by other people eating, drinking, chewing, and breathing [1–8]. The commonplace nature of these sounds (often referred to as “trigger sounds”) makes misophonia a devastating disorder for sufferers and their families, and yet nothing is known about the underlying mechanism. Using functional and structural MRI coupled with physiological measurements, we demonstrate that misophonic subjects show specific trigger-sound-related responses in brain and body. Specifically, fMRI showed that in misophonic subjects, trigger sounds elicit greatly exaggerated blood-oxygen-level-dependent (BOLD) responses in the anterior insular cortex (AIC), a core hub of the “salience network” that is critical for perception of interoceptive signals and emotion processing. Trigger sounds in misophonics were associated with abnormal functional connectivity between AIC and a network of regions responsible for the processing and regulation of emotions, including ventromedial prefrontal cortex (vmPFC), posteromedial cortex (PMC), hippocampus, and amygdala. Trigger sounds elicited heightened heart rate (HR) and galvanic skin response (GSR) in misophonic subjects, which were mediated by AIC activity. Questionnaire analysis showed that misophonic subjects perceived their bodies differently: they scored higher on interoceptive sensibility than controls, consistent with abnormal functioning of AIC. Finally, brain structural measurements implied greater myelination within vmPFC in misophonic individuals. Overall, our results show that misophonia is a disorder in which abnormal salience is attributed to particular sounds based on the abnormal activation and functional connectivity of AIC.
Article
Individuals with misophonia present with sensitivity to selective sounds and, may experience negative psychological and physiological reactions when exposed to triggers. Previous studies have examined the clinical correlates and phenomenology of misophonia; however, further research is warranted to extend findings beyond samples from Western cultures. Accordingly, this study investigated the incidence and phenomenology of misophonia in a sample of Chinese college students (N = 415; M age = 19.81; SD = 1.16) through the use of self-report measures. Approximately 6% of the sample exhibited clinically significant misophonia symptoms with associated impairment. In addition, misophonia symptoms were associated with impairment across work, school, social, and family domains. Medium to strong relationships were observed with general sensory sensitivities, obsessive-compulsive, anxiety, and depressive symptoms. Anxiety significantly mediated the relationship between misophonia and anger outbursts. This study indicates that symptoms of misophonia are common and directly associated with multiple domains of psychopathology.
Article
Misophonia, a phenomenon first described in the audiology literature, is characterized by intense emotional reactions (e.g., anger, rage, anxiety, disgust) in response to highly specific sounds, particularly sounds of human origin such as oral or nasal noises made by other people (e.g., chewing, sniffing, slurping, lip smacking). Misophonia is not listed in any of the contemporary psychiatric classification systems. Some investigators have argued that misophonia should be regarded as a new mental disorder, falling within the spectrum of obsessive-compulsive related disorders. Other researchers have disputed this claim. The purpose of this article is to critically examine the proposition that misophonia should be classified as a new mental disorder. The clinical and research literature on misophonia was examined and considered in the context of the broader literature on what constitutes a mental disorder. There have been growing concerns that diagnostic systems such as DSM-5 tend to over-pathologize ordinary quirks and eccentricities. Accordingly, solid evidence is required for proposing a new psychiatric disorder. The available evidence suggests that (a) misophonia meets many of the general criteria for a mental disorder and has some evidence of clinical utility as a diagnostic construct, but (b) the nature and boundaries of the syndrome are unclear; for example, in some cases misophonia might be simply one feature of a broader pattern of sensory intolerance, and (c) considerably more research is required, particularly work concerning diagnostic validity, before misophonia, defined as either as a disorder or as a key feature of some broader syndrome of sensory intolerance, should be considered as a diagnostic construct in the psychiatric nomenclature. A research roadmap is proposed for the systematic evaluation as to whether misophonia should be considered for future editions of DSM or ICD.
Article
Background: Misophonia is a psychiatric disorder in which ordinary human sounds like smacking or chewing provoke intense anger and disgust. Despite the high burden of this condition, to date there is no evidence-based treatment available. In this study we evaluated the efficacy of cognitive behavioral therapy (CBT) and investigated whether clinical or demographic characteristics predicted treatment response. Methods: Ninety patients with misophonia received eight bi-weekly group CBT sessions. Treatment response was defined as a Clinical Global Impression - Improvement Scale (CGI-I) score at endpoint of 1 or 2 (very much or much improved) and a 30% or greater reduction on the Amsterdam Misophonia Scale (A-MISO-S), a measure of the severity of misophonia symptoms. Results: Following treatment 48% (N=42) of the patients showed a significant reduction of misophonia symptoms. Severity of misophonia and the presence of disgust were positive predictors of treatment response. Limitations: The A-MISO-S is not a validated scale. Furthermore, this was an open-label study with a waiting list control condition. Conclusions: This is the first treatment study for misophonia. Our results suggest that CBT is effective in half of the patients.
Article
Misophonia is an important, yet understudied, psychological condition characterized by feelings of extreme anger and disgust in response to specific human-generated sounds. Several promising case studies using cognitive behavioral therapy to treat misophonia have been published, but given the limited work to date, exploring additional treatment options and expanding the potential options available to clients and clinicians remains important. In order to target the high levels of anger and disgust, we treated a case of misophonia in a 17-year-old male using 10 (50-minute) individual sessions based on mindfulness- and acceptance-based components drawn from dialectical behavior therapy and acceptance and commitment therapy. In particular, we focused on acceptance, mindfulness, opposite action, and nonjudgmentalness strategies. At 6-month follow-up, the client reported no significant difficulties and a continued decline in symptoms. Theoretical rationale and treatment implications are discussed.