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What sound sources trigger misophonia? Not just chewing and breathing

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Abstract

Objectives Misophonia is a highly prevalent yet understudied condition characterized by aversion toward particular environmental sounds. Oral/nasal sounds (e.g., chewing, breathing) have been the focus of research, but variable experiences warrant an objective investigation. Experiment 1 asked whether human-produced oral/nasal sounds were more aversive than human-produced nonoral/nasal sounds and non-human/nature sounds. Experiment 2 additionally asked whether machine-learning algorithms could predict the presence and severity of misophonia. Method Sounds were presented to individuals with misophonia (Exp.1: N = 48, Exp.2: N = 45) and members of the general population (Exp.1: N = 39, Exp.2: N = 61). Aversiveness ratings to each sound were self-reported. Results Sounds from all three source categories—not just oral/nasal sounds—were rated as significantly more aversive to individuals with misophonia than controls. Further, modeling all sources classified misophonia with 89% accuracy and significantly predicted misophonia severity (r = 0.75). Conclusions Misophonia should be conceptualized as more than an aversion to oral/nasal sounds, which has implications for future diagnostics and experimental consistency moving forward.

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... Considering that the sounds share similar acoustic properties regardless of who or what produces them, it is likely that a person's appraisal of a sound and context around it affect whether a misophonic reaction is produced or not. This involvement of top-down processes has been hinted at by self-reports and case studies, and briefly mentioned in Hansen et al. (2021), however it has yet to be supported by behavioral assessments. ...
... The difference in ratings observed between groups, on trials where the sounds could be identified, thus relates to a higher-level evaluation of the sounds, which is evidence for our third hypothesis. These observations about the involvement of top-down processes are in line with recent findings by Hansen et al. (2021) who showed, using selfreport data, that knowledge of the sound identity contributes to the discomfort experienced by people with misophonia. Using a similar design (participants identified sounds and provided aversiveness ratings), they showed that participants who correctly identified oral-nasal sounds rated them as more unpleasant and evoking more discomfort than those who could not identify them. ...
... As regards our experimental design, we chose to use an existing set of stimuli that focuses on orofacial trigger sounds and was used in previous research (Kumar et al., 2017(Kumar et al., , 2021. Misophonic trigger sounds are not all orofacially generated (the importance of other sources is highlighted in Hansen et al., 2021), although most people with misophonia do have at least one orofacially generated trigger sound (Jager et al., 2020). While a reasonable starting point for fundamental research, an exclusive focus on orofacial sounds across studies could lead to an incomplete mechanistic understanding of misophonia. ...
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Individuals with misophonia, a disorder involving extreme sound sensitivity, report significant anger, disgust, and anxiety in response to select but usually common sounds. While estimates of prevalence within certain populations such as college students have approached 20%, it is currently unknown what percentage of people experience misophonic responses to such “trigger” sounds. Furthermore, there is little understanding of the fundamental processes involved. In this study, we aimed to characterize the distribution of misophonic symptoms in a general population, as well as clarify whether the aversive emotional responses to trigger sounds are partly caused by acoustic salience of the sound itself, or by recognition of the sound. Using multi-talker babble as masking noise to decrease participants' ability to identify sounds, we assessed how identification of common trigger sounds related to subjective emotional responses in 300 adults who participated in an online study. Participants were asked to listen to and identify neutral, unpleasant and trigger sounds embedded in different levels of the masking noise (signal-to-noise ratios: −30, −20, −10, 0, +10 dB), and then to evaluate their subjective judgment of the sounds (pleasantness) and emotional reactions to them (anxiety, anger, and disgust). Using participants' scores on a scale quantifying misophonia sensitivity, we selected the top and bottom 20% scorers from the distribution to form a Most-Misophonic subgroup ( N = 66) and Least-Misophonic subgroup ( N = 68). Both groups were better at identifying triggers than unpleasant sounds, which themselves were identified better than neutral sounds. Both groups also recognized the aversiveness of the unpleasant and trigger sounds, yet for the Most-Misophonic group, there was a greater increase in subjective ratings of negative emotions once the sounds became identifiable, especially for trigger sounds. These results highlight the heightened salience of trigger sounds, but furthermore suggest that learning and higher-order evaluation of sounds play an important role in misophonia.
... Schröder et al. (2019), Eijsker et al. (2021a,b) used in-house diagnostic criteria to assess their participants, which requires that human-produced oral/nasal sounds be a trigger to be diagnosed (Schröder et al., 2013;Jager et al., 2020). However, it is clear from both anecdotal self-reports and clinical interviews (e.g., Hadjipavlou et al., 2008;Edelstein et al., 2013;Ferreira et al., 2013;Johnson et al., 2013;Neal and Cavanna, 2013;Jastreboff and Jastreboff, 2014;Webber et al., 2014) as well as large-scale sound bank experiments employing machine learning (Hansen et al., 2021) and a consensus based on metaanalysis (Swedo et al., 2021) that individuals with misophonia are bothered by more than just oral/nasal sounds; restricting the condition to study just those triggers is likely to miss important findings. ...
... If misophonia was a condition of aversion to solely (or primarily) oral/nasal triggering stimuli, there would not have been any reason to see systematic differences in connectivity between insula and finger regions. However, neural differences to finger regions seem plausible, given the plethora of non-oral/nasal misophonia triggers that are made using the fingers, either alone (e.g., finger-tapping; Cavanna and Seri, 2015;Claiborn et al., 2020) or with an object (e.g., typing on a keyboard, clicking a pen, clicking a mouse, etc.; Edelstein et al., 2013;Hansen et al., 2021). Moreover, prior work using magnetoencephalography (MEG) has shown similar neural representations in human primary motor cortex when participants tap a drum with their finger as when they observe or hear the drum being tapped (Caetano et al., 2007), demonstrating an involvement of finger motor cortex in finger-related sounds. ...
... Regardless, the present results have important implications for the study of misophonia moving forward. As we have previously argued, misophonia ought to be conceptualized as more than just an aversion to oral/nasal sounds (Hansen et al., 2021). Neural evidence provided here of abnormal connectivity to functionally defined finger regions underlines this point. ...
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Misophonia, an extreme aversion to certain environmental sounds, is a highly prevalent yet understudied condition plaguing roughly 20% of the general population. Although neuroimaging research on misophonia is scant, recent work showing higher resting-state functional connectivity (rs-fMRI) between auditory cortex and orofacial motor cortex in misophonia vs. controls has led researchers to speculate that misophonia is caused by orofacial mirror neurons. Since orofacial motor cortex was defined using rs-fMRI, we attempted to theoretically replicate these findings using orofacial cortex defined by task-based fMRI instead. Further, given our recent work showing that a wide variety of sounds can be triggering (i.e., not just oral/nasal sounds), we investigated whether there is any neural evidence for misophonic aversion to non-orofacial stimuli. Sampling 19 adults with varying misophonia from the community, we collected resting state data and an fMRI task involving phoneme articulation and finger-tapping. We first defined “orofacial” cortex in each participant using rs-fMRI as done previously, producing what we call resting-state regions of interest (rsROIs). Additionally, we functionally defined regions (fROIs) representing “orofacial” or “finger” cortex using phoneme or finger-tapping activation from the fMRI task, respectively. To investigate the motor specificity of connectivity differences, we subdivided the rsROIs and fROIs into separate sensorimotor areas based on their overlap with two common atlases. We then calculated rs-fMRI between each rsROI/fROI and a priori non-sensorimotor ROIs. We found increased connectivity in mild misophonia between rsROIs and both auditory cortex and insula, theoretically replicating previous results, with differences extending across multiple sensorimotor regions. However, the orofacial task-based fROIs did not show this pattern, suggesting the “orofacial” cortex described previously was not capturing true orofacial cortex; in fact, using task-based fMRI evidence, we find no selectivity to orofacial action in these previously described “orofacial” regions. Instead, we observed higher connectivity between finger fROIs and insula in mild misophonia, demonstrating neural evidence for non-orofacial triggers. These results provide support for a neural representation of misophonia beyond merely an orofacial/motor origin, leading to important implications for the conceptualization and treatment of misophonia.
... Most studies assessing misophonia utilized questionnaires to informally diagnose misophonia, with only three known studies performing full medical and psychiatric evaluation of participants (Schroder et al., 2013;Erfanian et al., 2019;Jager et al., 2020). More recent studies investigating misophonia and sound hypersensitivity have also used psychoacoustic methods, providing a quick and reliable means of assessing misophonia (Dozier and Morrison, 2017;Enzler et al., 2021;Hansen et al., 2021). However, limited studies have explored variability in the clinical presentation of misophonia (Cassiello-Robbins et al., 2021;Hansen et al., 2021). ...
... More recent studies investigating misophonia and sound hypersensitivity have also used psychoacoustic methods, providing a quick and reliable means of assessing misophonia (Dozier and Morrison, 2017;Enzler et al., 2021;Hansen et al., 2021). However, limited studies have explored variability in the clinical presentation of misophonia (Cassiello-Robbins et al., 2021;Hansen et al., 2021). Like some of the overlapping neurodevelopmental and neuropsychiatric disorders, misophonia may actually reflect a syndrome, in which any given symptom may be present or absent, but the constellation of symptoms produces the diagnosis. ...
... S-Five trigger endorsement results supported MQ trigger subscale findings with increased reports of reduced tolerance for sounds related to eating. Though aversion to oral/nasal sounds is common, the frequency with which participants endorsed triggers unrelated to oral/nasal sounds is consistent with objective reports that individuals with misophonia find human non-oral/throat and non-human/nature sounds to be more aversive compared to individuals who do not have misophonia (Hansen et al., 2021). ...
Article
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Misophonia is a condition characterized by hypersensitivity and strong emotional reactivity to specific auditory stimuli. Misophonia clinical presentations are relatively complex and reflect individualized experiences across clinical populations. Like some overlapping neurodevelopmental and neuropsychiatric disorders, misophonia is potentially syndromic where symptom patterns rather than any one symptom contribute to diagnosis. The current study conducted an exploratory k-means cluster analysis to evaluate symptom presentation in a non-clinical sample of young adult undergraduate students (N = 343). Individuals participated in a self-report spectrum characteristics survey indexing misophonia, tinnitus severity, sensory hypersensitivity, and social and psychiatric symptoms. Results supported a three-cluster solution that split participants on symptom presentation: cluster 1 presented with more severe misophonia symptoms but few overlapping formally diagnosed psychiatric co-occurring conditions; cluster 3 was characterized by a more nuanced clinical presentation of misophonia with broad-band sensory hypersensitivities, tinnitus, and increased incidence of social processing and psychiatric symptoms, and cluster 2 was relatively unaffected by misophonia or other sensitivities. Clustering results illustrate the spectrum characteristics of misophonia where symptom patterns range from more "pure" form misophonia to presentations that involve more broad-range sensory-related and psychiatric symptoms. Subgroups of individuals with misophonia may characterize differential neuropsychiatric risk patterns and stem from potentially different causative factors, highlighting the importance of exploring misophonia as a multidimensional condition of complex etiology.
... Misophonia is best characterised by a disproportionate emotional response occurring in association with a decreased tolerance for certain sounds [1][2][3][4][5][6]. The auditory "triggers" most reported are oral sounds, such as the sound of others eating [2,7,8], nasal/breathing sounds [7,8] and repetitive sounds including repetitive tapping or rustling sounds made by humans (e.g., finger tapping) or machines (e.g., clock ticking) [2,9]. ...
... One large study found that all participants reported an emotional reaction to at least one sound of oral or nasal origin, and the researchers proposed that a reaction to one of these types of sounds should be required in order to diagnose the condition [7]. Another study [9] employing machinelearning algorithms, found that those with misophonia rated all three sound categories (oral/nasal, human-produced non-oral/nasal and non-human/nature sounds) as more aversive than controls did, and that both the misophonic and control groups rated the oral/nasal sounds as causing more discomfort than the other two types of sounds (i.e., human-produced non-oral/nasal sounds and non-human/nature sounds). They reported that the inclusion of all three types of sounds improved predictions of severity and classification of misophonia and proposed that misophonia research should not be confined to using only human-produced oral and nasal sounds. ...
... The present study adds to previous work by identifying categories of sounds, demonstrating that the presence of a particular trigger may increase the probability of endorsing another trigger of a similar kind. It was interesting to note that eating sounds formed a factor distinct from nose/throat sounds, while previous research has combined these into a single oral/nasal category [9]. Human-produced repetitive sounds (not related to eating or nose/throat, e.g., footsteps) clustered together with non-human repetitive sounds (e.g., clock ticking), where these had previously been grouped separately [9]. ...
Article
Misophonia is characterised by a low tolerance for day-to-day sounds, causing intense negative affect. This study conducts an in-depth investigation of 35 misophonia triggers. A sample of 613 individuals who identify as experiencing misophonia and 202 individuals from the general population completed self-report measures. Using contemporary psychometric methods, we studied the triggers in terms of internal consistency, stability in time, precision, severity, discrimination ability, and information. Three dimensions of sensitivity were identified, namely, to eating sounds, to nose/throat sounds, and to general environmental sounds. The most informative and discriminative triggers belonged to the eating sounds. Participants identifying with having misophonia had also significantly increased odds to endorse eating sounds as auditory triggers than others. This study highlights the central role of eating sounds in this phenomenon and finds that different triggers are endorsed by those with more severe sound sensitivities than those with low sensitivity.
... Hyperacusis and misophonia have distinct profiles from one another (Jastreboff and Jastreboff, 2015). In hyperacusis, patients' negative reactions are dependent on the physical characteristics of the sound (e.g., spectrum and intensity/loudness) (for reviews, see Baguley and Hoare, 2018;Potgieter et al., 2020), whereas in misophonia, patients' negative reactions are dependent on the meaning and context for the individual and typically to specific sound categories (Jastreboff and Jastreboff, 2002Hansen et al., 2021). ...
... Misophonic triggers are often human-produced (e.g., eating or breathing sounds) (Schröder et al., 2013), and although many studies report a predominance of human-made triggers, there are both case studies and empirical research of misophonic reactions to a variety of other sounds, such as keyboard or pen tapping, clinking glasses, clock ticking, refrigerator sounds, etc. (Edelstein et al., 2013;Schröder et al., 2013;Jastreboff and Jastreboff, 2014;Taylor, 2017). Although both human-made and non-human-made sounds have been identified as misophonic triggers (Dozier et al., 2017;Hansen et al., 2021), most people with misophonia report at least some human-made triggers, and Jager et al. (2020) argue that misophonia should not be diagnosed for individuals who report exclusively non-human generated triggers. ...
Article
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Misophonia can be characterized both as a condition and as a negative affective experience. Misophonia is described as feeling irritation or disgust in response to hearing certain sounds, such as eating, drinking, gulping, and breathing. Although the earliest misophonic experiences are often described as occurring during childhood, relatively little is known about the developmental pathways that lead to individual variation in these experiences. This literature review discusses evidence of misophonic reactions during childhood and explores the possibility that early heightened sensitivities to both positive and negative sounds, such as to music, might indicate a vulnerability for misophonia and misophonic reactions. We will review when misophonia may develop, how it is distinguished from other auditory conditions (e.g., hyperacusis, phonophobia, or tinnitus), and how it relates to developmental disorders (e.g., autism spectrum disorder or Williams syndrome). Finally, we explore the possibility that children with heightened musicality could be more likely to experience misophonic reactions and develop misophonia.
... Given the function of the PMv, this pattern of results may also suggest over-preparedness for the reactions of others and higher importance given to the motor movements involved in trigger sounds versus other sensory inputs. This hypothesized mechanism doesn't explain why some trigger sounds, like clicking, elicit misophonic reactions (Hansen et al., 2021), but it offers a comprehensive explanation for neuroimaging findings presented in the literature thus far. A possibility exists that different subtypes of misophonia may exist, or that different mechanisms through which the misophonic reaction is triggered may be at play. ...
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.
... More specifically, common trigger sounds typically arise from everyday events which makes it particularly difficult to avoid triggers. Misophonia trigger sounds are often noises made by the body of another person, especially nasal and oral sounds, like slurping and chewing, and/or repetitive noises, such as keyboard typing or pencil tapping, but they are not confined to those categories (Enzler et al., 2021;Hansen et al., 2021). The person or context producing the sounds can affect the trigger's potency. ...
Article
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This study examines the role of source identification in the emotional response to everyday sounds. Although it is widely acknowledged that sound identification modulates the unpleasantness of sounds, this assumption is based on sparse evidence on a select few sounds. We gathered more robust evidence by having listeners judge the causal properties of sounds, such as actions, materials, and causal agents. Participants also identified and rated the pleasantness of the sounds. We included sounds from a variety of emotional categories, such as Neutral, Misophonic, Unpleasant, and Pleasant. The Misophonic category consists of everyday sounds that are uniquely distressing to a subset of listeners who suffer from Misophonia. Sounds from different emotional categories were paired together based on similar causal properties. This enabled us to test the prediction that a sound’s pleasantness should increase or decrease if it is misheard as being in a more or less pleasant emotional category, respectively. Furthermore, we were able to induce more misidentifications by imposing spectral degradation in the form of envelope vocoding. Several instances of misidentification were obtained, all of which showed pleasantness changes that agreed with our predictions.
... These sounds are known as "triggers, " and they are usually man or animal-made sounds, and often orofacial sounds (generated by the mouth and nose), such as sniffing and chewing. In addition, there is evidence to suggest that, regardless of the source of the triggers, they share similar properties, including repetition (Brout et al., 2018;Erfanian et al., 2019;Enzler et al., 2021b;Hansen et al., 2021). People with misophonia may also be intolerant of certain visual and tactile stimuli (Kumar et al., 2017(Kumar et al., , 2021Rouw and Erfanian, 2018;Schroder et al., 2019;Eijsker et al., 2021b). ...
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This paper evaluates the proportion and the audiological and other characteristics of patients with symptoms of misophonia among a population seeking help for tinnitus and/or hyperacusis at an audiology clinic (n = 257). To assess such symptoms, patients were asked “over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling angry or anxious when hearing certain sounds related to eating noises, lip-smacking, sniffling, breathing, clicking sounds, tapping?”. The results of routine audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Measures included: pure tone audiometry, uncomfortable loudness levels (ULLs), and responses to the tinnitus impact questionnaire (TIQ), the hyperacusis impact questionnaire (HIQ), and the screening for anxiety and depression in tinnitus (SAD-T) questionnaire. The mean age of the patients was 53 years (SD = 16) (age range 17 to 97 years). Fifty four percent were female. Twenty-three percent of patients were classified as having misophonia. The presence and frequency of reporting misophonia symptoms were not related to audiometric thresholds, except that a steeply sloping audiogram reduced the likelihood of frequent misophonia symptoms. Those with more frequent misophonia symptoms had lower values of ULLmin (the across-frequency average of ULLs for the ear with lower average ULLs) than those with less frequent or no reported symptoms. The reported frequency of experiencing misophonia symptoms increased with increasing impact of tinnitus (TIQ score ≥9), increasing impact of hyperacusis (HIQ score >11), and symptoms of anxiety and depression (SAD-T score ≥4). It is concluded that, when assessing individuals with tinnitus and hyperacusis, it is important to screen for misophonia, particularly when ULLmin is abnormally low or the TIQ, HIQ or SAD-T score is high. This will help clinicians to distinguish patients with misophonia, guiding the choice of therapeutic strategies.
... Misophonia is a relatively new and still little investigated clinical syndrome that is characterized by severe affective, physiological, and behavioral symptoms triggered by the perception or anticipation of specific, typically human-induced sounds, for instance people eating or drinking noisily [1][2][3]. Individuals with misophonia suffer from a decreased tolerance towards ordinary, innocuous sounds rather than sounds that are typically perceived as disturbing (e.g., microphone feedback [4]) [5]. Typical misophonic reactions to specific sounds include intense irritation, anger, distress, disgust, and anxiety [1,[6][7][8]. ...
Article
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Misophonia is a clinical syndrome which is characterized by intense emotional and physical reactions to idiosyncratic sounds. However, its psychometric measurement is still in the early stages. This study describes the optimization of a self-report instrument, the Berlin Misophonia Questionnaire (BMQ), and addresses its strengths in comparison to existing psychometric measures. This new measure integrates contemporary empirical findings and is based on the latest criteria of misophonia. A cross-sectional online study was conducted using data of 952 affected as well as non-affected individuals. The final BMQ-R consists of 77 items in 21 scales, which were selected using a probabilistic item selection algorithm (Ant Colony Optimization). The results of confirmatory factor analyses, the assessment of reliability, and an extensive construct validation procedure supported the reliability and validity of the developed scales. One outstanding strength of the BMQ-R is its comprehensive measurement of misophonic emotional and physical responses. The instrument further allows for distinguishing between behavioral, cognitive, and emotional dysregulation; the measurement of clinical insight and significance; as well as discerning reactive and anticipating avoidance strategies. Our work offers several improvements to the measurement of misophonia by providing a reliable and valid multidimensional diagnostical instrument. In line with the scientific consensus on defining misophonia, the BMQ-R allows to formally recognize individuals with misophonia and so to compare findings of future studies. Undoubtedly , this measure fills a research gap, which we hope will facilitate the investigation of causes and treatment of misophonia.
... Initially, it was proposed that the patient's discomfort was elicited by the presence or anticipation of a specific sound produced by a person [20]. However, years later, it was found that the triggering sounds did not always come from human activities but were everyday sounds [6] influenced by the context and individual characteristics of the patient [26,27] as well as sounds emitted by animals or objects [2,5,28,29]. ...
Article
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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.
... For example, if autistic hyper-sensitivities reflect stimulus discomfort rather than altered psychophysical thresholds, measures of stimulus discomfort, such as Loudness Discomfort Levels (see Khalfa et al., 2004), might yield more robust group differences than measures of stimulus detection and discrimination. These sorts of group differences might be most naturalistically valid if everyday, real-world sounds are included in task batteries (as in, e.g., Enzler et al., 2021a,b;Hansen et al., 2021). To further enhance naturalistic validity, paradigms could include distracting, taskirrelevant stimuli (e.g., Karhson and Golob, 2016;Keehn et al., 2016;Blomberg et al., 2021). ...
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Background Reconciling results obtained using different types of sensory measures is a challenge for autism sensory research. The present study used questionnaire, psychophysical, and neurophysiological measures to characterize autistic sensory processing in different measurement modalities.Methods Participants were 46 autistic and 21 typically developing 11- to 14-year-olds. Participants and their caregivers completed questionnaires regarding sensory experiences and behaviors. Auditory and somatosensory event-related potentials (ERPs) were recorded as part of a multisensory ERP task. Auditory detection, tactile static detection, and tactile spatial resolution psychophysical thresholds were measured.ResultsSensory questionnaires strongly differentiated between autistic and typically developing individuals, while little evidence of group differences was observed in psychophysical thresholds. Crucially, the different types of measures (neurophysiological, psychophysical, questionnaire) appeared to be largely independent of one another. However, we unexpectedly found autistic participants with larger auditory Tb ERP amplitudes had reduced hearing acuity, even though all participants had hearing acuity in the non-clinical range.LimitationsThe autistic and typically developing groups were not matched on cognitive ability, although this limitation does not affect our main analyses regarding convergence of measures within autism.Conclusion Overall, based on these results, measures in different sensory modalities appear to capture distinct aspects of sensory processing in autism, with relatively limited convergence between questionnaires and laboratory-based tasks. Generally, this might reflect the reality that laboratory tasks are often carried out in controlled environments without background stimuli to compete for attention, a context which may not closely resemble the busier and more complex environments in which autistic people’s atypical sensory experiences commonly occur. Sensory questionnaires and more naturalistic laboratory tasks may be better suited to explore autistic people’s real-world sensory challenges. Further research is needed to replicate and investigate the drivers of the unexpected association we observed between auditory Tb ERP amplitudes and hearing acuity, which could represent an important confound for ERP researchers to consider in their studies.
Article
Purpose For some people, exposure to everyday sounds presents a significant problem. The purpose of this tutorial was to define and differentiate between the various sound tolerance conditions and to review some options for their clinical management. Method We informally reviewed the literature regarding sound tolerance conditions. The terminology and definitions provided are mostly consistent with how these terms are defined. However, many inconsistencies are noted. Methods of assessment and treatment also differ, and different methodologies are briefly described. Results Hyperacusis describes physical discomfort or pain when any sound reaches a certain level of loudness that would be tolerable for most people. Misophonia refers to intense emotional reactions to certain sounds (often body sounds such as chewing and sniffing) that are not influenced by the perceived loudness of those sounds. Noise sensitivity refers to increased reactivity to sounds that may include general discomfort (annoyance or feeling overwhelmed) due to a perceived noisy environment, regardless of its loudness. Phonophobia, as addressed in the audiology profession, describes anticipatory fear of sound. Phonophobia is an emotional response such as anxiety and avoidance of sound due to the “fear” that sound(s) may occur that will cause a comorbid condition to get worse (e.g., tinnitus) or the sound itself will result in discomfort or pain. (Note that phonophobia is a term used by neurologists to describe “migraineur phonophobia”—a different condition not addressed herein.) Conclusions The literature addresses sound tolerance conditions but reveals many inconsistencies, indicating lack of consensus in the field. When doing an assessment for decreased sound tolerance, it is important to define any terms used so that the patient and all health care professionals involved in the care of the patient are aligned with the goals of the treatment plan. Treatment generally involves gradual and systematic sound desensitization and counseling. Supplemental Material https://doi.org/10.23641/asha.20164130
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Misophonia is characterized by intense rage and disgust provoked by hearing specific human sounds resulting in social isolation due to avoidance. We exposed patients with symptom provoking audiovisual stimuli to investigate brain activity of emotional responses. 21 patients with misophonia and 23 matched healthy controls were recruited at the psychiatry department of the Amsterdam UMC. Participants were presented with three different conditions, misophonia related cues (video clips with e.g. lip smacking and loud breathing), aversive cues (violent or disgusting clips from movies), and neutral cues (video clips of e.g. someone meditating) during fMRI. Electrocardiography was recorded to determine physiological changes and self-report measures were used to assess emotional changes. Misophonic cues elicited anger, disgust and sadness in patients compared to controls. Emotional changes were associated with increases in heart rate. The neuroimaging data revealed increased activation of the right insula, right anterior cingulate cortex and right superior temporal cortex during viewing of the misophonic video clips compared to neutral clips. Our results demonstrate that audiovisual stimuli trigger anger and physiological arousal in patients with misophonia, associated with activation of the auditory cortex and salience network.
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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.
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Misophonia is a neurobehavioral syndrome phenotypically characterized by heightened autonomic nervous system arousal and negative emotional reactivity (e.g., irritation, anger, anxiety) in response to a decreased tolerance for specific sounds. The purpose of this paper isto review the emerging research literature investigating misophonia, characterize clinical implications that canbe drawn from this body of research, and outline an agenda for future research on this topic. We extend previous reviews onthis topic by differentiating misophonia from other conditions characterized by decreased sound tolerance, reviewing the extant research on misophonia, and integrating this small but growing literature with basic and applied research from other literatures in a cross-disciplinary manner.
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Objective: We aim to elucidate misophonia, a condition in which particular sounds elicit disproportionally strong aversive reactions. Method: A large online study extensively surveyed personal, developmental, and clinical characteristics of over 300 misophonics. Results: Most participants indicated that their symptoms started in childhood or early teenage years. Severity of misophonic responses increases over time. One third of participants reported having family members with similar symptoms. Half of our participants reported no comorbid clinical conditions, and the other half reported a variety of conditions. Only posttraumatic stress disorder (PTSD) was related to the severity of the misophonic symptoms. Remarkably, half of the participants reported experiencing euphoric, relaxing, and tingling sensations with particular sounds or sights, a relatively unfamiliar phenomenon called autonomous sensory meridian response (ASMR). Conclusion: It is unlikely that another "real" underlying clinical, psychiatric, or psychological disorder can explain away the misophonia. The possible relationship with PTSD and ASMR warrants further investigation.
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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.
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Decreased sound tolerance (DST) is an underappreciated condition that affects the lives of a significant portion of the general population. There is lack of agreement regarding definitions, specific components, prevalence, methods of evaluation, and methods of treatment. Limited data are available on the results of treatments. Research is scant and constrained by the lack of an animal model. This article proposes a definition of DST and its division into hyperacusis and misophonia. The potential mechanisms of these phenomena are outlined, and the results of treatment performed at Emory University are presented. Out of 201 patients with DST, 165 (82%) showed significant improvement. Of 56 patients with hyperacusis (with or without misophonia), 45 (80%) showed significant improvement. This proportion was higher for the group with hyperacusis and concurrent misophonia (33 of 39, or 85%) and lower for patients with hyperacusis only (13 of 17, or 76%). Effectiveness of treatment for misophonia with or without hyperacusis was identical (152 of 184, 83% and 139 of 167, 83%, respectively, for misophonia accompanied by hyperacusis and for misophonia only). Even with current limited knowledge of DST, it is possible to propose specific mechanisms of hyperacusis and misophonia and, based on these mechanisms, to offer treatments in accordance with the neurophysiological model of tinnitus. These treatments are part of Tinnitus Retraining Therapy (TRT), which is aimed at concurrently treating tinnitus and DST and alleviating the effects of hearing loss. High effectiveness of the proposed treatments support the postulated mechanisms.
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The main objective of Tinnitus Retraining Therapy (TRT) is habituation of activation of the autonomic nervous system, evoked by signals present in the auditory pathways. Sound therapy aims at decreasing the strength of these signals. The same systems in the brain are involved in tinnitus and decreased sound tolerance, and the same basic neurophysiological mechanisms are utilised for decreasing the tinnitusrelated neuronal activity and, in case of hyperacusis, abnormally enhanced activity induced by external sounds. The similarity of TRT treatment between tinnitus and misophonia is even closer, as in both situations the goal is to achieve extinction of functional connections between the auditory and the limbic and autonomic nervous systems. The increased gain within the auditory pathways that are presumably responsible for hyperacusis could enhance the tinnitus signal, thus it is possible to expect coexistence of tinnitus and hyperacusis, and the predisposition of hyperacusis patients to develop tinnitus. As such, for some patients tinnitus and hyperacusis may be considered the double manifestation of the same internal phenomenon.
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Misophonia is a relatively unexplored chronic condition in which a person experiences autonomic arousal (analogous to an involuntary "fight-or-flight" response) to certain innocuous or repetitive sounds such as chewing, pen clicking, and lip smacking. Misophonics report anxiety, panic, and rage when exposed to trigger sounds, compromising their ability to complete everyday tasks and engage in healthy and normal social interactions. Across two experiments, we measured behavioral and physiological characteristics of the condition. Interviews (Experiment 1) with misophonics showed that the most problematic sounds are generally related to other people's behavior (pen clicking, chewing sounds). Misophonics are however not bothered when they produce these "trigger" sounds themselves, and some report mimicry as a coping strategy. Next, (Experiment 2) we tested the hypothesis that misophonics' subjective experiences evoke an anomalous physiological response to certain auditory stimuli. Misophonic individuals showed heightened ratings and skin conductance responses (SCRs) to auditory, but not visual stimuli, relative to a group of typically developed controls, supporting this general viewpoint and indicating that misophonia is a disorder that produces distinct autonomic effects not seen in typically developed individuals.
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Background Some patients report a preoccupation with a specific aversive human sound that triggers impulsive aggression. This condition is relatively unknown and has hitherto never been described, although the phenomenon has anecdotally been named misophonia. Methodology and Principal Findings 42 patients who reported misophonia were recruited by our hospital website. All patients were interviewed by an experienced psychiatrist and were screened with an adapted version of the Y-BOCS, HAM-D, HAM-A, SCL-90 and SCID II. The misophonia patients shared a similar pattern of symptoms in which an auditory or visual stimulus provoked an immediate aversive physical reaction with anger, disgust and impulsive aggression. The intensity of these emotions caused subsequent obsessions with the cue, avoidance and social dysfunctioning with intense suffering. The symptoms cannot be classified in the current nosological DSM-IV TR or ICD-10 systems. Conclusions We suggest that misophonia should be classified as a discrete psychiatric disorder. Diagnostic criteria could help to officially recognize the patients and the disorder, improve its identification by professional health carers, and encourage scientific research.
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This article reports on the development of a revised version of the Obsessive-Compulsive Inventory (OCI; E. B. Foa, M. J. Kozak, P. Salkovskis, M. E. Coles, & N. Amir, 1998), a psychometrically sound, theoretically driven, self-report measure. The revised OCI (OCI-R) improves on the parent version in 3 ways: It eliminates the redundant frequency scale, simplifies the scoring of the subscales, and reduces overlap across subscales. The reliability and validity of the OCI-R were examined in 215 patients with obsessive-compulsive disorder (OCD), 243 patients with other anxiety disorders, and 677 nonanxious individuals. The OCI-R, which contains 18 items and 6 subscales, has retained excellent psychometric properties. The OCI-R and its subscales differentiated well between individuals with and without OCD. Receiver operating characteristic (ROC) analyses demonstrated the usefulness of the OCI-R as a diagnostic tool for screening patients with OCD, utilizing empirically derived cutscores.
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Misophonia refers to one's sensitivity to specific sounds, which can range from minor annoyance to extreme distress. This experiment tested the role of individual differences in misophonia sensitivity on learning. College students read a text passage about migraines in a quiet room with 2 or 3 other participants and 1 confederate. In some sessions, the confederate audibly chewed gum while reading the text (sound group); in other sessions, the confederate read silently (control group). All participants then completed a comprehension test on the material, followed by an assessment of their misophonia sensitivity. Although there was no overall difference between the two groups on the comprehension test, misophonia sensitivity significantly moderated the effect of the trigger sound on learning. Students who scored relatively high on misophonia sensitivity performed worse on the comprehension test if they were in the sound group but performed better if they were in the control group.
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Psychophysical experiments conducted remotely over the internet permit data collection from large numbers of participants but sacrifice control over sound presentation and therefore are not widely employed in hearing research. To help standardize online sound presentation, we introduce a brief psychophysical test for determining whether online experiment participants are wearing headphones. Listeners judge which of three pure tones is quietest, with one of the tones presented 180° out of phase across the stereo channels. This task is intended to be easy over headphones but difficult over loudspeakers due to phase-cancellation. We validated the test in the lab by testing listeners known to be wearing headphones or listening over loudspeakers. The screening test was effective and efficient, discriminating between the two modes of listening with a small number of trials. When run online, a bimodal distribution of scores was obtained, suggesting that some participants performed the task over loudspeakers despite instructions to use headphones. The ability to detect and screen out these participants mitigates concerns over sound quality for online experiments, a first step toward opening auditory perceptual research to the possibilities afforded by crowdsourcing.
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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.
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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.
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The organization of human auditory cortex remains unresolved, due in part to the small stimulus sets common to fMRI studies and the overlap of neural populations within voxels. To address these challenges, we measured fMRI responses to 165 natural sounds and inferred canonical response profiles (“components”) whose weighted combinations explained voxel responses throughout auditory cortex. This analysis revealed six components, each with interpretable response characteristics despite being unconstrained by prior functional hypotheses. Four components embodied selectivity for particular acoustic features (frequency, spectrotemporal modulation, pitch). Two others exhibited pronounced selectivity for music and speech, respectively, and were not explainable by standard acoustic features. Anatomically, music and speech selectivity concentrated in distinct regions of non-primary auditory cortex. However, music selectivity was weak in raw voxel responses, and its detection required a decomposition method. Voxel decomposition identifies primary dimensions of response variation across natural sounds, revealing distinct cortical pathways for music and speech.
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Objective Individuals with misophonia display extreme sensitivities to selective sounds, often resulting in negative emotions and subsequent maladaptive behaviors, such as avoidance and anger outbursts. While there has been increasing interest in misophonia, few data have been published to date.Method This study investigated the incidence, phenomenology, correlates, and impairment associated with misophonia symptoms in 483 undergraduate students through self-report measures.ResultsMisophonia was a relatively common phenomenon, with nearly 20% of the sample reporting clinically significant misophonia symptoms. Furthermore, misophonia symptoms demonstrated strong associations with measures of impairment and general sensory sensitivities, and moderate associations with obsessive-compulsive, anxiety, and depressive symptoms. Anxiety mediated the relationship between misophonia and anger outbursts.Conclusion This investigation contributes to a better understanding of misophonia and indicates potential factors that may co-occur and influence the clinical presentation of a person with misophonia symptoms.
Article
SUMMARY Background: Those with misophonia experience distress in response to specific sounds (e.g., sounds of eating) and often to repetitive movements (e.g., seeing leg shaking). The literature on misophonia is sparse but it is gaining increased clinical attention. Methods: We report on four cases to highlight clinical characteristics associated with misophonia seen in a pediatric treatment setting. Results: Patients typically responded to triggers with avoidant behavior or made attempts to stop the production of the trigger. Misophonia caused varying levels of impairment and was often seen as the patient’s primary complaint. Onset began in childhood and demonstrated increasing severity until the point at which evaluation and treatment was sought. Family accommodation was consistently present and reinforced the patient’s difficulties. Conclusion: Misophonia is distinguished from existing psychological and auditory disorders that have known etiologies and treatments. Further research is required to understand the neurological and psychological underpinnings of the disorder, and identify appropriate treatments.
Article
In this case report, the authors describe three cases of misophonia in people with eating disorders. Misophonia is a condition where a specific trigger sound provokes an intense emotional reaction in an individual. Case 1 is a 29-year-old with childhood eating issues, anorexia nervosa and bulimia nervosa whose trigger was a high-pitched female voice. Case 2 is a 15-year-old diagnosed with anorexia nervosa after misophonia onset. Her trigger was people chewing and eating noisily. Case 3 is a 24-year-old woman who presented with anorexia nervosa prior to misophonia onset. Her trigger was the clinking and chewing of her mother and aunt eating cereal. All three cases identified an eating-related trigger sound with a violent aversive reaction and coping mechanisms involving eating avoidance or having a full mouth. Misophonia may be associated with presentations of eating disorders. This case report adds to the literature about the presentation of misophonia. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).
Article
Misophonia is a potentially debilitating condition characterized by increased sensitivity to specific sounds, which cause subsequent behavioral and emotional responses. The nature, clinical phenomenology and etiology of misophonia remain unclear, and misophonic clinical presentations are not currently accounted for by existing psychiatric or audiological disorders. We present a case of pediatric misophonia in the context of comorbid obsessive-compulsive disorder and Tourette's syndrome. Given the interrelationships among obsessive-compulsive spectrum disorders and misophonia, these disorders may share underlying pathophysiology, particularly within the dopaminergic and serotonergic neural systems. Clinical (i.e., treatment) and theoretical implications are discussed.
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Misophonia, or selective sound sensitivity syndrome, is a preoccupation with or aversion to certain types of sounds that evokes feelings of irritability, disgust, or anger. Recently, it has been suggested that misophonia is a discrete clinical entity deserving of its own place in psychiatric diagnostic manuals. In this paper, we describe 3 patients whose misophonia could be attributed to different underlying primary psychiatric disorders. Case series report. In these patients, we argue that misophonia is better described as a symptom of a) obsessive-compulsive disorder, b) generalized anxiety disorder, and c) schizotypal personality disorder. The nosological status of misophonia remains a matter of debate. Patients who exhibit misophonia as a major complaint should be assessed for other conditions. Further studies on the prevalence, natural history, and additional features of misophonia are needed.
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This paper presents a simple and widely ap- plicable multiple test procedure of the sequentially rejective type, i.e. hypotheses are rejected one at a tine until no further rejections can be done. It is shown that the test has a prescribed level of significance protection against error of the first kind for any combination of true hypotheses. The power properties of the test and a number of possible applications are also discussed.
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The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in a normal sample of N = 717 who were also administered the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The DASS was shown to possess satisfactory psychometric properties, and the factor structure was substantiated both by exploratory and confirmatory factor analysis. In comparison to the BDI and BAI, the DASS scales showed greater separation in factor loadings. The DASS Anxiety scale correlated 0.81 with the BAI, and the DASS Depression scale correlated 0.74 with the BDI. Factor analyses suggested that the BDI differs from the DASS Depression scale primarily in that the BDI includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to discriminate between depression and other affective states. The factor structure of the combined BDI and BAI items was virtually identical to that reported by Beck for a sample of diagnosed depressed and anxious patients, supporting the view that these clinical states are more severe expressions of the same states that may be discerned in normals. Implications of the results for the conceptualisation of depression, anxiety and tension/stress are considered, and the utility of the DASS scales in discriminating between these constructs is discussed.
Investigating misophonia: A review of the empirical literature, clinical implications, and a research agenda
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