Symptoms And Clinical Presentation Of Misophonia

  • Yunqi He Master of Arts - MA, History of Science, Technology and Medicine, The University of Manchester
  • Dr. Sheromeya Ducklas MBBS (Hull York Medical School), BSc Biological Sciences (University of Leicester)

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Introduction

Have you ever felt unusually angry or anxious after hearing the repeated clicking of a pen, loud keyboard typing or someone audibly chewing? If so, you might be experiencing misophonia. A condition where everyday noises can trigger a severe emotional response and subsequent distress which can hinder your ability to participate in day-to-day activities and social interactions.

Although misophonia is not well understood, it is being recognised by researchers to be a complex condition that affects emotional regulation and sensory processes. This article will explain what misophonia is, its symptoms, how it is diagnosed, as well as how common sounds, known as "trigger sounds," can have a significant impact on those who suffer from this challenging condition. 

What is misophonia?

In 2001, Jastreboff and Jastreboff1 coined the term misophonia to describe an emotional sound processing disorder. Individuals with misophonia experience intense negative emotions such as irritation, anger, or even rage when exposed to specific sounds like eating, chewing, or breathing.2 These reactions are so overpowering that they can disrupt the sufferer's ability to concentrate, causing significant distress and impacting their quality of life 

"Misophonia" does not mean "hatred of sound". Instead, it denotes an abnormal sensitivity to everyday sounds that most people find unremarkable, which provokes strong emotional and physical reactions in those with the condition. Although these trigger sounds are common, the underlying mechanisms of misophonia are not well understood. Additionally, accurately determining the prevalence of misophonia proves difficult, as distinguishing between general sound aversion and the severe reactions typical of misophonia is challenging. Whilst many might find the sound of messy eating unpleasant, only those with misophonia experience an extreme emotional response to such sounds.

Researchers agree that misophonia does not fit neatly into any recognised neurological or psychiatric categories, and there is not yet little evidence to support theories involving biological, genetic, or behavioural causes.3 

Currently, there are no established treatments or medications specifically for misophonia, but therapeutic approaches designed to manage its symptoms do exist.

Who is affected by misophonia?

Research shows that misophonia usually starts when people are young typically around the age of 12, and sometimes as early as age 5.2 A study from 2022 found that those with misophonia often feel more anxious and have more compulsive behaviours compared to other kids. They also tend to be less happy with their lives and have lower health quality.4

Misophonia can happen to people whether they have good hearing or not. It can appear by itself, or with other hearing issues like tinnitus(ringing in the ears) or hyperacusis(sensitivity to noise). It’s also common for people with misophonia to have other mental or brain-related conditions like anxiety, mood disorders, personality disorders, obsessive-compulsive disorders, PTSD, autism, or ADHD. However, it’s still not well understood why people get misophonia or how it relates to these other conditions.

Common triggers and reactions in misophonia

While triggers can vary from person to person, there are some common patterns observed in those with misophonia:

  • Auditory Triggers: These are the most common and include sounds related to oral functions such as chewing, eating, lip-smacking, sucking, coughing, clearing the throat, and swallowing. Nasal sounds like breathing and sniffing also frequently act as triggers. Other auditory triggers might include non-mouth/nose sounds such as pen tapping, keyboard typing, tapping of fingers or feet, and dragging footsteps, as well as sounds produced by objects like the ticking of a clock or noises made by animals.
  • Visual Triggers: These can include seeing movements like knuckle cracking, leg shaking, or swinging, which are often related to the auditory triggers. For example, seeing someone eat can trigger a response if the individual is sensitive to the sound of eating such as chewing

Emotional and physical reactions

People with misophonia may experience a range of negative emotional reactions such as anger, annoyance, disgust, and anxiety. Physiological responses include increased autonomic function like muscle tension, accelerated heart rate, and sweating. In rare cases, this can lead to aggressive outbursts, either verbal or physical; these are reportedly more common in children with misophonia than in adults.

The severity of reactions can be more intense when the sounds come from close friends and family members. A 2013 study highlighted that participants with misophonia reported stronger or exclusively intense reactions to trigger sounds specifically from close loved ones.5

Management of misophonia

Due to the limited understanding of the pathophysiology of misophonia, finding effective treatments for the condition remains a challenge. Consequently, there aren’t yet any standardised methods for identifying, diagnosing, or measuring the severity of misophonia.6

Two main approaches have been developed to manage misophonia:

  • Medical Approach: Focusing on the neurophysiological aspects, exploring how the brain reacts to trigger sounds and attempting to modify this response.
  • Psychiatric Approach: Offering psychological therapies to manage the condition:

Management approaches 

Associative Conditioning:7 This technique tries to change the reaction to misophonia triggers by linking them with unrelated, more pleasant sounds. For example, pairing the sound of eating with the calming noise of running in the snow to reduce the negative reaction to the eating sounds. Cognitive behavioural therapy (CBT) and sound therapy (using sound vibrations to relieve stress and induce relaxation) may be used to help manage an individual's response to certain triggers and can have a positive long-term effect on those affected by misophonia.

Ending Toxic Hope:8 This involves letting go of the urge to control or avoid the triggers. It challenges the intuitive response to do something about the annoyance and instead promotes doing nothing. By accepting the triggers without attempting to change them, individuals can learn to live with the presence of these sounds. Imagining oneself as powerless against the triggers helps detach from the need to react. This approach aims to achieve “victorious surrender” a state where the individual no longer needs to focus on the noise.

Reducing Avoidance: This approach aims to minimise efforts to escape from trigger sounds. This could mean focusing attention elsewhere, ignoring the sounds, or choosing not to leave the area when triggers occur. Although using headphones or earplugs to block out sounds is only a temporary solution and does not address the root cause of misophonia, it remains the simplest and most practical way to avoid disturbances caused by this condition.

Mindfulness: Mindfulness involves being aware of the present moment and observing your thought, feelings, and emotional responses in the here and now. It encourages individuals to examine their emotional and physical responses to their environment and being aware of them. It can help individuals to pause at the moment and give them time to respond in a calm manner and in the long-term offer improved emotional regulation and reduction in stress which may be beneficial for those with misophonia.

Mindfulness is a mental practice that involves paying attention to the present moment with awareness, non-judgment, and acceptance. It encourages individuals to observe their thoughts, feelings, bodily sensations, and the environment without becoming overwhelmed by them. Instead of reacting to stimuli automatically, mindfulness helps people pause, acknowledge their experience, and respond in a calm, measured way.

Summary 

Misophonia is a disorder where everyday sounds such as chewing or breathing spark intense emotional responses. This condition can profoundly impact personal relationships and disrupt daily life, leading to feelings of anger, anxiety, and physical discomfort. Typical triggers can involve common noises associated with eating or breathing. Diagnosing misophonia can be complex, and as of now there are no approved medications specifically for treating misophonia, and there is no definitive evidence that medication is effective for this disorder. Howeverthere are effective methods to help manage its symptoms such as CBT, sound therapy and mindfulness. 

Reference

  1. Jastreboff MM, Jastreboff PJ. Hyperacusis. Audiology Online. 2001. Available from: https://www.audiologyonline.com/articles/hyperacusis-1223
  2. Kumar S, Hancock O, Cope T, Sedley W, Winston J, Griffiths TD. Misophonia: a disorder of emotion processing of sounds. J Neurol Neurosurg Psychiatry. 2014;85.
  3. Swedo SE, Baguley DM, Denys D, Dixon LJ, Erfanian M, Fioretti A, et al. Consensus Definition of Misophonia: A Delphi Study. Front Neurosci. 2022 Mar 17;16.
  4. Rinaldi LJ, Smees R, Ward J, Simner J. Poorer Well-Being in Children With Misophonia: Evidence From the Sussex Misophonia Scale for Adolescents. Front Psychol. 2022 Apr 6;13.
  5. Edelstein M, Brang D, Rouw R, Ramachandran VS. Misophonia: Physiological investigations and case descriptions. Front Hum Neurosci. 2013;7:296. doi: 10.3389/fnhum.2013.00296
  6. Jastreboff PJ, Jastreboff MM. The neurophysiological approach to misophonia: Theory and treatment. Front Neurosci. 2023 Mar 23;17.
  7. Schröder AE, Vulink NC, van Loon AJ, Denys DA. Cognitive behavioral therapy is effective in misophonia: An open trial. J Affect Disord. 2017;217:289–294. doi: 10.1016/j.jad.2017.04.017
  8. Cowan EN, Marks DR, Pinto A. Misophonia: A psychological model and proposed treatment. J Obsess-Compuls Relat Disord. 2021 Oct;100691.

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Yunqi He

Master of Arts - MA, History of Science, Technology and Medicine, The University of Manchester

Yunqi is currently pursuing a Master's degree in History of Science, Technology, and Medicine at the University of Manchester. As a digital marketer in the healthcare industry, Yunqi has interned at international pharmaceutical companies and possesses extensive experience in writing health communication articles.

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