Misophonia

The term was coined in 2001 by professor Pawel Jastreboff and doctor Margaret M. Jastreboff, with the assistance of the classicist Guy Lee,[6][7] introducing it in their article "Hyperacusis",[8] with further explanation in the International Tinnitus and Hyperacusis Society's ITHS Newsletter.[9]

The term was first used in a peer-reviewed journal in 2002.[10]

"Misophonia" comes from the Ancient Greek words μῖσος (IPA: /mîː.sos/), meaning "hate", and φωνή (IPA: /pʰɔː.nɛ̌ː/), meaning "voice" or "sound", loosely translating to "hate of sound", and was coined to differentiate the condition from other forms of decreased sound tolerance such as hyperacusis (hypersensitivity to certain frequencies and volume ranges) and phonophobia (fear of sounds).[3][11][12]

As of 2016, the literature on misophonia was limited.[5] Some small studies show that people with misophonia generally have strong negative feelings, thoughts, and physical reactions to specific sounds, which the literature calls "trigger sounds". These sounds usually appear quiet to others, but can seem loud to the person with misophonia, as if they can't hear anything except the sound. One study found that around 80% of the sounds were related to the mouth (e.g., eating, slurping, chewing or popping gum, whispering, whistling) and around 60% were repetitive. A visual trigger may develop related to the trigger sound,[5][13] and a misophonic reaction can occur in the absence of an actual sound.[2]

Reactions to triggers can range from mild (anxiety, discomfort, and/or disgust) to severe (rage, anger, hatred, panic, fear, and/or emotional distress).[4] Reactions to the triggers can include aggression toward the origin of the sound, leaving, remaining in its presence but suffering, trying to block it or trying to mimic the sound.[13] In extreme cases, sufferers may become physically violent toward the source of the sound.[14]

The first misophonic reaction may occur when a person is young, often between the ages of 9 and 13,[4] and can originate from someone in a close relationship, or a pet.[13]

People with misophonia are aware they experience it and some consider it abnormal; the disruption it causes in their lives ranges from mild to severe.[5][13] Avoidance and other behaviors can make it harder for people with this condition to achieve their goals and enjoy interpersonal interactions.[3]

Misophonia's mechanism is not known, but it appears that it may be caused by a dysfunction of the central auditory system in the brain and not of the ears.[5][2] The perceived origin and context of the sound appears to be essential to trigger a reaction.[2]

A 2017 study[15] found that the anterior insular cortex (which plays a role both in emotions like anger and in integrating outside input, such as sound, with input from organs such as the heart and lungs) causes more activity in other parts of the brain in response to triggers, particularly in the parts responsible for long-term memories, fear, and other emotions. It also found that people with misophonia have higher amounts of myelin (a fatty substance that wraps around nerve cells in the brain to provide electrical insulation). It is not clear whether myelin is a cause or an effect of misophonia and its triggering of other brain areas.[16]

A 2021 study found that the orofacial motor cortex, a part of the brain representing lip, jaw, and mouth movement, has enhanced activation for typical trigger sounds much more than for aversive or neutral sounds in misophonia sufferers. It also found enhanced functional connectivity between orofacial motor cortex and secondary auditory cortex during sound perception for any sound. It further reported resting state fMRI functional connectivity between orofacial motor cortex and secondary auditory and visual brain areas as well as secondary interoceptive cortex (left anterior insula). This suggests that misophonia, which is typically thought of as a disorder of sound emotion processing, is a result of overactivation of the motor mirror neuron system involved in producing the movements associated with these trigger sounds or images.[17]

There are no standard diagnostic criteria,[5][13] and many doctors are unaware of this condition.[4] Misophonia is distinguished from hyperacusis, which is not specific to a given sound and does not involve a similar strong reaction, and from phonophobia, which is a fear of loud sounds,[13] but it may occur with either.[18]

It is not clear whether people with misophonia usually have comorbid conditions, nor whether there is a genetic component.[5][13] It appears that misophonia can occur on its own or along with other health, developmental and psychiatric problems.[4] When attempting to diagnose a patient with misophonia, doctors sometimes mistake its symptoms for an anxiety disorder, bipolar disorder or obsessive-compulsive disorder.[4]

As of 2018, there are no evidence-based treatments[5] for the condition and no randomized clinical trial has been published; health care providers generally try to help people cope with misophonia by recognizing what the person is experiencing and working on coping strategies.[13] Some small studies have been published on the use of sound therapy similar to tinnitus retraining therapy and on cognitive behavioral therapy and particularly exposure therapy, to help people become less aware of the trigger sound.[3] None of these approaches has been sufficiently studied to determine its effectiveness.[3][11]

Misophonia's prevalence is not known; nor is it known whether sex, gender, or age affect the likelihood of having misophonia.[5][2][13]

The existence of several online support groups with thousands of members has been cited as possibly indicative of its prevalence.[19]

Some people have sought to relate misophonia to autonomous sensory meridian response, or auto-sensory meridian response (ASMR), a pleasant form of paresthesia, a tingling sensation that typically begins on the scalp and moves down the back of the neck and upper spine. ASMR is described as the opposite of what can be observed in reactions to specific audio stimuli in misophonia.[20] There are plentiful anecdotal reports of people who claim to have both misophonia and ASMR. Common to these reports is the experience of ASMR in response to some sounds and misophonia in response to others.[20][21][22]

People who experience misophonia have formed online support groups.[23][19]

In 2016, Quiet Please, a documentary about misophonia, was released.[24][25][26]

In 2020, a team of misophonia researchers[27] received the Ig Nobel Prize in Medicine "for diagnosing a long-unrecognized medical condition: Misophonia, the distress at hearing other people make chewing sounds".[28]

• Stimulus control

• Jastreboff, P. J. (1 January 2017), "Tinnitus, Hyperacusis, Misophonia☆", Reference Module in Neuroscience and Biobehavioral Psychology, Elsevier, ISBN 978-0-12-809324-5

• The Duke Center for Misophonia and Emotion Regulation, part of Duke University Health System
• Misophonia Research Fund, initiative of a private family foundation
• Quiet Please, official website of 2016 documentary about misophonia, with trailer