Misophonia

misophonia by eliza stein

Misophonia [mee-so-fo-nee-uh], literally ‘hatred of sound,’ is a rarely diagnosed neuropsychiatric disorder in which negative emotions (anger, flight, hatred, disgust) are triggered by specific sounds. The sounds can be loud or soft. The term was coined by American neuroscientists Pawel Jastreboff and Margaret Jastreboff and is sometimes referred to as ‘selective sound sensitivity syndrome.’

A 2013 review of neurological studies and fMRI studies of the brain as it relates to the disorder postulated that abnormal or dysfunctional assessment of neural signals occurs in the anterior cingulate cortex and insular cortex. These cortices are also implicated in Tourette Syndrome, and are the hub for processing anger, pain, and sensory information. Other researchers concur that the dysfunction is in central nervous system structures. It has been speculated that the anatomical location may be more central than that involved in hyperacusis (over-sensitivity to certain frequency and volume ranges of sound). An alternate view, by two misophonia treatment providers, is that misophonia is a Pavlovian conditioned reflex.

People who have misophonia are most commonly angered by specific sounds, such as slurping, throat-clearing, nail-clipping, chewing, drinking, tooth-brushing, breathing, sniffing, talking, sneezing, yawning, walking, gum-chewing or popping, laughing, snoring, swallowing, gulping, typing, coughing, humming, whistling, singing, certain consonants, or repetitive sounds. Sufferers experience fight/flight symptoms such as sweating, muscle tension, and quickened heartbeat. Some even feel unwanted sexual arousal, caused by the over-activation of hormonal circuits. Some are also affected by visual stimuli, such as repetitive foot or body movements, fidgeting, or movement they observe out of the corners of their eyes. Intense anxiety and avoidance behavior often develops, which can lead to decreased socialization. Some people feel the compulsion to mimic what they hear or see. Mimicry is an automatic, non-conscious, and social phenomenon. It has a palliative aspect, making the sufferer feel better. The act of mimicry can elicit compassion and empathy, which ameliorates and lessens hostility, competition, and opposition. There is also a biological basis for how mimicry reduces the suffering from a trigger.

The prevalence of misophonia is unknown, but groups of people identifying with the condition suggest it is more common than previously recognized. Among patients with tinnitus (ringing in the ears), which is found at clinically significant levels in between 4 and 5% of the general population, some surveys report prevalence as high as 60%, while prevalence in a 2010 study was measured at 10%. Misophonia may be correlated with OCD, anxiety and depressive disorders. It has also been suggested that there is a connection between misophonia and synesthesia, a neurological condition in which stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second sensory or cognitive pathway. The basic problem may be a pathological distortion of connections between various limbic structures and the auditory cortex, causing sound-emotion synesthesia. There are people with both misophonia and synesthesia, and many people with synesthesia have more than one form of synesthesia (there are over 60 reported types).

There are a limited number of journal articles and conference reports on treatment for misophonia, none of which involve controlled studies. The most widely used treatment is to add noise to the patient’s environment. With increased ambient noise, many misophonia sufferers have a greatly reduced response to triggers. Noise can be added to an environment with a sound generator or fan, or directly to the ear with a behind-the-ear sound generator that looks like a small hearing aid. There are two treatment protocols that use sound generators. The second treatment that uses sound is ‘Tinnitus Retraining Therapy.’ This treatment uses ear-level noise generators, counseling, and gradual exposure to triggers. This was reported to have produced significant reduction in the severity of misophonia in 83% of the 182 patients treated.

A case study of a counterconditioning treatment called the ‘Neural Repatterning Technique’ reported a drastic reduction in the severity of misophonia in a middle-aged woman by individually counterconditioning three auditory triggers and a visual trigger. This treatment used an intermittent, reduced-intensity (short and quiet) trigger stimulus while talking about positive life experiences, listening to music, and dancing. This treatment is effective only for people who have a small number of triggers from a single person or in a single setting.

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