Misophonia: Diagnostic Criteria for a New Psychiatric Disorder

Abstract

BackgroundSome 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 Findings42 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.ConclusionsWe 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.

Treating the Initial Physical Reflex of Misophonia With the Neural Repatterning Technique: A Counterconditioning Procedure

“…It was posited that the physical reflex response mediated the emotional response, as shown in Figure 3 (Dozier, 2015b). The NRT treatment described by Dozier (2015a) Misophonia is reported to persist and often worsen with time (Schröder et al, 2013). Therefore, if misophonia includes a conditioned physical reflex response to the trigger, there must be a mechanism that allows Pavlovian conditioning to occur, such that the trigger-response reflex is maintained or strengthened.…”

What is misophonia and how can we treat it?

“…Since the first scientific descriptions by Jastreboff [1][2][3], there have been a few case reports [4][5][6] and original studies [7,8] focusing on this condition. It is now known that the repertoire of trigger sounds reported by people with misophonia can include repetitive and social sounds typically produced by another individual, including eating (chewing/ crunching) sounds, pen clicking, clock ticking, finger tapping, whistling and lip smacking.…”

“…However, misophonia differs from tinnitus in a crucial aspect: it is triggered by external, human-produced sounds and situations, rather than focusing on internally perceived, abstract sounds. The catalog of conditions included in the differential diagnosis of misophonia encompasses specific phobias, post-traumatic stress disorder, social phobia, obsessive compulsive disorder, intermittent explosive disorder, personality disorders (emotionally unstable, borderline, antisocial and obsessive compulsive personality disorder), autistic spectrum disorders, sensory processing disorders, phonophobia and synesthesia [7,8]. Moreover, recent reports have suggested that misophonic symptoms could be ascribed to the wider clinical spectrum of Gilles de la Tourette syndrome [10][11][12][13][14], obsessive compulsive disorder [7,[14][15][16], generalized anxiety disorder and schizotypal personality disorder [17].…”

“…Schröder et al [7] recently characterized the largest sample to date, consisting of 42 persons with misophonia. Their findings led them to suggest that misophonia is a primary disorder, rather than being secondary to the presence of other known neurological or psychiatric conditions.…”

“…The coping strategies adopted by persons with this condition do not necessarily involve avoidance (removing self from certain situations) or other socially dysfunctional behaviors (challenging other people in order to stop them making noises): mimicry to 'cancel out' the trigger sound, use of earplugs/headsets/music, focus consciousness to own sounds, self-distraction and positive internal dialogues have all been reported as useful techniques to cope with misophonia symptoms [8]. It is also possible that patients who report misophonia in association with severe obsessive compulsive symptoms [6][7][8]14] might benefit from serotonergic or antidopaminergic agents; however, these suggestions are speculative at the moment and need to be tested in future clinical studies.…”