Misophonia, Maladaptive Schemas and Personality Disorders: A Report of Three Cases

Abstract

Misophonia is a chronic condition in which specific sounds cause intense negative emotions and autonomic arousal. Misophonia is considered a psychological disorder without any relationship with specific alterations of hearing receptors and independent from physical characteristics of the sound. Moreover if misophonia can be defined as a specific psychiatric disorder or a correlate of other conditions is still under debate. The patients were two women and one man. In this case series we first identified the presence of triggers sounds inducing misophonia as reported during the psychotherapy sessions. At a qualitative level all the three patients perceived that the others were intentionally acting with the purpose of underline their maladaptive interpersonal schemas. All the patients were evaluated with the use of questionnaires. Regarding personality disorders (PD) all three patients suffered from at least one PD. As regard depression, one had moderate depression and one had severe depression. Two patients had moderate/severe anxiety. All the three patients can be considered as highly problematic in the interpersonal domain. Our findings have clinical implications for the treatment of misophonia because it seems to be sustained by underlying PD or maladaptive interpersonal schemas. The qualitative analysis of these cases has highlighted how patients with misophonia tended to ascribe intentionality to the people who emit the sounds that trigger their negative emotional reactions. Further studies are necessary to evaluate which kind of interpersonal patterns occur in these patients.

A Preliminary Investigation of the Association Between Misophonia and Symptoms of Psychopathology and Personality Disorders

“…Overall, these results are consistent with extant literature noting relationships between misophonia and symptoms of psychopathology (e.g., Wu et al, 2014 ; Schröder et al, 2017 ; Frank and McKay, 2019 ; Natalini et al, 2019 ). The results indicating a relationship between high misophonia symptoms and number of PD symptoms are of particular interest.…”

“…Two studies investigating misophonia have used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—4th edition (DSM-IV) personality disorders (SCID-II). Natalini et al (2019) described three cases in which all patients met criteria for OCPD, two met criteria for co-occurring borderline personality disorder (BPD), and one met criteria for co-occurring avoidant personality disorder (APD). Schröder et al (2013) reported 52.4% of participants with misophonia ( N = 42) met criteria for OCPD.…”

Development and Initial Validation of the Duke Misophonia Questionnaire

“…A related limitation to the A-MISO-S is that item generation and refinement was not done using psychometric analyses. Nonetheless, the original A-MISO-S and a revised version have been widely used in misophonia research across multiple countries, suggesting it merits additional psychometric evaluation and is promising as a useful and brief measure (Kluckow et al, 2014 ; Schröder et al, 2014 ; Erfanian et al, 2018 , 2019 ; Quek et al, 2018 ; Rouw and Erfanian, 2018 ; Eijsker et al, 2019 ; Jager et al, 2020 ; Natalini et al, 2020 ; Naylor et al, 2020 ).…”

The Mediating Role of Emotion Regulation Within the Relationship Between Neuroticism and Misophonia: A Preliminary Investigation

“…Results from imaging studies support the hypothesis that emotion regulation is relevant to misophonia and report exaggerated responses in brain areas including the anterior insula cortex and amygdala, both of which are implicated in emotional processing and regulation (19,20). Evidence from clinical research suggests that misophonia symptoms co-occur with a wide range of psychiatric disorders characterized by emotion dysregulation, including personality (e.g., borderline, avoidant, and obsessive-compulsive), depressive, anxiety (e.g., panic, agoraphobia, generalized anxiety, and social anxiety), and obsessive-compulsive disorders (11,(21)(22)(23). Therefore, misophonia may be especially related to clinically relevant difficulties with emotion regulation, which also have been shown to be transdiagnostic across a range of problems (24).…”