Suicidal misophonia: a case report

Abstract

Misophonia is still an unclassified disorder and means literally "strong dislike (hate) of sounds". In this paper, we present a case report of an adolescent female who had misophonia that was complicated with two non-fatal suicide attempts. She presented with anxiety features and started to follow up for three years. Assessment of the level of misophonia for a year using Amsterdam Misophonia Scale (A-MISO-S) showed an extreme degree soon after the second suicide attempt. Initially, psychotherapy was noticed to be ineffective due to her poor motivation. Escitalopram was added to the management plan and improvement was reported in the depressive symptoms and obsessional thoughts of misophonia but were intolerable eventually because of the weight gain. Therefore, it was switched into Fluoxetine and Bupropion but six weeks later she attempted her second suicide by Bupropion overdose. At that point, the psychiatrist, the patient and her parents agreed to continue therapy with non-psychopharmacological treatment. Gradually she became more engaged in psychotherapy sessions after noticing its effectiveness. It was concluded that significant improvement of misophonia was reported when she was treated by Selective Serotonin Reuptake Inhibitors (SSRI) namely Escitalopram or Fluoxetine, motivated in psychotherapy sessions, adapted good coping strategies, decreased her dysfunctional challenging behaviour, rejoined social interaction and activity in her life, was more insightful and aware about her illness and developed self-acceptance.

Listening to People with Misophonia: Exploring the Multiple Dimensions of Sound Intolerance Using a New Psychometric Tool, the S-Five, in a Large Sample of Individuals Identifying with the Condition

“…During incidents where they are triggered by sounds, individuals with misophonia have reported feelings of anger [12,17,18], distress [14,17,19,20], disgust [12,21], and anxiety [18,22]. People who identify with the condition have described negative appraisals about the character and intent of the perpetrators of sounds [3,4,18,19], intrusive thoughts about the sounds and the people making them [21], and a sense of violation from friends and family members who make noises despite being aware of the individual's sensitivities [17,19,23].…”

“…Catastrophic predictions are made about what would happen if unable to escape sounds, such as being unable to cope [19], having verbal and physical outbursts [4,18,24], embarrassing oneself, and physically exploding [17]. Safety-Psych 2021, 3 seeking behaviours intended to prevent predicted outcomes in the moment include leaving the situation [17,22], blocking sounds [21,22,24], distraction, seeking reassurance [18], and verbal aggression [18,24]. Physical outbursts towards others [21,25] and the environment [18], while rare [12], have also been reported.…”

“…Safety-Psych 2021, 3 seeking behaviours intended to prevent predicted outcomes in the moment include leaving the situation [17,22], blocking sounds [21,22,24], distraction, seeking reassurance [18], and verbal aggression [18,24]. Physical outbursts towards others [21,25] and the environment [18], while rare [12], have also been reported.…”

“…The impact of misophonia is not contained to moments of being bothered by sounds, with reports of anticipatory anxiety about eating situations [21], rumination and replaying events [20], and beliefs about continuing to be bothered by sounds and being impacted negatively in the future [18]. Common strategies intended to minimise impact include avoidance [4,17,19,21], withdrawal, and organising life in a way so as not to encounter triggers [17,[19][20][21][22]24].…”

Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report

“…3 These reactions may include emotional components (e.g., fear, annoyance) and physical manifestations (e.g., pain, panic) 2 that can significantly impact a person's quality of life. [4][5][6] There is not a consensus related to the recommended process of evaluating and treating DST. Many agree that an evaluation should include audiometric data (including uncomfortable loudness level [ULL] measurements), self-report questionnaire data, and a detailed interview.…”