Toward a Multidimensional Understanding of Misophonia Using Cluster-Based Phenotyping

Abstract

Misophonia is a condition characterized by hypersensitivity and strong emotional reactivity to specific auditory stimuli. Misophonia clinical presentations are relatively complex and reflect individualized experiences across clinical populations. Like some overlapping neurodevelopmental and neuropsychiatric disorders, misophonia is potentially syndromic where symptom patterns rather than any one symptom contribute to diagnosis. The current study conducted an exploratory k-means cluster analysis to evaluate symptom presentation in a non-clinical sample of young adult undergraduate students (N = 343). Individuals participated in a self-report spectrum characteristics survey indexing misophonia, tinnitus severity, sensory hypersensitivity, and social and psychiatric symptoms. Results supported a three-cluster solution that split participants on symptom presentation: cluster 1 presented with more severe misophonia symptoms but few overlapping formally diagnosed psychiatric co-occurring conditions; cluster 3 was characterized by a more nuanced clinical presentation of misophonia with broad-band sensory hypersensitivities, tinnitus, and increased incidence of social processing and psychiatric symptoms, and cluster 2 was relatively unaffected by misophonia or other sensitivities. Clustering results illustrate the spectrum characteristics of misophonia where symptom patterns range from more “pure” form misophonia to presentations that involve more broad-range sensory-related and psychiatric symptoms. Subgroups of individuals with misophonia may characterize differential neuropsychiatric risk patterns and stem from potentially different causative factors, highlighting the importance of exploring misophonia as a multidimensional condition of complex etiology.

The central role of symptom severity and associated characteristics for functional impairment in misophonia

“…These are usually conceptualized as “triggers” as they are responsible for the sequelae of subsequent intense emotional (e.g., irritation, anxiety, disgust, and tension), physiological (e.g., increased heart rate), cognitive (e.g., internalizing or externalizing appraisal of own reaction), and behavioral (e.g., avoid the stimuli) reactions ( 1 ). Misophonia is currently not included in the International Classification of Diseases (ICD-11) ( 2 ) or Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) ( 3 ) although most research demonstrates significant symptom presentation which seems unrelated to hearing levels or perceptual abilities ( 1 , 4 , 5 ).…”

Misophonia: A Systematic Review of Current and Future Trends in This Emerging Clinical Field

“…A recent study, 2022, found two potential subgroups of individuals with misophonia: one with “pure form” misophonia with more severe misophonic symptoms but few concurrent conditions, the second subgroup showed greater numbers of concurrent conditions that may represent misophonia as a secondary phenomenon of other neuropsychiatric conditions [ 64 ]. These subgroups create a new demand: to explore the relationship between misophonia sensory symptoms, misophonia emotional reactivity/behavioral symptoms, and other related neuropsychiatric conditions, such as ASD and anxiety, with emphasis on neural mechanisms.…”

A genome-wide association study of a rage-related misophonia symptom and the genetic link with audiological traits, psychiatric disorders, and personality

“…Another result that could be considered unexpected is that the positive correlation with aggression was not significant, even though anger and aggressive thoughts are often reported symptoms of misophonia (Bruxner, 2016;Dozier and Morrison, 2017;Jager et al, 2020;Norris et al, 2022). It has been argued, however, that misophonia is based on the feelings of guilt about the evoked irritation and anger rather than behavioral expressions of anger itself that causes the distress (Jager et al, 2020) making the disorder more compulsive and internalizing than impulsive and externalizing in character (Eijsker et al, 2020).…”

“…The main limitation of the current study is the fact that the GWAS of misophonia was based on a self-reported symptom of misophonia rather than a case-control study of misophonia. In addition, the GWAS sampled a common symptom of misophonia with anger as a primary response ( Jager et al, 2020 ; Norris et al, 2022 ). Most research groups seem to agree that misophonia is independent of the overt expression of anger as a primary emotional response ( Jager et al, 2020 ; Norris et al, 2022 ; Siepsiak et al, 2022 ; Vitoratou et al, 2022 ).…”

“…In addition, the GWAS sampled a common symptom of misophonia with anger as a primary response ( Jager et al, 2020 ; Norris et al, 2022 ). Most research groups seem to agree that misophonia is independent of the overt expression of anger as a primary emotional response ( Jager et al, 2020 ; Norris et al, 2022 ; Siepsiak et al, 2022 ; Vitoratou et al, 2022 ). However, many groups also include a wider variety of primary emotional responses than irritability or anger (anxiety, panic) ( Vitoratou et al, 2022 ).…”