![]() There are no official criteria for diagnosing misophonia in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) however, it has been proposed that misophonia may be most appropriately categorized under “Obsessive Compulsive and Related Disorders.” In 2013, Schröder and colleagues proposed diagnostic criteria based on their clinical observations. The rate of misophonia among individuals with tinnitus (a condition that causes ringing in the ears) is also elevated. While the prevalence of misophonia is unknown, recent studies suggest high rates of SOR among youth with OCD and anxiety. This suggests possible overlap in neuropathology. Respondent/classical conditioning also plays a role as previously neutral places and situations become associated with unpleasant sounds (for example, a young girl may be triggered by the sound of her brother chewing and may develop a conditioned reaction to the family’s dinner table regardless if anyone is eating at it).Īs mentioned above, sensory over-responsivity (SOR), including heightened sensitivity to sounds is common among individuals with OCD, anxiety, and Tourette Syndrome. ![]() ![]() The neurobiological mechanisms and etiological causes of misophonia are still unknown although it is thought that it results from abnormal functioning within the limbic system (the part of the brain that regulates emotions), the autonomic nervous system (the part of the brain that controls our involuntary organ functions such as breathing and our hearts beating, and the “fight or flight response”), and the auditory cortex (the part of the brain that manages hearing and interprets sounds). being in a room full of Halloween candy may trigger an outburst in a child with extreme sensitivity to the sound of opening a plastic wrapper). Among youth with misophonia, rage or anger outbursts may occur in the presence of triggering sounds or stimuli associated with sounds (e.g. For example, an individual may avoid restaurants because of the high likelihood of encountering chewing sounds. In some cases, situations or stimuli associated with specific sounds are also avoided (i.e., conditioned aversion), as just the possibility of encountering triggers may result in distress or discomfort. The most common behavioral response is the avoidance of and/or withdrawal from sound triggers or situation/stimuli that are likely to result in exposure to the sound. For example, some children may exhibit an intense outburst when seemingly low-intensity sounds are encountered. The magnitude of disturbance is not necessarily proportional to the duration or the volume of the sound trigger. Affected individuals liken experience of the sound trigger more closely to irritation, disgust, or even pain, rather than anxiety/fear. Individuals with misophonia describe encounters with triggering sounds resulting in discomfort, distress, or anger. In some cases, extreme sound sensitivity, a characteristic of misophonia, is associated with the behavior of a specific individual, such as “my brother chewing,” or “my mother’s voice.” In other cases, the presentation may be more generalized (e.g., all women’s voices, barking dogs) or may include environmental or engineered stimuli (e.g., “the hum of fluorescent lighting, clocks ticking, etc.”). These sound triggers are often highly specific, including sounds emitted in the context of common human behavior such as sounds associated with: chewing, breathing, swallowing, stepping, lip smacking, tapping, and speaking (sometimes specific spoken sounds). Misophonia may range from mild (for example, decreased tolerance of certain types of sounds) to severe, excessive sensitivity to specific auditory (sound) triggers. Similar to OCD, misophonia presents differently in each individual. This co-occurrence has led clinicians and researchers to look into whether misophonia is related to these disorders, including potential overlaps in how the brain is affected (i.e, neurobiological overlaps). Sound sensitivity can be common among individuals with OCD, anxiety disorders, and/or Tourette Syndrome. Misophonia, or “hatred or dislike of sound,” is characterized by selective sensitivity to specific sounds accompanied by emotional distress, and even anger, as well as behavioral responses such as avoidance. This article was initially published in the Summer 2015 edition of the OCD Newsletter. Murphy, MD, MS, University of South Florida Like Nails on a Chalkboard: A Misophonia Overviewīy Adam B.
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