Misophonia

Misophonia (or selective sound sensitivity syndrome) is a disorder of decreased tolerance to specific sounds or their associated stimuli, or cues. These cues, known as "triggers", are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses not seen in most other people. Misophonia and the behaviors that people with misophonia often use to cope with it (such as avoidance of "triggering" situations or using hearing protection) can adversely affect the ability to achieve life goals, communicate effectively, and enjoy social situations. Originating within the field of audiology in 2001, the condition remained largely undescribed in the clinical and research literature until 2013, when a group of psychiatrists at Amsterdam University Medical Center published a detailed misophonia case series and proposed the condition as a "new psychiatric disorder" with defined diagnostic criteria. At present, misophonia is not listed as a diagnosable condition in the DSM-5-TR, ICD-11, or any similar manual, making it difficult for most people with the condition to receive official clinical diagnoses of misophonia or billable medical services. An international panel of misophonia experts has rigorously established a consensus definition of misophonia as a medical condition, and since its initial publication in 2022, this definition has been widely adopted by clinicians and researchers studying the disorder.

When confronted with specific "trigger" stimuli, people with misophonia experience a range of negative emotions, most notably anger, extreme irritation, disgust, anxiety, and sometimes rage. The emotional response is often accompanied by a range of physical symptoms (e.g., muscle tension, increased heart rate, and sweating) that may reflect activation of the fight-or-flight response. Unlike the discomfort seen in hyperacusis, misophonic reactions do not seem to be elicited by the sound's loudness but rather by the trigger's specific pattern or meaning to the hearer. Many people with misophonia cannot trigger themselves with self-produced sounds, or if such sounds do cause a misophonic reaction, it is substantially weaker than if another person produced the sound.

Misophonic reactions can be triggered by many different auditory, visual, and audiovisual stimuli, most commonly mouth/nose/throat sounds (particularly those produced by chewing or eating/drinking), repetitive sounds produced by other people or objects, and sounds produced by animals. The term misokinesia has been proposed to refer specifically to misophonic reactions to visual stimuli, often repetitive movements made by others. Once a trigger stimulus is detected, people with misophonia may have difficulty distracting themselves from the stimulus and may experience suffering, distress, and/or impairment in social, occupational, or academic functioning. Many people with misophonia are aware that their reactions to misophonic triggers are disproportionate to the circumstances, and their inability to regulate their responses to triggers can lead to shame, guilt, isolation, and self-hatred, as well as worsening hypervigilance about triggers, anxiety, and depression. Studies have shown that misophonia can cause problems in school, work, social life, and family. In the United States, misophonia is not considered one of the 13 disabilities recognized under the Individuals with Disabilities Education Act (IDEA) as eligible for an individualized education plan, but children with misophonia can be granted school-based disability accommodations under a 504 plan.

The expression of misophonia symptoms varies, as does their severity, which can range from mild and sub-clinical to severe and highly disabling. The reported prevalence of clinically significant misophonia varies widely across studies due to the varied populations studied and methods used to determine whether a person meets diagnostic criteria for the condition. But three studies that used probability-based sampling methods estimated that 4.6–12.8% of adults may have misophonia that rises to the level of clinical significance. Misophonia symptoms are typically first observed in childhood or early adolescence, though the onset of the condition can be at any age. Treatment primarily consists of specialized cognitive-behavioral therapy, with limited evidence to support any one therapy modality or protocol over another and some studies demonstrating partial or full remission of symptoms with this or other treatment, such as psychotropic medication.