Misophonia

What Causes Misophonia?

Scientists don’t know precisely what causes misophonia, but research suggests that it may be triggered by atypical brain activity that associates unremarkable sounds with a threat. When these sounds are (incorrectly) perceived as a threat, the brain begins to generate a “flight-or-flight” survival response, and negative feelings such as panic and anger result.

Is Misophonia Hereditary?

Researchers have not yet determined which genes or gene variants might contribute to the risk of developing misophonia. One study has found evidence that the condition might run in families, suggesting that it could have a genetic component. However, this study had a very small sample size, and further research is necessary into the possibility that misophonia can be inherited.

How Is Misophonia Detected?

Misophonia most often emerges in childhood or adolescence. It can be difficult for parents to identify early signs of the disorder in children because children may not be able to effectively explain how they are feeling in reaction to triggers.

Potential warning signs of misophonia in children include:

• Extreme sensitivity to sounds
• Irritability or anger in noisy situations
• Removing themselves from situations with triggering sounds (e.g., leaving the room when other people are eating)
• Attempts to avoid situations (e.g., eating in restaurants) where triggering sounds may occur
• Problems in school or with friends

How Is Misophonia Diagnosed?

Misophonia is not yet part of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the reference that psychiatrists and psychologists use to diagnose disorders, and many practitioners are unaware of the relatively recently described condition. Because of this, it may be challenging to obtain a diagnosis of misophonia when you are experiencing symptoms.

Some researchers have proposed diagnostic criteria that describe misophonia and differentiate it from other mental health-related issues. The proposed criteria include:

• A person experiences a negative physical and emotional reaction (e.g., anger) in response to a specific sound produced by another person.
• The reaction produces a feeling of loss of self-control.
• The person realizes that the reaction is out of proportion to the situation.
• The person attempts to avoid the situation or endures it with distress.
• The person’s reactions cause significant distress or impair their ability to function in their daily routines.
• The symptoms are not better explained by another mental health disorder.

How Is Misophonia Treated?

There is no cure for misophonia, but a combination of psychotherapy and other behavioral therapies may help a person with the disorder effectively cope with their symptoms.

Some possible treatment approaches include:

• Cognitive-behavioral therapy. This psychotherapy technique helps a person recognize the sounds and situations that trigger their misophonia and develop strategies to cope with their reactions when those triggers occur.
• Tinnitus retraining therapy. This therapy was developed to help people with tinnitus, a condition causing persistent ringing in the ears. The therapy helps people learn to tolerate distressing sounds, and it may be effective in treating some people with misophonia.
• Coping techniques. This approach encourages a person with misophonia to find techniques or activities that reduce the impact of triggering sounds. These techniques might include using noise-canceling headphones, white noise generators, or music to mask the distressing sounds.

How Does Misophonia Progress?

For some people, the symptoms of misophonia cause only minor annoyance or frustration. Although the symptoms are distressing, they do not cause serious long-term impairments or complications. However, for other people, the emotional reactions caused by misophonia are extreme and may interfere with their ability to function well and maintain healthy relationships.

Possible long-term complications of misophonia include:

• Social isolation
• Aggressive or inappropriate reactions to triggering situations
• Problems in school or at work
• Relationship difficulties
• Other mental health-related issues, such as depression or anxiety

How Is Misophonia Prevented?

There is no known way to prevent misophonia. However, prompt treatment may lessen the impact of symptoms and prevent long-term consequences.

Misophonia Caregiver Tips

Many people with misophonia also suffer from other brain-related issues, a condition called co-morbidity. Here are a few of the disorders sometimes associated with misophonia:

• Some people with misophonia also suffer from anxiety disorders.
• People with obsessive-compulsive disorder (OCD) may be at increased risk for misophonia.
• Misophonia may be associated with Tourette syndrome in some cases.
• Misophonia may be associated with attention-deficit/hyperactivity disorder (ADHD).

Misophonia Brain Science

Researchers have found several distinctions between the brains of people with misophonia and those of people who don’t have the disorder. For example, one study exposed its participants, divided into misophonic and non-misophonic groups, to a variety of sounds, including known misophonia triggers (e.g., lip-smacking), broadly offensive sounds (e.g., people screaming), and neutral sounds (e.g., rain falling). Both groups reacted negatively to the offensive sounds, and neither group responded negatively to the neutral sounds. However, the misophonic group had significant negative reactions (including physical responses such as increased heart rate) to the trigger sounds, while the non-misophonic group did not.

These results appear to confirm that people with misophonia have an actual neurological response to trigger sounds. But what causes it? The study also found people with misophonia, when exposed to trigger sounds, showed increased activity in their anterior insular cortex (AIC), part of the brain responsible for interpreting sensory input and initiating responses to those inputs. In people with misophonia, the AIC seems to be hypersensitive to trigger sounds and, in response to those sounds, it activates other parts of the brain, especially those associated with fear, anger, and other emotions. The unusual sensitivity of the AIC may be one of the underlying causes of misophonic reactions.

Misophonia Research

Title: Exploring the Acceptability and Efficacy of a Transdiagnostic Treatment for Misophonia

Stage: Recruiting

Principal Investigator: M. Zachary Rosenthal, PhD

Duke University 

Durham, NC

Despite increasing recognition of misophonia, there are currently no evidence-based treatments to help those who are suffering. Therefore, the primary purpose of this study is to assess the acceptability, feasibility, and preliminary efficacy of a treatment for misophonia. This study will be conducted in two phases. In Phase 1, participants will receive a treatment the investigators believe can help manage symptoms of misophonia: The Unified Protocol. This treatment uses evidence-based psychological principles (e.g., managing attention or behavior) in a flexible manner and will focus on developing skills to help reduce the distress and impairment associated with Misophonia. After treatment, patients will provide feedback about their experience. The investigators will use this feedback to revise the treatment as indicated. In Phase 2, participants will receive the revised treatment and provide feedback on their experience. Throughout treatment in either phase, participants will provide daily and weekly information about their symptoms.

The aims of this study are (1) to explore the acceptability and feasibility of the Unified Protocol for individuals who experience Misophonia and (2) to examine whether this treatment helps reduce symptoms associated with Misophonia.

Title: Treatment for Youth (Ages 8 to 16 Years Old) With Misophonia (U-HEAR) (U-HEAR)

Stage: Recruiting

Principal Investigator: Adam Lewin, PhD

University of South Florida 

Tampa, FL

If someone is overly sensitive to certain noises and sounds, they might have misophonia. U-HEAR is a study created to determine what helps kids and teens with misophonia. Two treatments are being tested in this study. The treatment children will receive is determined at random. There will be a Two-Thirds (2/3rds or 66%) chance a child will receive a treatment called the Unified Protocol for Children and Adolescents (UP-C/A) that has been modified to meet the needs of youth with misophonia. There is a One-Third (1/3rd or 33%) chance a child will receive a treatment called Psychoeducation and Relaxation. All participants will get ten free treatment sessions. Each session will last one hour and happen once a week. The study aims to evaluate the feasibility and preliminary efficacy of the UP-C/A for youth with misophonia.

Misophonia is a condition characterized by intense affective and/or physical responses to auditory triggers. Negative affective states, including significant distress and avoidance, are characteristic of misophonia. These negative emotional responses to trigger sounds, which result in behavioral problems and impairment, may be the primary targets for effective psychosocial intervention for misophonia. Transdiagnostic treatment approaches address clinically-significant distress through the use of evidence-based, cognitive-behavioral techniques (e.g., mindful awareness, problem-solving, and opposite action strategies) that allow for flexible and personalized treatment of core dysfunctions that cut across emotional disorders and lead to on-going impairment. This type of evidence-based, transdiagnostic approach includes skills applicable for problems observed frequently in misophonia, including adaptability, problem-solving, emotional (arousal) dysregulation, and poor distress tolerance. The hypothesized mechanism of change of these core-dysfunction-focused treatments is increased tolerance of distress in response to strong or intense emotional states. A secondary target is the reduction of maladaptive emotional behaviors (e.g., avoidance, aggression, escape) that may reinforce distress over time. To that end, this proposal aims to evaluate the feasibility and preliminary efficacy of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) for youth with misophonia. We will compare UP-C/A in a 2:1 ratio against a comparison condition (PRT: psychoeducation plus relaxation training), a behavioral approach that represents usual treatment in the community and has been utilized in clinical trials (35% response rate).

Title: Exploring Two Treatments for Misophonia

Stage: Recruiting

Principal Investigator: M. Zachary Rosenthal, PhD

Duke University 

Durham, NC

While the investigators continue to work on better understanding Misophonia, it is also important to identify treatments that can help people currently suffering. Further, the treatments provided must be acceptable to those who receive them. In this study, participants will complete one of two treatments the investigators believe can help manage symptoms of Misophonia: The Unified Protocol or process-based therapy. Both treatments will use evidence-based psychological principles (e.g., managing attention or behavior) in a flexible manner. They will focus on developing skills to help reduce the distress and impairment associated with Misophonia. The aims of this study are (1) to explore the acceptability and feasibility of these treatments for individuals who experience Misophonia and (2) to examine whether these treatments help reduce symptoms associated with Misophonia.