Misophonia

Pawel Jastreboff and Margaret M. Jastreboff coined the term "misophonia" in 2001 with the assistance of classical scholar Guy Lee, introducing it in their article "Hyperacusis", with further explanation in the International Tinnitus and Hyperacusis Society's ITHS Newsletter. "Misophonia" comes from the Ancient Greek words μῖσος (IPA: ), meaning "hate", and φωνή (IPA: ), meaning "voice" or "sound", loosely translating to "hate of sound", and was coined to differentiate the condition from other forms of decreased sound tolerance, such as hyperacusis (hypersensitivity to certain frequencies and volume ranges) and phonophobia (fear of sounds). The term "misophonia" was first used in a peer-reviewed journal in 2002. Before that, the disorder was more commonly called "selective sound sensitivity syndrome", or "4S", a term coined by audiologist Marsha Johnson. Even after the term "misophonia" was coined, 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. Other authors have proposed "Conditioned Aversive Response Disorder" (C.A.R.D.) as a more suitable name, which seeks to incorporate both the respective auditory and non-auditory aspects of misophonia and misokinesia into a single condition. Adopting DSM-5-like terminology, some research groups have also advocated the term "misophonic disorder" to distinguish clinically significant and disabling misophonia from what they term "misophonic reactions" (i.e., sub-clinical manifestations of misophonia that do not cause marked distress or substantially impair a person's daily life, relationships, or activities). and by the primary philanthropic agency funding research into it, The Misophonia Research Fund (MRF), and the term selected for use in an (MRF-funded) project to derive a field-wide consensus definition of the condition for clinical and research use. ==Signs and symptoms==

Misophonia is a disorder of sound tolerance characterized by extreme and disproportionate emotional reactions to specific sounds (or less commonly, visual stimuli) in one's environment, termed "triggers." upon encountering the trigger stimulus. This symptom is often grossly misunderstood and misinterpreted, but not uncommon or unusual. Trigger stimuli are highly varied and sometimes idiosyncratic. Certain stimuli, such as chewing and other oronasal sounds, are among the most commonly reported triggers in both clinically referred and population-based samples. a commonly used misophonia symptom measure, groups misophonia triggers into the following categories: • People making mouth sounds while eating or drinking (e.g., chewing, crunching, slurping). • People making nasal/throat sounds (e.g., sniffing, sneezing, nose-whistling, coughing, throat clearing). • People making mouth sounds when not eating (e.g., flossing, whispering, making the "tsk" sound, heavy breathing, snoring, whistling). • People making repetitive sounds (e.g., typing, tapping nails on a table, pen clicking, writing, construction work, using machinery). • Rustling or tearing objects (e.g., paper, plastic). • Sounds produced during speech (e.g., "p" sounds, hissing "s" sounds, someone speaking with a lisp, high-pitched voices, whispering or mouthing words). • Body or joint sounds (e.g., finger snapping, joint cracking, jaw clicking). • Rubbing sounds (e.g., hands on pants, hands against one another, Styrofoam rubbing together). • Stomping or loud walking (e.g., heels clicking, flip flops, etc.). • Muffled sounds (e.g., voices separated by a wall, TV/music in another room). • People talking in the background (e.g., phone calls in public, many people talking at once, unintelligible whispering). • Repetitive or continuous sounds made by inanimate objects (e.g., clock ticking, air conditioner humming, running water). • Animals making repetitive sounds (e.g., licking, chirping, barking, eating, drinking). • Seeing someone making or about to make a specific sound that causes distress, even if the sound itself isn't audible (e.g., seeing someone reach into a bag of chips, seeing someone eating on TV with the volume off). Although less well studied, reported visual triggers in misokinesia include another person's repetitive movements (foot/leg shaking, arms swinging, hands rubbing together, hair twirling, fidgeting), as well as the sight of an auditory trigger that one cannot actually hear (such as someone chewing with their mouth open or tapping their fingers on a desk). are as follows: • Internalizing appraisals such as self-critical thoughts, feeling guilty about one's reactions, and feeling ashamed for reacting to triggers • Externalizing appraisals such as blaming others for making triggering sounds, feeling that others are being selfish or disrespectful, and believing that specific sounds are "just bad manners" and should never be made by anyone • Anxiety/avoidance responses such as isolating oneself, moving away from the sound, or limiting opportunities to avoid potential trigger exposure • Feeling threatened/overwhelmed such as feeling trapped, having thoughts of helplessness, or panicking when one can't escape a trigger • Aggressive outbursts such as yelling, screaming, pushing, hitting, throwing things, or (rarely in adults) becoming physically violent People with misophonia, particularly adults, are typically aware that their emotional reactions and behaviors in response to triggers are disproportionate to the situation, ==Diagnosis and assessment==

In 2022, clinical and scientific leaders convened to create a consensus definition of misophonia, there is no scholarly consensus about diagnostic criteria or assessment procedures for misophonia. OCD, and depressive disorders. Misophonia is distinguishable from hyperacusis, which is not specific to a given sound and need not involve a similarly strong emotional reaction, and from phonophobia, the fear of sounds, When attempting to diagnose a patient with misophonia, doctors sometimes mistake its symptoms for an anxiety disorder, bipolar disorder, obsessive-compulsive disorder, or obsessive-compulsive personality disorder. Due in part to the need for differential diagnosis with other psychiatric and audiological conditions, academic commentaries make various recommendations regarding misophonia assessment, including that misophonia diagnoses be made by multidisciplinary groups and draw upon multiple sources of data. Classification The diagnosis of misophonia is not recognized in the DSM-5-TR or the ICD-11 and it is not classified as a hearing or psychiatric disorder. The consensus among misophonia experts is that the relationship between misophonia and other conditions is unclear. A 2021 review of misophonia and hyperacusis measures found only three misophonia instruments with reported psychometric properties, all of which were adult self-report measures; the review called the evidence regarding the measures' psychometrics "limited". Further unvalidated misophonia questionnaires are available on the internet. More recently, self-report and caregiver proxy-report measures to assess misophonia in children and youth have begun to appear in the scholarly literature. At least one study uses interviews with caregivers, and sometimes their children, to assess misophonia in children and adolescents. Another relatively novel development in misophonia assessment is a psychoacoustic measure, which uses adults' self-reported ratings of the pleasantness of sounds to identify a set of sounds that appear to distinguish between people with and without misophonia. Due to the difficulty of distinguishing misophonia from other psychiatric and audiological conditions, it is unclear whether any single tool can be relied upon to diagnose misophonia. It has been suggested that assessment should involve collection of multiple sources of data, such as patient case histories, interviews, audiological examination, and self-report tools. ==Management==

Despite high demand in the community, there has been relatively limited research into misophonia treatment and intervention, Indeed, no misophonia treatments or interventions currently qualify as evidence-based. one of them a randomized clinical trial, Several case reports on third-wave psychotherapies such as DBT or ACT have found preliminary evidence of possible benefits. which may suggest that at least some level of avoidance is beneficial. There are other approaches to management and coping; some people with misophonia mimic trigger sounds, either to retaliate or cancel them out in a way they can control. People with misophonia may attempt cognitive strategies such as self-talk and diverting their attention. Relaxation is also commonly attempted. Participants in a CBT program considered relaxation, training to shift attention away from triggers, and peer support the most successful parts of the intervention. Given the limited nature of the misophonia intervention evidence base, it has been suggested that providers work collaboratively and flexibly with patients to identify strategies that are useful to them. It is speculated that treatment methods vary significantly in effectiveness from patient to patient. Where there are gaps in the misophonia-specific literature, transdiagnostic research on interventions found to be efficacious or effective for other conditions may be relevant. Multidisciplinary treatment approaches, incorporating insights from diverse experts such as audiologists, mental health professionals, and occupational therapists, may also improve the quality of support. ==Mechanism==

The mechanism of misophonia is not yet fully understood, and all proposed causes of the disorder are hypothesized based on a combination of clinical observation and the limited existing empirical research. suggesting that any "auditory" abnormalities may be caused by a dysfunction of the central auditory system or other parts of the brain that govern "higher-order" perceptor or cognition, rather than the ears per se. An unpublished study suggests a genetic locus is associated with responses to a single question asking about the misophonic symptom of experiencing rage to sounds of people chewing. "Neurophysiological" (Jastreboff) model The first mechanistic theory of misophonia, proposed by Jastreboff and Jastreboff in 2014, is based on the authors' clinical experience and little empirical data. This model, which the authors call the "neurophysiological model", The Jastreboffs' neurophysiological model posits that the fundamental difference between misophonia and hyperacusis is that decreased sound tolerance in hyperacusis is closely coupled to the physical properties of the sound stimulus (i.e., intensity, frequency) while, in misophonia, decreased tolerance of "trigger" sounds has little to do with acoustic properties (beyond louder sounds perhaps being easier to perceive and respond to) Its creators have used this model to explain certain aspects of the misophonia phenotype, such as that most people with misophonia do not present with peripheral hearing loss and that context (including whether a trigger is produced by oneself) plays a large role in response to a trigger sound. indicate that (a) their activation may be driven by other pathways than simple auditory→limbic or auditory→limbic→autonomic hyper-connectivity and (b) additional structures outside of the Jastreboffs' model (such as premotor cortex) may play a central role in this disorder. The "neurophysiologic" model has also been criticized by other theorists for its vagueness and unwillingness to specify the specific neural structures/processes involved in the "limbic system" portion of the model, as well as its inability to account for non-sound trigger stimuli. "Action perception" (Berger-Gander-Kumar) model A more recently developed model of misophonia was published by neuroscientist Sukhbinder Kumar and colleagues at the University of Iowa in 2024. (alternatively the Berger-Gander-Kumar model), sought to build on the perceived shortcomings of earlier models Based on what is known from neuroimaging and behavioral studies of misophonia, the action perception model conceptualizes the disorder as follows: • The aberrant motor representation conveys an abnormally strong signal to the (anterior) insular cortex, which is then hyperactive relative to non-misophonic controls. and whether the source can be identified appear to be among the largest drivers of the severity of a given misophonic reaction. engage in mimicry (deliberate or unconscious imitation of the trigger sound). As the anterior insula is engaged when counter-imitating an action (i.e., performing the opposite of the imitated movement), Kumar and colleagues theorize that this mimicry conveys an "error signal" that helps inhibit the hyperactive insular cortex involved in the triggering process, thereby reducing the intensity of the misophonic response. is also an area for future research to explore and test the model. The evidence supporting the action perception model is essentially correlational, not causal; that is, it is unclear whether motor representations cause misophonic reactions or misophonia is a primarily auditory experience sometimes accompanied by motor representations. ==Epidemiology==

Research is still being conducted on misophonia's global prevalence, and studies of misophonia's prevalence vary considerably. Medscape, and Medical Xpress. A household interview study in Ankara, Turkey, reported a slightly lower prevalence of 13%. Authors of both German studies discussed the possibility that misophonia may be less common in Germany than in countries like Turkey or the U.S. Methodological explanations for the studies' divergent results cannot be ruled out. and 24% among Iranian university students. Misophonia symptoms may vary along a continuous spectrum, with varying proportions of people experiencing few or no, mild, moderate, or severe symptoms. Accordingly, the consensus definition of misophonia recognises that misophonia severity and expression vary. Although some studies report the prevalence and severity of misophonia are similar across genders, others report women are more likely to have misophonia than men. At least among youth and adults, younger age may be related to higher levels of misophonia symptoms, though other studies find no relationship between age and misophonia. ==Associated experiences==

There is some indication that misophonia may be related to the experience of autonomous sensory meridian response (ASMR), or auto-sensory meridian response, a pleasant form of paresthesia, a tingling sensation that typically begins on the scalp and moves down the back of the neck and upper spine. ASMR is described as the opposite of what can be observed in reactions to specific audio stimuli in misophonia. Studies have reported high prevalence of ASMR in people with misophonia. Other research shows no relationship between ASMR and misophonia. Further, in the auditory modality, misophonia also appears to be related to other forms of sound intolerance. Many people with hyperacusis experience co-occurring misophonia Moreover, several studies suggest that people with misophonia are more likely to have emotion regulation difficulties. Misophonia has also been linked to behavioural impulsivity. Several studies also link misophonia to anxiety. Higher levels of perfectionism have been reported in people with misophonia. Misophonia has been linked to obsessive-compulsive disorder (OCD). Not-just-right experiences also appear to be more common in people with misophonia. ==Society and culture==

People who experience misophonia have formed online support groups. Nonprofit organizations such as soQuiet, Misophonia Hub, and Teens for Education + Advocacy for Misophonia (TEAM) actively share resources for people affected by misophonia. In 2025, Duke University's Center for Misophonia and Emotion Regulation (CMER) partnered with the Italian Misophonia association, TEAM, Swansea University, and others to host a research workshop called PRIMER for high school students to gain knowledge in the science of misophonia, conduct of human research, and project development. In 2016, a documentary about the condition, Quiet Please, was released. In 2020, a team of misophonia researchers The 2022 film Tár depicts a conductor with misophonia. Notable cases • Melissa Gilbert • Richard E. Grant • Glenn Howerton • Barron H. Lerner • Lisa Loeb • Melanie Lynskey • Laila McQueen • Kelly Osbourne • Kelly Ripa • Sarah Silverman • Pharrell Williams • January Jones == See also ==