Misophonia: A new mental disorder?
Introduction
We live in an era in which the major psychiatric classification systems, such as the successive editions of DSM, have been steadily expanding in the number of phenomena that are considered to be mental disorders. This has led to a growing concern that commonplace quirks, eccentricities, or problems of living are becoming over-pathologized and over-diagnosed as mental disorders [1], [2], [3]. Accordingly, there is good reason to be skeptical when some new psychiatric disorder is proposed. The purpose of this article is to critically examine the evidence for a purportedly new mental disorder, misophonia, characterized by marked distress from hearing particular sounds. Misophonia is not listed in any of the major psychiatric classification systems and, until recently, has received little attention from psychiatric researchers, having been described almost exclusively in the audiology literature.
The question of whether misophonia, or some syndrome in which misophonia is a prominent feature, should be classified as a mental disorder is important for several reasons. The recognition of misophonia as a distinct mental disorder, if indeed it is a disorder, could facilitate recognition of the condition to health-care providers, raise public awareness, provide information and validation to sufferers (i.e., the positive effects of labeling), and could facilitate research and treatment. A disadvantage in classifying misophonia as a mental disorder is the possibility of stigmatizing and over-pathologizing possibly benign eccentricities (i.e., negative effects of labeling). Accordingly, it is important to carefully consider whether misophonia meets criteria for a mental disorder, and whether there is sufficient evidence for clearly specifying its essential features and delineating the boundaries of any syndrome of which it might be a part.
This article begins by defining misophonia and related concepts, and by distinguishing it from other phenomena, particularly phenomena arising from dysfunctions of the primary auditory system. This is followed by a review of the common features of misophonia, as described by case studies, case series, and larger investigations. Theories of misophonia are also discussed. Such theories are relevant to the question of whether misophonia is a mental disorder because if it is such a disorder, then it should arise from a psychobiological dysfunction as opposed to some other (e.g., purely audiological) dysfunction. General considerations for diagnosing mental disorders are considered followed by a critical review of the proposals regarding the diagnostic classification of misophonia. Finally, a roadmap for further research is discussed, including research strategies for evaluating the clinical utility of misophonia, or some variant thereof, as a mental disorder.
Section snippets
Definition of concepts
Originally described in the audiology literature, misophonia (literally “hatred of sound”) refers to a strong dislike of sounds—particularly oral and nasal sounds produced by other people—accompanied by unusually intense, distressing emotional reactions [4]. Misophonia has also been called “selective sound sensitivity syndrome” and “soft sound sensitivity syndrome” [5]. The latter term emphasizes the finding that some of the distressing sounds in misophonia are soft rather than loud.
Misophonia
Empirical studies
Descriptive data for the present article were obtained from published case studies, case series, and experimental investigations reporting data on cases classified as having misophonia, as identified in searches of PsychInfo and Medline up to March 1, 2017, using the search terms “misophonia”, “selective sound sensitivity” and “soft sound sensitivity syndrome”. Reference lists of source articles were also searched, along with review articles.
A total of 19 misophonia clinical investigations
Etiological hypotheses
If misophonia is to be classified as a mental disorder, then this carries the assumption that the disorder arises from some type of psychobiological dysfunction. Accordingly, etiological hypotheses are relevant as to how misophonia should be classified.
Diagnostic considerations
There are several important considerations in deciding whether or not a particular diagnostic construct should be included in a diagnostic classification system.
RDoC and misophonia
If the promise of RDoC is fulfilled and it becomes viable as a clinical diagnostic system, the most likely result is that misophonia (and perhaps many other disorders classified in ICD and DSM) would not be diagnostic classifications. Instead the diagnosis would be based on the underlying mechanisms; for example, a diagnostic formulation might be “Mr. A. presents with intense distress when he hears other people chewing. Biometric assessment reveals dysregulation in brain circuits x, y, and z.”
Development and refinement of assessment instruments
In order to establish whether misophonia is a stand-alone disorder or part of a broader syndrome of sensory intolerance, it is important to develop reliable, valid measures of misophonia and other forms of sensory intolerance. Questionnaire measures have been developed for research purposes [29], [43], and a structured clinical interview has been developed, adapted from a measure of OC symptoms [15]. The psychometric properties of these instruments have yet to be firmly established. Most
Conclusion
Misophonia meets many of the general criteria for a mental disorder and there is preliminary evidence as to its clinical utility. Schröder et al. [15] proposed that misophonia be regarded as a new diagnostic category, related to OC disorders. A review of the evidence indicates that this proposal is premature, and that Schröder’s proposed diagnostic criteria overstate the importance of anger, to the relative neglect of other emotional reactions, and fail to adequately capture the clinical
Declaration of interests
The author declares no conflict of interest.
References (66)
- et al.
Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis
Handbook Clin Neurol
(2015) - et al.
Misophonia: a disorder of emotion processing of sounds
J Neurol Neurosurg Psychiatry
(2014) - et al.
Intensive cognitive-behavioral therapy for comorbid misophonic and obsessive-compulsive symptoms: a systematic case study
J Obsessive-Compulsive Rel Disord
(2016) The effect of visual stimuli on the horribleness of awful sounds
Appl Acoust
(2008)- et al.
Sensory intolerance: latent structure and psychopathologic correlates
Compr Psychiatry
(2014) - et al.
Toward a theoretical model of misophonia
Gen Hosp Psychiatry
(2015) - et al.
Sensory over-responsivity, psychopathology, and family impairment in school-aged children
J Am Acad Child Adol Psychiatry
(2011) - et al.
Sensory over-responsivity: a diagnosis whose time has come?
J Am Acad Child Adol Psychiatry
(2011) - et al.
The future of selective serotonin reuptake inhibitors (SSRIs) in psychiatric treatment
Med Hypoth
(2006) - et al.
Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood
Clin Psychol Rev
(2015)
The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder
Shyness: how normal behavior became a sickness
What is mental illness? Cambridge
Decreased sound tolerance and tinnitus retraining therapy (TRT)
Aust NZ J Audiol
“Mastication rage”: a review of misophonia—An under-recognised symptom of psychiatric relevance?
Aust Psychiat
Insights from the First International Conference on Hyperacusis: Causes, evaluation, diagnosis and treatment
Noise Health
Audiometric characteristics of hyperacusis patients
Front Neurol
Behavioral models of tinnitus and hyperacusis in animals
Front Neurol
Counterconditioning treatment for misophonia
Clin Case Studies
Case series: sensory intolerance as a primary symptom of pediatric OCD
Ann Clin Psychiatry
Pediatric misophonia with comorbid obsessive–compulsive spectrum disorders
Gen Hosp Psychiatry
A compelling desire for deafness
J Deaf Stud Deaf Ed
Hyperacusis and misophonia: the lesser-known siblings of tinnitus
Minnesota Med
Misophonia: diagnostic criteria for a new psychiatric disorder
PLoS ONE
Selective sound sensitivity syndrome (misophonia) in a patient with Tourette syndrome
J Neuropsychiatry Clin Neurosci
Cognitive-behavioral therapy for 2 youths with misophonia
J Clin Psychiatry
Should we screen for misophonia in patients with eating disorders? A report of three cases
Int J Eating Disord
When selective audiovisual stimuli become unbearable: a case series on pediatric misophonia
Neuropsychiatry
Selective sound intolerance and emotional distress: what every clinician should hear
Psychosom Med
Hatred of sounds: misophonic disorder or just an underreported psychiatric symptom?
Ann Clin Psychiatry
Misophonia: Physiological investigations and case descriptions
Frontiers Hum Neurosci
A brief course of cognitive behavioural therapy for the treatment of misophonia: a case example
Cog Beh Ther
Cited by (64)
A neuropsychological study of misophonia
2024, Journal of Behavior Therapy and Experimental PsychiatryFactors associated with internalizing and externalizing symptoms in a clinical sample of youth with misophonia
2023, Journal of Obsessive-Compulsive and Related DisordersMindfulness and cognitive emotion regulation in pediatric misophonia
2023, Journal of Contextual Behavioral ScienceA systematic review of treatments for misophonia
2023, Personalized Medicine in PsychiatryDevelopment and psychometric exploration of a semi-structured clinical interview for Misophonia
2022, Personality and Individual Differences