Misophonia Research Takes Another Leap Forward

This past year there has been significant advancement in misophonia research. The research is more cohesive and reflects a greater understanding of the underlying mechanisms of misophonia, as well as new ideas about treatment. We are seeing the beginning of work related to adolescents, as well as new ideas about misophonia trigger sounds. I will review the highlights of current research.

Misophonia and Brain Processes

Following up on earlier work, Dr. Sukhbinder Kumar (Iowa Carver College of Medicine) researched mimicry in misophonia. Dr. Kumar theorized that an overabundance of mirror neurons may compel the individual to mimic. The mirror neuron hypothesis gives us a brain-based reason for this drive, taking it out of a purely behavioral paradigm. Kumar and colleagues set out to quantify the percentage of people who experience misophonia who use mimicry. Data demonstrated that almost half of individuals with misophonia reported using mimicry. In addition, the tendency to mimic is directly correlated with misophonia severity, with chewing sounds more likely to cause mimicking. Finally, individuals with misophonia reported that mimicking provides some degree of relief from distress. Dr. Kumar’s theoretical framework of misophonia suggests that mimicry (as an action) may be modified to help those with misophonia relieve distress.

Misophonia, Psychology, and Psychiatry

Dr. Julia Simner (University of Sussex) researched self-harm and suicidal ideation. Dr. Simner’s work strongly highlights the need for more research in this area, as well as support for young people with the disorder. Using a cohort of children born in the 1990’s, the researchers looked at the data for well-being, self-harm, and suicidal ideation. Adults with misophonia demonstrated poorer scores on numerous measures related to general well-being, as well as self-harm and suicidal ideation. Females appear to be at a higher risk early in their teenage years, whereas males demonstrate a higher risk at age 24. While this and related studies out of the University of Sussex call attention to the great need for screening for those with misophonia, other factors may have contributed to findings, such as the fact that this cohort grew up without any recognition of their disorder (prior to misophonia being termed in 2001).

Dr. Zach Rosenthal (Duke Center for Misophonia and Emotion Regulation) looks at the relationship between misophonia, trauma, and stress. 3.5 % of adults with misophonia had a current diagnosis of PTSD, and 21.7% had a history of PTSD during their lifetime. According to Dr. Rosenthal, this is slightly higher than one would expect in the general population. However, the experience of high daily stress was more directly correlated with misophonia than was age, sex, number of stressful lifetime events, acute stress related to the pandemic, and total PTSD symptoms. Researchers also used network analysis to determine that within PTSD symptoms, hyperarousal was the one connected to misophonia.

Dr. Jane Gregory (Oxford University) researched various interventions to help those with misophonia. Dr. Gregory, a misophonia sufferer herself (and a researcher and clinician), discussed therapist guidelines for misophonia treatment and offered excellent advice for individuals looking for therapy. First, misophonia has layers, including the neurological, the physical, the emotional, and the cognitive components. Dr. Gregory stated that it is the therapist’s job to be flexible and offer different strategies in therapy, while assessing whether improvement is taking place. Therapists should be able to refine and alter strategies that are not working. She also pointed out that traditional exposure therapy is contraindicated in misophonia. Finally, although coping skills are difficult to develop and maintain in misophonia, she reassured us that change is possible!

Misophonia and Co-occurring Symptoms & Disorders

Dr. Jamie Ward's (University of Sussex) research uses a symptom network model to explain why misophonia co-occurs with other disorders. Symptom network modeling assumes that disorders arise from an interaction of traits that occur in the general population and across different diagnoses. In symptom network modeling, transdiagnostic symptoms will appear as an inter-connected hub with some symptoms/traits closely connected to misophonia and others distant. Therefore, more severe misophonia will have a wider reach in the network. In this study, the severe group had autistic traits, obsessive-compulsive traits, anxiety sensitivity, and migraine with visual aura, elevated attention to detail, and hypersensitivity across multiple senses. The moderate group was also elevated in attention to detail and sensory sensitivity, but not other clinical traits. This study tells us that those with severe misophonia may be characterized as having multiple sensory sensitivities and a higher number of clinically significant symptoms/traits of other disorders across disciplines. According to Dr. Ward, the data suggest that sensory over-responsivity (and pain associated with sensory stimuli) is a central trait in misophonia and may explain the negative impact seen on mental health.

Misophonia and Audiology

Dr. Savvas Kazazis (McGill University) researches how sound itself organizes our perceptions. That is, we process sound from the bottom up. We hear a sound and perceive its meaning based on our experiences, memory, and other basic mechanisms that have been preserved by evolution. Dr. Kazazis sought out to see if modifying elements of sound would change perception and adverse reactivity. Dr. Kazazis looked at spectral information of sound, which refers to the frequencies that make up a sound. Think of the “tone of a piano versus nails screeching on a chalkboard.” He also looked at temporal information, which refers to the timing and rhythm of sounds. Temporal modifications did not reduce aversive responses to trigger sounds compared to the unmodified stimuli when the spectrum was kept intact. That is, changing the rhythm of a sound did not change its aversive nature to those with misophonia if the spectral information was unchanged. These findings suggest that the spectral information is more important than the temporal organization in terms of how disturbing a particular sound is to those with misophonia.

Summary

It is great to see researchers working together in a coordinated matter to advance the field. Of note over this past year are findings that clarify our understanding of co-occurring disorders and perhaps emphasize how important it is to view misophonia as a disorder that crosses multiple disciplines. We see a high co-occurrence of hyperacusis and tinnitus in the auditory realm. From the mental health and developmental disorders domains we see that sensory over-responsivity (sensory sensitivity) is a common trait in misophonia, and that while chronic stress is related to misophonia, misophonia is not highly correlated with PTSD diagnostically. It is also encouraging to see researchers agreeing that habituation-based exposure therapy does not work for misophonia and moving on together to trials of other interventions.