Stop That Noise!
Misophonia can cause real distress. Yet very little is known about it.
Posted December 19, 2018
You might have been annoyed by the occasional pen-tapper in a meeting, or the rude table partner who chews loudly. I’ve had some fussy guests in my apartment for whom I had to put my wall clock away because its tick-tack was too loud for them to fall asleep.
What is Misophonia?
Now, imagine if there certain sounds that will trigger your anxiety to high levels, and make you have a negative emotional and physical reaction. This is a real condition that receives a few different names, but in 2001 it was defined as misophonia and described by Margaret and Pawel Jastreboff.
Misophonia means aversion to sound. Patients live in a permanent state of anxiety, as they are hyperalert, trying to identify the trigger sound that will prompt their misophonic response. This causes a significant level of stress and reduction in the quality of life.
Research in misophonia is quite recent and mainly started during the 2000s. A very recent study from last year tried to go into more depth and unravel the neurobiological underpinnings of misophonia.
The Neurobiology of Misophonia
Kumar and collaborators published studies in Current Biology on misophonic patients, using fMRI. Patients and healthy people (control group) were presented with trigger sounds, unpleasant sounds (but not related to the triggering of misophonia), and neutral sounds. Trigger sounds were repetitive sounds that have been reported by misophonic patients to be a cause of their discomfort, such as pen clicking, breathing or chewing sounds. The so-called unpleasant sounds, such as a baby cry or a scream, and the neutral sounds, like rain, are not reported to cause misophonic responses.
Though both triggers and unpleasant sounds may appear annoying to the average listener, the misophonic brain reacts quite differently, according to the findings of Kumar and colleagues.
They found that misophonic patients had higher activation of the anterior insular cortex (AIC), and abnormal connections between this region and others, such as the ventromedial prefrontal cortex, posteromedial cortex, amygdala and hippocampus, all of them involved in regulating and processing emotions. The control group didn’t show any special reaction to trigger sounds. Both control and misophonic group didn’t react to unpleasant or neutral sounds.
AIC is implicated in salience network, which is in charge of discerning which stimuli (sounds in this case) are worth our attention. This may be the reason for why someone with misophonia gets fixated in the trigger sound, and the extreme difficulty for the patient to escape it. The high activation of the AIC in misophonic patients represents a catch-22 situation: while the trigger sound is present, AIC will be active, prompting the patient to pay attention to the trigger sound, worsening the misophonic response.
Is There an Effective Treatment?
Kumar’s study was initially argued by Schroder and collaborators not long after it was published, and questioned whether the patients that they examined actually suffered from misophonia. The controversy that rose was mainly rooted in the fact that, at the time and still, there is no consensus on diagnosing misophonia.
The IMRN (International Misophonia Research Network) Advisory Board has been working towards clarifying preliminary research findings, as well as cross-disciplinary terms, in order to make misophonia diagnosis easier.
At the moment, the most promising treatment consists of a combination of CBT (Cognitive Behavioral Therapy), a physiologically-based therapy that helps self-regulation (i.e. Occupational Therapy) and supportive counseling. Generation of white noise to deviate the attention from the trigger sound seems to have helped some patients. Nevertheless, as Dr. Jennifer Jo Brout, member of the IMRN Advisory Board, points out misophonia research is at very preliminary stages and is limited, not by a lack of awareness or interest, but by funding. Dr. Jo Brout also warns that current published research must be taken with a grain of salt. Misophonia studies as of today have been done in small sample sizes (e.g. few participants were included), and often not randomly selected (e.g. all from the same clinic).
What clinicians and researchers agree on is that misophonia is real. Misophonia goes beyond simple annoyance that any of us could feel when sitting with the above-mentioned noisy chewer, or the loud-breather at the theater. Misophonia can cause real distress on the sufferer, like any other auditory-based disorders such as tinnitus , or hyperacusis , but it is important to be able to discern the condition that the patient shows.
Efficient classification of misophonia will help physicians to recognize this disorder in patients, and thus assist them accordingly to find the best way of support. Quality of life can be affected in many ways, and none are to be disregarded, especially if they affect the emotional well being of the patient.
Helpful links recommended by Dr. Jo Brout
Brout JJ, Edelstein M, Erfanian M, Mannino M, Miller LJ, Rouw R, Kumar S, Rosenthal MZ. (2018) Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda. Front Neurosci. 12:36. doi: 10.3389/fnins.2018.00036
Jastreboff, M. M., and Jastreboff, P. J. (2001). Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia. ITHS News Lett. 2, 5–7.
Kumar, S., Hancock, O. T., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., et al. (2017). The brain basis for misophonia. Curr. Biol. 27, 527–533. doi: 10.1016/j.cub.2016.12.048
Schröder A, van Wingen G, Vulink NC, Denys D. (2017). Commentary: The Brain Basis for Misophonia. Front Behav Neurosci. 11:111. doi: 10.3389/fnbeh.2017.00111.