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What Was the Original Theory of Misophonia?

Misophonia was not originally conceptualized as a psychiatric disorder

Almost every article about misophonia begins like this:

“Misophonia, which means ‘hatred of sound” was termed by Jastreboff and Jastreboff in 2001.”​

HolgersFotografie/Pixaby used with permisson
Source: HolgersFotografie/Pixaby used with permisson

After this cursory mention of the Jastreboff’s and their role in naming misophonia, academic authors often jump to their own interpretations about the disorder. This leaves readers wondering why these two esteemed doctors at Emory University thought to conceive of a new disorder in the first place.

In order to comprehend a newly proposed disorder, it is important to understand its history. If we don’t, members of the medical community often regard these disorders as "unreal" because descriptions of them have been haphazardly built out of ambiguous bits of information that ultimately don’t add up to anything grounded in theory. I like to call this process the “dominos of disbelief”. Misophonia is a very real condition that has unfortunately fallen victim to this phenomenon. In order to help put together the puzzle pieces of misophonia, let’s talk about the conception of the disorder, and the doctors who named it.

While working in their audiology clinic, the Jastreboff’s (who happened to be married) observed that some people reacted to sounds, such as chewing, pencil tapping, keyboard typing, and coughing, with high levels of irritability, sometimes to the extent of rage, or disorientation. This group of patients responded to “repetitive" and “pattern based noises.”

Unlike their patients with hyperacusis (a disorder in which individuals feel pain in response to loud sounds), individuals with misophonia appeared to respond to “repetitive” and pattern-based sounds with autonomic arousal. That is, upon presentation of such stimuli, patients reported rising stress levels (such as elevated heart beat, muscle tension and sweating) along with strong negative emotions. This was different from what the Jastreboffs had seen with regard to other forms of “decreased sound tolerance” such as tinnitus (ringing in one or both ears), hyperacusis, and phonophobia (fear of sound often secondary to hyperacusis).

Due to the high cost of research the Jastreboffs did not study their misophonia theory, but ventured to begin treatment at their clinic based on methods previously used for tinnitus and hyperacusis. Since then a small body of academic literature coupled with a great deal of popular press has emerged replete with consistent misunderstandings about the Jastreboff’s original concepts. Lets begin to set the record straight.

Although the Jastreboff’s suggested that misophonia involves negative associations between auditory, cognitive and emotional areas of the brain, they did not view misophonia as a “psychiatric disorder” and certainly not any specific one such as Obsessive Compulsive Disorder (personal communication, 2015). Similarly, the Jastreboff’s ideas about misophonia treatment were based on neuroplasticity (the brains ability to reorganize itself based on making new associations). This treatment has its roots in their tinnitus and hyperacusis retraining therapy. It is not simply “exposure therapy” as it is often described. Unfortunately, both research and treatment has followed some of these misconceptions.

Taking this step back, how should we conceptualize misophonia? I think a judicious way to describe the disorder is as one in which auditory stimuli provokes a neurophysiological response with accompanying negative, emotions, cognitions and behavior. Misophonia should not be referred to as a psychiatric disorder.

How should therapists treat misophonia? Therapists and doctors must be very clear that treatments are all experimental at this point and that efficacy studies will hopefully ensue. Therapists can also help sufferers cope by consulting and communicating with other clinicians across disciplines, and taking the initiative to utilize individualized strategies for each client.

Most of all, therapists and doctors can help by taking the time to learn about this easily misunderstand disorder, and sharing this knowledge with misophonia sufferers. As a psychologist who has misophonia (and who has raised a child with the disorder) I know this: In the case of misophonia knowledge may not be “power” but it can help take some of the “power” out of the disorder.

For more information about misophonia research

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