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Misophonia is a common condition that causes significant distress and impairment for patients and families. Despite the growing body of literature, most treatment descriptions do not incorporate objective assessment measures or detail techniques to involve family members in addressing misophonia. This case report provides a step-by-step family-based cognitive-behavioral approach to treat youth with misophonia, uses objective rating scales to monitor therapeutic improvement, and elicits feedback on the therapeutic skills used between therapy sessions. It also provides guidance on implementing inhibitory learning exposures for youth with misophonia.

Purpose: Misophonia is a condition in which individuals experience negative reactions, including anger and disgust, to specific sounds in their environment. Individuals with misophonia often report feelings of anxiety and a reduced quality of life. While there is no cure for misophonia, there are management protocols supported by case studies in the literature, including tinnitus retraining therapy (TRT) and Misophonia Management Protocol (MMP), along with coping strategies. The purpose of this case study is to contribute to the field of clinical research on patients with misophonia. Method: Case studies involving misophonia are limited, and further research in this area is needed to provide evidence-based treatment. This case details misophonia questionnaires and assessment, case formulation, and management of misophonia in an 11-year-old girl, using a variation of both the TRT and MMP, including ear-level sound generators and coping strategies. Conclusions: This case serves as a contribution to the evidence base for the use of sound therapy and coping strategies in the treatment and management of misophonia, as well as tools that are available in diagnosing misophonia. Clinical implications reveal sound therapy and coping strategies as a means to manage misophonia symptoms. Further research is needed for large-scale data to be available.

Misophonia involves a strong emotional response to certain sounds and can cause significant distress and functional impairment. The aim of this study was to present and psychometrically evaluate a new, multidimensional measure of misophonia, the S-Five. The study also aimed to present and test a supplementary tool, a checklist of triggers that measure the nature and intensity of reactions. The stages of development for the measure are described. Psychometric testing on the final version of the tool was conducted using a sample of 828 individuals who identified with having misophonia. Analyses included factor structure assessment, measurement invariance testing, reliability (test–retest and internal consistency), and (concurrent) convergent validity assessment. Five factors emerged in the S-Five as dimensions of the experience of misophonia: internalising appraisals, externalising appraisals, sense of emotional threat, outbursts, and impact. No measurement bias was identified with respect to gender and age. All reliability and validity indices were satisfactory. The S-Five is a multidimensional measurement scale with satisfactory psychometric properties and will be a valuable tool for improving understanding of misophonia in research and clinical settings.

Stimulating the Vagus nerve helps maintain the autonomic tone, indicating stabilising any hyperactivity in the nervous system. The vagus nerve stimulation is applied in individuals with seizures, depression, sepsis, pain, obesity, cardiovascular disease, lung disease, diabetes, stroke, and traumatic brain injury. Auditory neuroscience has been widely applied in individuals with tinnitus and has been demonstrated as a successful neuromodulation technique. Individuals with peripheral lesions of the hair cells induce a maladaptive change in the plasticity resulting in hyperactivity in the auditory and non-auditory structures. In order to reduce this hyperactivity, neuromodulation techniques such as; transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, transcranial random noise stimulation, neurofeedback, epidural and subdural cortical and deep brain stimulation. The vagus nerve stimulation is also one form of neuromodulation technique considered to reduce the symptoms of tinnitus. It is believed that the ramus Auricularis Nervi vagi, an afferent sensory branch of the vagus nerve, innervates the afferent sensory branch of the vagus nerve, the ramus auricularis nervi vagi also innervate the outer ear canal and parts of the auricle. This auricular branch of the vagus nerve also called Arnold's nerve, which gives a projection to the nucleus of the solitary tract. The vagus nerve stimulation in individuals with tinnitus works to activate the auricular branch of the vagus nerve to reduce its symptoms. A similar principle of vagus nerve stimulation can be tried upon in individuals with misophonia. Literatures states that individuals with misophonia have hyperactivity in their non-classical auditory pathway that can be suppressed with the help of vagus nerve stimulation. The article discusses the possible effects of vagus nerve stimulation in individuals with misophonia.

Hyperacusis is highly prevalent in the autism spectrum disorder (ASD) population. This auditory hypersensitivity can trigger pragmatically atypical reactions that may impact social and academic domains. Objective: The aim of this report is to describe the relationship between decreased sound tolerance disorders and the ASD population. Topics covered: The main topics discussed include (1) assessment and prevalence of hyperacusis in ASD; (2) etiology of hyperacusis in ASD; (3) treatment of hyperacusis in ASD. Conclusions: Knowledge of the assessment and treatment of decreased sound tolerance disorders within the ASD population is growing and changing.

Misophonia is characterised by a low tolerance for day-to-day sounds, causing intense negative affect. This study conducts an in-depth investigation of 35 misophonia triggers. A sample of 613 individuals who identify as experiencing misophonia and 202 individuals from the general population completed self-report measures. Using contemporary psychometric methods, we studied the triggers in terms of internal consistency, stability in time, precision, severity, discrimination ability, and information. Three dimensions of sensitivity were identified, namely, to eating sounds, to nose/throat sounds, and to general environmental sounds. The most informative and discriminative triggers belonged to the eating sounds. Participants identifying with having misophonia had also significantly increased odds to endorse eating sounds as auditory triggers than others. This study highlights the central role of eating sounds in this phenomenon and finds that different triggers are endorsed by those with more severe sound sensitivities than those with low sensitivity.

Although misophonia is not yet included in the primary diagnostic manuals used by psychologists or psychiatrists, proposed criteria suggest that this condition is characterized by a strong negative reaction to and avoidance of certain trigger sounds. Misophonic trigger sounds are largely human-made (e.g., chewing and slurping) and evoke responses such as disgust, irritation, and/or anger that are out of proportion to the situation and cause distress and/or impairment. Currently, there is no gold standard evidence-based treatment for misophonia. As the misophonia treatment literature grows, several important questions are arising: (1) should exposure to aversive sound triggers be included in treatment for misophonia and (2) how can clinicians best assess misophonia symptoms. This case offers one example of misophonia being successfully treated with a cognitive-behavioral approach to treatment (including exposures) in an adolescent girl. This case also offers an example of how clinicians may conduct a comprehensive assessment of misophonia symptoms. Theoretically and empirically derived recommendations for including exposure in misophonia treatment are presented. Information from this case may be helpful in informing future research, as there is a paucity of evidence-based assessment and treatment protocols for misophonia.

Decreased sound tolerance (DST) is the most common sensory difficulty experienced by autistic individuals. Parents of 88 autistic children and young adults between the ages of 3 and 30 described coping strategies and physical and emotional responses used to deal with distressing sounds, and their impact on daily activities. Loud, sudden, and high-pitched sounds were most commonly endorsed as distressing, most often causing autistic children and young adults to cover their ears or yell, while producing stress, irritation, fear, and anxiety. Parents reported warning their child, providing breaks, or avoiding noisy settings as the most used coping strategies. Overall, findings indicate that DST leads to fewer opportunities for autistic children and young adults to participate at home, at school, and in the community. Further, results suggest hyperacusis, misophonia, and phonophobia, subtypes of DST, are present in autistic children and young adults.

Background Misophonia is a condition marked by dysregulated emotions and behaviors in response to trigger sounds, often chewing, breathing, or coughing. Evidence suggests that misophonia develops in adolescence and the emotions and behaviors are a conditioned response to distress, resulting in social avoidance, stress, and family conflict. In addition, co-occurrence with other psychiatric illnesses such as anxiety, OCD, and Tourette syndrome is common. A transdiagnostic cognitive behavioral therapeutic (CBT) approach appears appropriate. There are currently no controlled studies of youth with misophonia. The current paper describes the approach to a pilot randomized, blinded family-based treatment study for youth ages 8-16 years. Preliminary results from a pilot open trial also are described. Methods A 2-phase dual site telehealth treatment study using a transdiagnostic CBT approach, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May et al., 2018), is proposed. Phase 1 consisted of a 4-case pilot of UP-C/A. Phase 2 includes a randomized trial comparing the UP-C/A to a standard relaxation and education protocol. Results Preliminary results from the pilot show modest improvements in evaluator-rated misophonia symptoms on the Clinical Global Impression Severity and Improvement scales. Limitations There is little research to inform evidence-based practice for youth with misophonia. Study limitations include lack of standardized misophonia assessment instruments and an absence of formal diagnostic criteria. Conclusions The current paper describes proposed methods for the first randomized controlled trial for youth with misophonia and their families along with results from a 4-case pilot.

Mizofoni, diğer insanların oluşturduğu günlük seslere ve bazen hayvan seslerine orantısız şekilde duygusal tepki vermek olarak tanımlanmaktadır. Kişilerin mesleki ve sosyal işlevselliklerini bozabilecek kadar şiddetli olabilir. Hastalığın risk faktörleri ve etiyolojisi tam olarak bilinmemektedir. Bazı nörogelişimsel hastalıklar ve psikiyatrik bozukluklarla birlikte görülebilmektedir. Amsterdam Mizofoni Ölçeği ve Mizofoni Ölçeği mizofoniyi değerlendirmek için geliştirilmiş ölçeklerdir. Tanı kriteleri tam olarak belirlenmemiştir ve güncel tanı sınıflamalarında yer almamaktadır. Tedavisinde, bilişsel davranışçı terapi, farkındalık (mindfullnes), diyalektik davranış terapisi ve maruz bırakma gibi yöntemler kullanılmakta olup belirli bir farmakolojik tedavi tanımlanmamıştır.

Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.

Misophonia is a condition characterized by marked distress following the perception of innocuous sounds and is often accompanied by behavioral avoidance. This presentation is currently absent from the Diagnostic and Statistical Manual of Mental Disorders, as it remains poorly understood and understudied. Despite these limitations, there have been recent efforts to develop empirically supported assessment tools and intervention. Interventions for misophonia predominantly incorporate principles of cognitive-behavioral interventions. This article describes in detail the assessment and intervention process of working with an individual with misophonia.

Misophonia is a common disorder characterized by the experience of strong negative emotions of anger and anxiety in response to certain everyday sounds, such as those generated by other people eating, drinking, and breathing. The commonplace nature of these “trigger” sounds makes misophonia a devastating disorder for sufferers and their families. How such innocuous sounds trigger this response is unknown. Since most trigger sounds are generated by orofacial movements (e.g., chewing) in others, we hypothesized that the mirror neuron system related to orofacial movements could underlie misophonia. We analyzed resting state fMRI (rs-fMRI) connectivity (N = 33, 16 females) and sound-evoked fMRI responses (N = 42, 29 females) in misophonia sufferers and controls. We demonstrate that, compared with controls, the misophonia group show no difference in auditory cortex responses to trigger sounds, but do show: (1) stronger rs-fMRI connectivity between both auditory and visual cortex and the ventral premotor cortex responsible for orofacial movements; (2) stronger functional connectivity between the auditory cortex and orofacial motor area during sound perception in general; and (3) stronger activation of the orofacial motor area, specifically, in response to trigger sounds. Our results support a model of misophonia based on “hyper-mirroring” of the orofacial actions of others with sounds being the “medium” via which action of others is excessively mirrored. Misophonia is therefore not an abreaction to sounds, per se, but a manifestation of activity in parts of the motor system involved in producing those sounds. This new framework to understand misophonia can explain behavioral and emotional responses and has important consequences for devising effective therapies. SIGNIFICANCE STATEMENT Conventionally, misophonia, literally “hatred of sounds” has been considered as a disorder of sound emotion processing, in which “simple” eating and chewing sounds produced by others cause negative emotional responses. Our data provide an alternative but complementary perspective on misophonia that emphasizes the action of the trigger-person rather than the sounds which are a byproduct of that action. Sounds, in this new perspective, are only a “medium” via which action of the triggering-person is mirrored onto the listener. This change in perspective has important consequences for devising therapies and treatment methods for misophonia. It suggests that, instead of focusing on sounds, which many existing therapies do, effective therapies should target the brain representation of movement.

We investigated auditory processing in a young patient who experienced a single embolus causing an infarct in the right middle cerebral artery territory. This lead to damage to auditory cortex including planum temporale that spared medial Heschl’s gyrus, and included damage to the posterior insula and inferior parietal lobule. She first reported difficulty hearing all sounds, which fully recovered within days, but she subsequently reported chronic difficulties with segregating speech from noise and segregating elements of music. Clinical tests showed no evidence for abnormal cochlear function. Follow-up tests confirmed difficulties with auditory segregation in her left ear that spanned multiple domains, including speech-in-noise and music streaming. Testing with a stochastic figure-ground task—a way of estimating generic acoustic foreground and background segregation—demonstrated that this was also abnormal. This is the first demonstration of an acquired deficit in the segregation of complex acoustic patterns due to cortical damage, which we argue is a causal explanation for the symptomatic deficits in the segregation of speech and music. These symptoms are analogous to the visual symptom of simultaneous agnosia. Consistent with functional imaging studies on normal listeners, the work implicates non-primary auditory cortex. Further, the work demonstrates a (partial) lateralisation of the necessary anatomical substrate for segregation that has not been previously highlighted.HighlightsRare case of auditory agnosia in a young patient with a right-hemisphere infarctDamage affecting non-primary auditory cortex, but sparing primary auditory cortexGeneralised auditory segregation deficit, revealed by auditory figure-ground taskThis explains segregation deficits for speech-in-noise and music streamingThe deficit affects stimuli presented on the left

Autonomous Sensory Meridian Response (ASMR) describes a tingly physical response triggered by specific visual and auditory stimuli such as whispering, personal attention, crisp sounds and slow movements. Some investigations find that ASMR is associated with specific personality traits such as openness. There also exist individual differences in functional neural connectivity across individuals who do and do not experience ASMR. The similarity and high correlation between ASMR and frisson and misophonia allow us to guess the possible formation mechanism of ASMR from the perspective of those two. The high correlation with mindfulness reveals the potential for assisting psychotherapy.

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Misophonia is characterized by an autonomic response (e.g., increased heart rate) that is elicited by certain innocuous or repetitive sounds, and individuals with misophonia may display an extreme, overt response commonly associated with rage, hatred, and a loss of self-control. In this investigation, we used a combined respondent and operant approach to treat problem behavior evoked by bodily sounds (i.e., coughing, sneezing, sniffling, and clearing throat) for an adult with autism spectrum disorder. The intervention produced immediate reductions of problem behavior and the effects of treatment maintained during progressively lean schedules of reinforcement. The results of this study will be discussed in light of past research, along with limitations, and future directions for research and clinical practice.

Misophonia is a newly recognized condition involving adverse emotional reactions to environmental sounds, most often produced by other people. This study reports results of a survey describing the phenomenology of misophonia based on a large sample. Survey data were collected from individuals self-identified as having misophonia. A total of 1,061 individuals reported specific distressing reactions to sounds, and responses indicating severity of misophonia and perceived comorbidity. Over 82% of respondents were female. The average age of the study participants was 37.49 years (SD = 12.24; range from 18 to 72). Most respondents reported multiple triggers and adverse emotional reactions, as well as multiple coping responses. The majority of respondents reported comorbid diagnoses. Misophonia severity is described, as well as impact on quality of life. A minority of respondents had some experience with treatment and most reported no change in symptoms. Treatments reported for misophonia were typically ineffective, and once developed, misophonia symptoms persist. The results of the study showed that misophonia is a newly recognized condition that appears to have important impact on people’s lives. It typically develops in early life, and is associated with a reduced quality of life, substantial comorbidity, negative emotional experiences, and behaviors that are likely to impact interpersonal relationships.

Misophonia is a condition of abnormal emotional responses to specific auditory stimuli. There is limited information available on the prevalence of this condition. This study aimed to estimate the prevalence of misophonia in an undergraduate medical student population at the University of Nottingham. A secondary aim of this study was to assess the psychometric validity of the Amsterdam Misophonia Scale (A-Miso-S) questionnaire tool in this population. The A-Miso-S was administered online to medical students at the University of Nottingham. To assess the validity of the A-Miso-S, a factor analysis was conducted. To determine prevalence and severity the results of the questionnaire were quantitatively analysed using SPSS. Actor analysis was conducted. Free text responses to one questionnaire item were analysed using a thematic approach. Responses were obtained from 336 individuals. Clinically significant misophonic symptoms appear to be common, effecting 49.1% of the sample population. This is statistically significantly higher prevalence than previous studies have found (p

Misophonia is an understudied condition that is commonly viewed as an extreme sensitivity to specific soft sounds and visual stimuli which elicit strong negative emotions and physiological arousal. Recent research using self-report measures indicates that misophonia includes an elicited physical respondent (e.g. skeletal muscle flinch). Using electromyography (EMG) and direct observation, an immediate physical response to trigger stimuli was verified in three misophonic participants. Consistent movement of the body was observed in each subject when the subject reported having a moderate to strong response, though the location was unique for each subject. The response appeared to be immediate with the onset of a brief auditory stimulus and occurred at the start and throughout longer visual trigger stimuli. Additionally, an EMG measured response was consistent in one participant, and occurred in another participant when there was a strong self-reported response. Response latency for the EMG measured response was several hundred milliseconds, indicating the responses were elicited by the misophonic trigger stimulus and not general physiological arousal. This provides empirical evidence of an elicited physical response to misophonic stimuli in these individuals with misophonia. This supports conceptualization of misophonia as a condition which includes a respondent behavior (e.g. muscle flinch) elicited by the misophonic trigger stimulus. This highlights the need for additional research on the elicited physical response to misophonic stimuli and classical conditioning as a mechanism for the development of such a response.

Soundscape is defined as the entire acoustic environment and the human responses to it. This review summarizes different human reactions to sound exposure, their development, prevalence, symptoms, comorbidities, methods for their assessment, and possible origins. The interpretation of sounds from the environment depends, not only on the characteristics of the sound itself, but also on the characteristics of the listener, their judgments, preferences, motivations, and emotional reactions to the sound or its source. Typical sound-related reactions are presented from two standpoints: population reactions, from the community perspective, and individual reactions, from the clinical perspective. Noise annoyance is a specific, unique, and typical psychological and physiological reaction to noise, which is assessed from the community perspective. Noise sensitivity, a stable personality trait, is at the basis of noise annoyance. Both noise annoyance and noise sensitivity play important roles in the development of other noise-related health disturbances. From the clinical perspective, hyperacusis and misophonia are the most distinctive individual responses to specific sounds. They may become so pronounced that they disturb one's physical and mental health, behavior, and functioning. Human reactions to sounds in the environment are widespread and well-investigated. This review goes beyond merely defining terminology in the domain of psychoacoustics; it may help health professionals understand human reactions to sound better. Further studies need to be directed towards developing methods for alleviating or treating the described reactions, but also towards creating a more pleasant acoustic environment for the purpose of protecting public health.

Misophonia is a newly described condition in which specific ordinary sounds provoke disproportionately strong negative affect. Since evidence for neurobiological abnormalities underlying misophonia is scarce, we tested whether misophonia patients differed from healthy controls in grey matter volumes and resting-state functional connectivity. We collected structural magnetic resonance imaging and resting-state functional magnetic resonance imaging data from 24 misophonia patients and 25 matched controls. Compared to controls, voxel-based morphometry showed larger right amygdala volume in misophonia patients. Follow-up seed-based functional connectivity analysis of the amygdala showed a different pattern of connectivity with the cerebellum, driven by greater connectivity with the left amygdala. Additional data-driven independent component analysis showed greater connectivity within lateral occipital cortices and fusiform gyri in the ventral attention network. We propose that the amygdala enlargement may be associated with heightened emotional reactivity in misophonia. The higher connectivity between left amygdala and cerebellum might be linked to a tendency to exhibit reflex-like physical reactions to triggers. Higher attention network connectivity may reflect sensory enhancement of visual triggers or visual imagery related to trigger sounds. In sum, we found structural and functional abnormalities which implicate dysfunction of emotional and attentional systems in misophonia.

Purpose-\ud \ud Meaningfully grouping individuals with tinnitus who share a common characteristics (ie, subgrouping, phenotyping) may help tailor interventions to certain tinnitus subgroups and hence reduce outcome variability. The purpose of this study was to test if the presence of tinnitus subgroups are discernible based on hearing-related comorbidities, and to identify predictors of tinnitus severity for each subgroup identified.\ud \ud Methods-\ud \ud An exploratory cross-sectional study was used. The study was nested within an online survey distributed worldwide to investigate tinnitus experiences during the COVID-19 pandemic. The main outcome measure was the tinnitus Handicap Inventory- Screening Version.\ud \ud Results-\ud \ud From the 3400 respondents, 2980 were eligible adults with tinnitus with an average age of 58 years (SD = 14.7) and 49% (n = 1457) being female. A three-cluster solution identified distinct subgroups, namely, those with tinnitus-only (n = 1306; 44%), those presenting with tinnitus, hyperacusis, hearing loss and/or misophonia (n = 795; 27%), and those with tinnitus and hearing loss (n = 879; 29%). Those with tinnitus and hyperacusis reported the highest tinnitus severity (M = 20.3; SD = 10.5) and those with tinnitus and no hearing loss had the lowest tinnitus severity (M = 15.7; SD = 10.4). Younger age and the presence of mental health problems predicted greater tinnitus severity for all groups (β ≤ −0.1, P ≤ .016).\ud \ud Conclusion-\ud \ud Further exploration of these potential subtypes are needed in both further research and clinical practice by initially triaging tinnitus patients prior to their clinical appointments based on the presence of hearing-related comorbidities. Unique management pathways and interventions could be tailored for each tinnitus subgroup.

Extoling and promoting listening is deeply ingrained in sound art practice and discourse, even on occasion its raison d’être, where listening is understood as a wholly congenial, benign activity. This can be seen through the routine use of affirmative tropes such as, through listening we: connect, locate, are embodied, discern, are immersed or enveloped. And through specific listening methods such as Deep Listening, we are offered ‘expand[ed] consciousness to the whole space/time continuum of sound/silences’ (Oliveros, 2005, p. xxiv). Refocusing from the act of listening to the audiological—the mechanisms related to the sense of hearing—from the findings of the author’s recent research, in particular his review on the noise impact of high-speed hand dryers (Drever, 2013), the author feels obliged to assert that the contrary is a reality for many—hearing, from time to time or incessantly: perturbs, isolates, excludes, disconnects, disembodies, and dislocates, hearing hurts! This will be familiar for those living with hyperacusis, misophonia, and phonophobia, but it can also be the case for those with particular hearing needs such as the partially sighted, hearing aid users or those with sensitive hearing such as infants and ASD. Bringing audiology into the sphere of sound art, this chapter recognizes a prevailing sensitization of hearing in the culture at large, and proposes a paradigm for situating hearing that diverges from a singular, idealized, symmetrical model of hearing, the auraltypical, that has predominated. In its place, we are beginning to enjoy a fluidity and openness to diverse forms of hearing and sensitive hearers in sound art, on embracing the emerging agenda of auraldiversity.

Misophonia is characterized by decreased tolerance and accompanying defensive motivational system responding to certain aversive sounds and contextual cues associated with such stimuli, typically repetitive oral (e.g., eating sounds) or nasal (e.g., breathing sounds) stimuli. Responses elicit significant psychological distress and impairment in functioning, and include acute increases in (a) negative affect (e.g., anger, anxiety, and disgust), (b) physiological arousal (e.g., sympathetic nervous system activation), and (c) overt behavior (e.g., escape behavior and verbal aggression toward individuals generating triggers). A major barrier to research and treatment of misophonia is the lack of rigorously validated assessment measures. As such, the primary purpose of this study was to develop and psychometrically validate a self-report measure of misophonia, the Duke Misophonia Questionnaire (DMQ). There were two phases of measure development. In Phase 1, items were generated and iteratively refined from a combination of the scientific literature and qualitative feedback from misophonia sufferers, their family members, and professional experts. In Phase 2, a large community sample of adults (n = 424) completed DMQ candidate items and other measures needed for psychometric analyses. A series of iterative analytic procedures (e.g., factor analyses and IRT) were used to derive final DMQ items and scales. The final DMQ is 86 items, and includes subscales: (1) Trigger frequency (16 items), (2) Affective Responses (5 items), (3) Physiological Responses (8 items), (4) Cognitive Responses (10 items), (5) Coping Before (6 items), (6) Coping During (10 items), (7) Coping After (5 items), (8) Impairment (12 items), and Beliefs (14 items). Composite scales were derived for overall Symptom Severity (combined Affective, Physiological, and Cognitive subscales) and Coping (combined the three Coping subscales). The analytic procedures used enable administration of the total DMQ, individual subscales, or the derived composite scales.

Misophonia, a condition marked by extreme intolerance to certain classes of sounds (e.g., respiratory or gustatory noises), has recently attracted increased research attention. As yet there are no evidence-based treatments, although some promising options are under empirical consideration. This paper presents a stress management and exposure therapy-based treatment protocol for adults with misophonia. The protocol details considerations specific to exposure therapy for misophonia, including unique considerations for developing hierarchies and example misophonia exposure exercises and exposure homework. Stress management approaches employed to facilitate engagement with exposure are also described. Two case examples are included, which illustrate the application of the misophonia treatment protocol. The first case describes treatment for a client whose misophonia symptoms are the primary focus and the second case describes treatment for a client whose misophonia symptoms are secondary to relationship difficulties. This protocol can be used to stimulate further treatment research for misophonia and guide treatment for individuals with misophonia.

Misophonia is a recently described condition that is marked by extreme adverse reactions to select classes of trigger sounds. It has recently received attention as a putative diagnosable condition, and specifically as a member of the class of obsessive-compulsive and related disorders. Adverse reactions may include physiological responses, emotional responses, and behaviors. Common trigger sounds include gustatory and respiratory noises and other sounds created by humans but vary widely among affected individuals. This chapter describes misophonia, including coverage of other audiological conditions that need to be ruled out in potential cases, the current state of assessment, and brief consideration of treatment approaches. Future clinical and research directions are highlighted.

Background Misophonia is defined as significant distress (anger, distress or disgust) when exposed to certain sounds that would not affect most people, such as lip smacking or gum chewing. Although misophonia is common, the aetiology, prevalence and effective treatments are largely unknown. Aims Based on our proposed diagnostic criteria, we examined the prevalence of misophonia and its relationship with clinical and demographic variables in a large representative population sample. Method We used a household sample (N = 541) of all residents aged >15 years, living in 300 homes randomly selected in Ankara city centre, Turkey. All participants were assessed at their homes by trained interviewers, for sociodemographic variables, misophonic sounds and related factors, using a semi-structured interview (the Misophonia Interview Schedule) developed for the current research. Results The current misophonia diagnosis prevalence was 12.8% (n = 69 of 541), although 427 (78.9%) participants reported at least one sound that was distressing. The mean number of misophonic sounds was 8.6 (s.d. 8.9, range 0–44); the figure was 17.6 in those with misophonia compared with 7.3 in those without misophonia. Of those with misophonia, only 5.8% contacted services for their condition. Predictors of misophonia diagnosis included younger age, family history of misophonia and previous contact with mental health services. Conclusions Our study showed that misophonia is common in the general population, may cause significant disruption in daily life and is undertreated. Although more evidence is needed to classify misophonia as a psychiatric disorder, our findings support others who claim that the condition belongs to the group of mental disorders.

Objective A large number of people experience misophonia. In 2013, the Amsterdam Study Group recommended diagnostic criteria for misophonia. However, misophonia is not yet included in the Diagnostic and Statistical Manual of Mental Disorders. This report is the first report on drug use that directly affects misophonia and demonstrates a 14-year-old adolescent girl with misophonia successfully treated with fluoxetine. Methods The patient's misophonia symptoms had been continuing for approximately 2 years, and her quality of life was significantly reduced. Psychotherapy conditions could not be applied, and fluoxetine 10 mg/d was started and increased to 20 mg/d after a week. At the second-month follow-up, because of partial improvement, fluoxetine dose was increased to 30 mg/d. Results At the fourth-month follow-up, there was a 40% decrease in Amsterdam Misophonia Scale score with a 70% decrease in the children's global assessment scale scores. By the 16th week, the overall functionality level was good at the end. Conclusions Fluoxetine may be used as an effective drug in the treatment of misophonia.

This article reviews the evidence related to the efficacy of Cognitive Behavioral Therapy (CBT) for alleviating the distress caused by tinnitus, hyperacusis and misophonia. Where available, the review was focused on meta-analyses of randomized controlled trials (RCTs) using either passive control groups (typically waiting list or education only) or active control groups (receiving some other form of treatment). Where data from RCTs were not available, case studies and retrospective studies were reviewed. Analyses were conducted separately for studies of patients with tinnitus, hyperacusis and misophonia. RCTs show that CBT is effective in alleviating the distress caused by tinnitus in comparison to passive control groups and sometimes active control groups. CBT for tinnitus can be effective both in individual and in group settings, whether delivered by psychiatrists, clinical psychologists, or specially trained audiologists. CBT for tinnitus can also be effective when delivered via the internet, when combined with help from audiologists. Usually, CBT does not reduce the loudness of tinnitus but it can improve quality of life. Case studies and some limited RCTs suggest that CBT can also be effective in alleviating the distress caused by hyperacusis and misophonia. However, RCTs with active control groups are currently lacking. There is strong evidence supporting the effectiveness of CBT in alleviating the distress caused by tinnitus. However, it is not yet clear whether CBT is more effective than some other forms of treatment. RCTs with active control groups are needed to establish more clearly the extent to which CBT is effective in alleviating the distress caused by hyperacusis and misophonia.

Introduction: Misophonia is marked by abnormal negative reactions to specific and idiosyncratic sounds. Despite unclear etiology and diagnostic conceptualization, neuropsychology may be abl...

Misophonia is a chronic condition in which specific sounds cause intense negative emotions and autonomic arousal. Misophonia is considered a psychological disorder without any relationship with specific alterations of hearing receptors and independent from physical characteristics of the sound. Moreover if misophonia can be defined as a specific psychiatric disorder or a correlate of other conditions is still under debate. The patients were two women and one man. In this case series we first identified the presence of triggers sounds inducing misophonia as reported during the psychotherapy sessions. At a qualitative level all the three patients perceived that the others were intentionally acting with the purpose of underline their maladaptive interpersonal schemas. All the patients were evaluated with the use of questionnaires. Regarding personality disorders (PD) all three patients suffered from at least one PD. As regard depression, one had moderate depression and one had severe depression. Two patients had moderate/severe anxiety. All the three patients can be considered as highly problematic in the interpersonal domain. Our findings have clinical implications for the treatment of misophonia because it seems to be sustained by underlying PD or maladaptive interpersonal schemas. The qualitative analysis of these cases has highlighted how patients with misophonia tended to ascribe intentionality to the people who emit the sounds that trigger their negative emotional reactions. Further studies are necessary to evaluate which kind of interpersonal patterns occur in these patients.

Mizofonia jest stosunkowo mało zbadanym zjawiskiem odnoszącym się do doświadczania silnych emocji (głównie złości i wstrętu) oraz reakcji somatycznych (np. skurczów mięśni, wzmożonego bicia serca), podczas kontaktu ze specyficznym bodźcem dźwiękowym. Wśród najczęściej spotykanych awersyjnych dźwięków tego typu wymienia się m. in odgłosy jedzenia, oddychania, pisania na klawiaturze. Doświadczanie mizofonii związane jest z cierpieniem i znacznym obniżeniem jakości życia. Zjawisko to zostało po raz pierwszy zidentyfikowane w 2002 roku. Od tamtej pory opisano liczne studia przypadków oraz opublikowano dane pochodzące z badań psychofizjologicznych, neuropsychologicznych i kwestionariuszowych. Prace te wskazują, że mizofonia jest zjawiskiem spójnym i możliwym do wstępnego zidentyfikowania. Z najnowszych badań wynika, iż zjawisko to występuje samodzielnie, niezależnie od żadnego konkretnego zaburzenia. Wciąż jednak wiele pytań dotyczących definicji i kryteriów diagnostycznych mizofonii pozostaje bez odpowiedzi. W prezentowanym artykule opisano najważniejsze problemy diagnostyczne mogące pojawić się w pracy klinicznej z osobami z mizofonią. Przedstawiono ponadto główne koncepcje teoretyczne dotyczące mizofonii oraz związane z nimi wyniki analiz empirycznych.

Misophonia is still an unclassified disorder and means literally “strong dislike (hate) of sounds”. In this paper, we present a case report of an adolescent female who had misophonia that was complicated with two non-fatal suicide attempts. She presented with anxiety features and started to follow up for three years. Assessment of the level of misophonia for a year using Amsterdam Misophonia Scale (A-MISO-S) showed an extreme degree soon after the second suicide attempt. Initially, psychotherapy was noticed to be ineffective due to her poor motivation. Escitalopram was added to the management plan and improvement was reported in the depressive symptoms and obsessional thoughts of misophonia but were intolerable eventually because of the weight gain. Therefore, it was switched into Fluoxetine and Bupropion but six weeks later she attempted her second suicide by Bupropion overdose. At that point, the psychiatrist, the patient and her parents agreed to continue therapy with non-psychopharmacological treatment. Gradually she became more engaged in psychotherapy sessions after noticing its effectiveness. It was concluded that significant improvement of misophonia was reported when she was treated by Selective Serotonin Reuptake Inhibitors (SSRI) namely Escitalopram or Fluoxetine, motivated in psychotherapy sessions, adapted good coping strategies, decreased her dysfunctional challenging behaviour, rejoined social interaction and activity in her life, was more insightful and aware about her illness and developed self-acceptance.

Objective To scope the literature describing misophonia populations, management, and research opportunities. Method Literature searches for research studies describing patients diagnosed with misophonia, defining a patient profile, or outlining development or testing of an intervention for misophonia. A data extraction form was developed and piloted before data from each article were independently charted by two researchers. Researchers then agreed on a final data set for each article. Results Thirty‐one records were included. The misophonia population was described in terms of onset age, triggers, reaction, coping strategies, and comorbid conditions. We identified nine outcome measures. Case studies on treatments included cognitive behavioral therapy, counterconditioning, mindfulness and acceptance, dialectical behavioral therapy, and pharmaceuticals. Future research priorities identified included clarifying the phenomenology and prevalence of misophonia, and randomized controlled trials of treatments. Conclusion Misophonia is under‐researched but there are strong foundations for future research to finalize diagnostic criteria, validate outcome measures, and trial treatments.

Tics and stereotypies are the most common pathological repetitive complex motor behaviors occurring during the neurodevelopmental period. Although they may appear transiently during development without acquiring a pathological status, when they become chronic they may be distressing, socially impairing, or even, in the case of malignant tics, potentially physically harmful. Despite a certain similarity in their phenomenology, physicians should be able to distinguish them for their different variability over time, topographical distribution, association with sensory manifestations, and relationship with environmental triggers. The complex phenomenology of tics and stereotypies is constantly enriched by the characterization of novel variants, e.g. tics triggered by auditory stimuli in association with misophonia and stereotypies associated with intense imagery activity. Their pathophysiology remains partially elusive, but both animal model and brain imaging studies confirm the involvement of all the three major loops (sensorimotor, associative and limbic) within the cortico-basal ganglia circuitry. From a management perspective, the greatest advances witnessed in the last decade involve the diffusion of behavioral strategies (e.g. habit reversal training or response interruption and redirection), including the development of protocols for telehealth on online training in order to optimise access. In the context of severe tics, e.g. in refractory Tourette syndrome, there is increasing experience with deep brain stimulation of the intralaminar thalamic nuclei or the globus pallidus internus, although more research is needed to fine tune target choice and stimulation setting definition.

Recent findings have led to a reconceptualization of the mechanisms that account for the efficacy of exposure-based treatments. Termed the “inhibitory learning model,” this approach emphasizes new learning when confronted with previously avoided stimuli rather than merely the cessation of fear or aversive emotional responding. In this paper, we propose the applicability of the inhibitory learning model for conditions and contexts in which simple exposure does not produce habituation. We illustrate this application from an in-progress randomized controlled treatment trial for adults with misophonia. Misophonia is a condition marked by strong aversive reactions to specific sounds. It is a difficult to treat and understudied syndrome. All participants in the trial received exposure, either before or after a stress management module of treatment. Exposure treatment emphasized altered expectancies for the target sounds as well as deliberate practice in hearing sounds on the individually developed hierarchy. Inhibitory learning strategies were employed to increase treatment adherence and commitment, shape patient behavior during exposures, manufacture negative prediction errors, increase perceived control over reactions, and promote learning that generalized to functional improvements. The findings are discussed in the context of future applications of the inhibitory learning model for psychopathology associated with avoidance.

Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, a project was conducted to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.

Misophonia is a condition characterized by defensive motivational system emotional responding to repetitive and personally relevant sounds (e.g., eating, sniffing). Preliminary research suggests misophonia may be associated with a range of psychiatric disorders, including personality disorders. However, very little research has used clinician-rated psychometrically validated diagnostic interviews when assessing the relationship between misophonia and psychopathology. The purpose of this study was to extend the early research in this area by examining the relationship between symptoms of misophonia and psychiatric diagnoses in a sample of community adults, using semi-structured diagnostic interviews. Results indicated higher misophonia symptoms were associated with more clinician-rated symptoms of personality disorders, but not other disorders. Anxiety partially mediated the relationship between personality disorder symptoms and misophonia. These results suggest misophonia may be associated with a range of psychiatric symptoms and highlight the role of anxiety in this poorly understood condition.

Background Autonomous Sensory Meridian Response (ASMR) describes the experience of a pleasant tingling sensation along the back of the head, accompanied with a feeling of well-being and relaxation, in response to specific audio-visual stimuli, such as whispers, soft sounds, and personal attention. Previous works have assessed individual variations in personality traits associated with ASMR, but no research to date has explored differences in emotion regulation associated with ASMR. This omission occurred even when ASMR, a sensory-emotional experience, has been proposed to be located in a sound sensitivity spectrum as the opposite end of misophonia, a phenomenon associated with difficulties regulating emotions. The present work aimed to assess group differences between ASMR self-reporters and non-ASMR controls associated with emotion regulation strategies. Methods We used the validated Spanish version of the Emotion Regulation Questionnaire to assess individual differences in the use of cognitive reappraisal and expressive suppression. Results Our results showed that participants who experience ASMR had higher scores in the cognitive reappraisal subscale of the emotion regulation questionnaire than the non-ASMR group. Conclusions Individuals who experience ASMR reported higher use of cognitive reevaluation of emotionally arousing situations, suggesting more effectiveness in regulating emotions. Our finding further elucidates individual differences related to this experience, supporting that ASMR is a real psychophysiological phenomenon associated with other psychological constructs and has remarkable consequences in affective/emotional dimensions and general well-being.

International audience; Misophonia is a condition where a strong arousal response is triggered when hearing specific human generated sounds, like chewing, and/or repetitive tapping noises, like pen clicking. It is diagnosed with clinical interviews and questionnaires since no psychoacoustic tools exist to assess its presence. The present study was aimed at developing and testing a new assessment tool for misophonia. The method was inspired by an approach we have recently developed for hyperacusis. It consisted of presenting subjects (n = 253) with misophonic, pleasant, and unpleasant sounds in an online experiment. The task was to rate them on a pleasant to unpleasant visual analog scale. Subjects were labeled as misophonics (n = 78) or controls (n = 55) by using self-report questions and a misophonia questionnaire, the MisoQuest. There was a significant difference between controls and misophonics in the median global rating of misophonic sounds. On the other hand, median global rating of unpleasant, and pleasant sounds did not differ significantly. We selected a subset of the misophonic sounds to form the core discriminant sounds of misophonia (CDS Miso). A metric: the CDS score, was used to quantitatively measure misophonia, both with a global score and with subscores. The latter could specifically quantify aversion towards different sound sources/events, i.e., mouth, breathing/ nose, throat, and repetitive sounds. A receiver operating characteristic analysis showed that the method accurately classified subjects with and without misophonia (accuracy = 91%). The present study suggests that the psychoacoustic test we have developed can be used to assess misophonia reliably and quickly. Misophonia, literally hatred of sound 1 , is a condition where subjects experience negative emotional reactions (e.g., irritation, anger and/or disgust) 2,3 and a strong autonomic arousal response when hearing specific "trigger" sounds 4,5. These triggers most often contain human generated mouth sounds (e.g., chewing and slurping), breathing and nose sounds (e.g., heavy breathing and sniffing), throat sounds (e.g., swallowing and throat clearing), but also repetitive sounds of objects operated by humans (e.g., pen clicking and keyboard typing) 2-4. In some cases, visual repetitive stimuli, like leg-rocking or finger tapping, can act as misophonic triggers, a phenomenon known as "misokinesia" 2-4. The physical characteristics of sounds (e.g., intensity and frequency) only partially influence the reaction of misophonics to triggers, rather it is their psychological profile, previous experience, and the context in which triggers are experienced that are the most important 1,4,6,7. For instance, experiencing triggers when one cannot escape from the situation (e.g., plane trip) worsens negative reactions 4. Also, eating and chewing sounds are less annoying when originating from babies or animals, as it is "not their fault" if they are generating them 4. Similarly, an individual's own chewing sounds do not trigger a reaction and are often used as a coping mechanism to "cancel out" incoming triggers 3,4. Other coping mechanisms include listening to music, walking away, avoiding social situations, using earplugs/headphones, and asking the originator of the trigger to stop 2-4. Prevalence reports of misophonia show large variability and range from 6% to 49.1% 8-10. These differ considerably due to the different assessment methods and criterion that were used to define misophonia. Besides, misophonia severity varies: Naylor et al. 10 found that 37%, 12% and 0.3% of medical students had mild, moderate, and severe symptoms, respectively. They suggested that misophonia affects many people mildly, but only a few severely. Misophonia can be accompanied by different comorbidities such as obsessive-compulsive personality traits, depression, and anxiety 2,3,8,11. Perfectionism 2 , neuroticism 2,3,12 , difficulties with emotion regulation 12 , and high interoceptive sensibility 5 are also observed. Generally, no audiological problems are detected (e.g., audiogram, loudness discomfort levels, and speech audiometry) 2,3 , and cases of tinnitus and hyperacusis are scarce (2% and

Background Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as loud chewing or breathing, causing avoidance of cue-related situations resulting in significant functional impairment. Though the first treatment studies with cognitive behavioural therapy (CBT) showed promising results, an average of 50% of the patients has not improved much clinically. Objective The aim of this pilot study was to assess the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a trauma-focused approach in treating misophonia symptoms. Method A sample of 10 adult participants with misophonia was studied at the outpatient clinic of the Academic Medical Center in Amsterdam. Participants were either on the waiting list for CBT or non-responders to CBT. EMDR was focused on misophonia-related emotionally disturbing memories and delivered in a mean of 2.6 sessions of 60–90 minutes. Pre- and post-treatment self-assessed ratings of misophonia symptoms (AMISOS-R, primary outcome), of general psychopathology (SCL-90-R) and of quality of life (SDS) were administered. The co-primary outcome was the Clinical Global Impression Improvement scale (CGI-I). Results A paired t-test (n = 8) showed improvement on the primary outcome (−6.14 [MD], 5.34 [SD]) on the AMISOS-R (P = .023). Three of the eight patients showed clinically significant improvement measured with the CGI-I. No significant effect on secondary outcomes was found. Conclusions These preliminary results suggest that EMDR therapy focused on emotionally disturbing misophonia-related memories can reduce misophonia symptoms. RCTs with sufficient sample sizes are required to firmly establish the value of EMDR therapy for misophonia., HIGHLIGHTS This pilot study investigated the potential benefits of EMDR for 10 patients with misophonia.Three of the seven completers showed clinical improvement in misophonia symptoms within a mean of 2.6 sessions.The exploratory nature of this study makes further research necessary.

The extreme, unprecedented situations in the current COVID-19 pandemic are risk factors for psychosocial stress for the entire population. However, strict confinement had a particular impact on people suffering from misophonia and their families. Misophonia is a condition in which hearing certain sounds triggers intense anger, disgust and even severe autonomic nervous system responses. This prospective cohort study examined the impact of strict confinement (Spain, March 14–June 21, 2020) on a sample of 24 people (16 women and eight men) who had been diagnosed with moderate to extreme misophonia and were regularly attending a medical psychology center in Barcelona. The 3-month period of confinement caused general emotional maladjustment, distress, and a transitory crisis. Long-term biomonitoring of their heart variability rate (HRV) enabled to identify a significant increase in physiological arousal after the confinement period, which had already been recorded in a loss of cardiac coherence under basal rest/relaxation conditions. Certain auditory stimuli triggered adverse responses, lowered HRV scores, and an increased stress level and heart rate. Loss of cardiac coherence in their responses to these auditory stimuli (triggering mouth, nose and other sounds), as well as to non-triggering mouth, nose and other sounds was increased when compared to two assessments performed during the previous year. Despite the limited sample size, sex differences were observed in the incidence. Loss of cardiac coherence worsened with the severity of the misophonia. Most importantly, imagined or evoked triggering sounds, as well as real ones, were enough to cause the aversive responses, as displayed by the increased loss of cardiac coherence with respect to the at-rest basal level. A semi-structured interview revealed the exceptional nature of the situations, increased hyper-sensorial sensitivity, fear of being infected with or dying from COVID-19, the patients' coping strategies, and the difficulties and constraints they faced. Finally, the article gives recommendations for better management of misophonia. Improved knowledge of this disorder would help address the current lack of health and social care, hopefully preventing this shortfall's impact on social and affective relationships, which are particulary important for well-being now and in the coming periods of physical distancing measures.

Highlights • We found micro and macro-structural white matter alterations in misophonia. • Patients had greater white matter volumes in left frontal cortex. • Patients had lower averaged radial and mean diffusivities. • Voxel-wise comparison indicated widespread clusters of lower mean diffusivity., Misophonia is a condition in which specific ordinary sounds provoke disproportionately strong negative affect and physiological arousal. Evidence for neurobiological abnormalities underlying misophonia is scarce. Since many psychiatric disorders show white matter (WM) abnormalities, we tested for both macro and micro-structural WM differences between misophonia patients and healthy controls. We collected T1-weighted and diffusion-weighted magnetic resonance images from 24 patients and 25 matched controls. We tested for group differences in WM volume using whole-brain voxel-based morphometry and used the significant voxels from this analysis as seeds for probabilistic tractography. After calculation of diffusion tensors, we compared group means for fractional anisotropy, mean diffusivity, and directional diffusivities, and applied tract-based spatial statistics for voxel-wise comparison. Compared to controls, patients had greater left-hemispheric WM volumes in the inferior fronto-occipital fasciculus, anterior thalamic radiation, and body of the corpus callosum connecting bilateral superior frontal gyri. Patients also had lower averaged radial and mean diffusivities and voxel-wise comparison indicated large and widespread clusters of lower mean diffusivity. We found both macro and microstructural WM abnormalities in our misophonia sample, suggesting misophonia symptomatology is associated with WM alterations. These biological alterations may be related to differences in social-emotional processing, particularly recognition of facial affect, and to attention for affective information.

We propose that synesthetic cross-activation between the primary auditory cortex and the anatomically adjacent insula may help explain two puzzling conditions—autonomous sensory meridian response (ASMR) and misophonia—in which quotidian sounds involuntarily trigger strong emotional responses. In ASMR the sounds engender relaxation, while in misophonia they trigger an aversive response. The insula both plays an important role in autonomic nervous system control and integrates multiple interoceptive maps representing the physiological state of the body to substantiate a dynamic representation of emotional wellbeing. We propose that in ASMR cross-activation of the map for affective (sensual) touch leads to an increase in subjective wellbeing and parasympathetic activity. Conversely, in misophonia the effect of the cross-activation is to decrease emotional wellbeing and increase sympathetic activity. Our hypothesis also illuminates the connection between hearing and wellbeing more broadly and helps explain why so many people experience decreased wellbeing from modern urban soundscapes.

Forced strict confinement to hamper the COVID-19 pandemic seriously affected people suffering from misophonia (M+) and those living with them. Misophonia is a complex neurophysiological and behavioral disorder of multifactorial origin, characterized by an intense physiological and emotional response produced by intolerance to auditory stimuli of the same pattern, regardless of physical properties. The present work studied the secondary impact that strict confinement caused in 342 adults (224 women: 118 men) regularly attending a medical psychological center in Barcelona. Misophonia, usually underdiagnosed, showed a prevalence of 35%, the same for women (37%) than men (31%). A retrospective analysis using a physical-psychological-social inventory of 10 variables evaluated the number of individuals that during confinement and self-confinement (March 11 - June 29, 2020) canceled (mostly M-) and/or requested a therapeutic intervention, the reasons for their request, and the strategies they used to self-manage the situation. Ten main variables indicated that the confinement exponentially increased the effects of misophonia compared with results from the same individuals during the last quarter of 2019. Most people diagnosed with misophonia continued with tele-assistance during the confinement because of this impact's self-concern. Besides the impacts as part of the general population, M+ also developed different symptoms causing significant personal, social, and job/occupational imbalance, as compared to M-. Health, fears, conflicts with neighbors, study-related difficulties were outstanding reasons for consultations. The LSB-50 test for ‘Psychological and Psychosomatic Symptoms’ applied to M+ revealed the increase of 8 of 9 items of this psychopathological test. Sleep disorders (coronasomnia), hostility, depression, and somatization were more severe than in previous assessments. Women presented the worst psychological and psychosomatic states (eight out of nine, as compared to one out of nine in males). The study unveiled the complex physical-psychological-social burden, the need for dissemination and a gender perspective to understand the secondary impact of COVID-19 pandemic on the mental health of the population with misophonia. The results also show that in this new COVID era people suffering from misophonia need to develop coping strategies addressing modifiable risk and protective factors. They deserve familial/social comprehension, stronger clinical support and a gender medicine perspective.

For individuals with misophonia, specific innocuous sensory stimuli - such as hearing another person chewing or breathing - evoke strong negative emotional and physiological responses, such as extreme anger, disgust, stress and anxiety. Instead people with misophonia do not experience or display atypical reactions to generic aversive sounds such as screams or nails scratching on a blackboard. Misophonia appears to be unrelated to neurological trauma or hearing deficit, and features a characteristic developmental pattern. Its aetiology is currently unknown.The few previous fMRI studies on misophonia showed that sufferers feature increased dorsal anterior insula activity during trigger vs. generic aversive sounds. While this effect likely reflects the saliency associated with the perception of trigger sounds in people with misophonia, in the present fMRI study we investigate the neural mechanisms underlying the emotional reaction to trigger stimuli. To this aim, we probe the task-dependent connectivity of mid-cingulate, medial premotor and ventrolateral premotor cortex. We observe that only in participants with misophonia the presentation of trigger audio-visuals prompts an increased interaction of these three brain regions with the lateral orbitofrontal cortex. This brain region is crucial for behavioural inhibition mediated by cognitive and emotional content (such as in reward-reversal learning) and is part of the temporo-amygdala-orbitofrontal network, which integrates visceral and emotional states with cognition and behaviour. We also observe that in people with misophonia trigger sounds prompt a significant increase in the interaction between mid-cingulate and the primary auditory cortex.Our study replicates previous results and expands the network of brain regions involved in misophonia. The involvement of the orbitofrontal cortex suggests a defective functioning of high-order integrative processes allowing the reappraisal of experience-dependent negative emotional association with harmless sensory stimuli, and sheds light on the mechanisms underlying the compulsive nature of the misophonic reaction. The increased interaction, rather than the overall activity, of the primary auditory cortex with the mid-cingulate supports the hypothesis that the emotional response in misophonia is subserved by an indirect auditory-limbic pathway processing the subjective valence of specific sounds, rather than their physical properties alone.