Inattention in misophonia: Difficulties achieving and maintaining alertness

Using a standardized sound set to help characterize misophonia: The International Affective Digitized Sounds

Misophonia is a condition characterized by negative affect, intolerance, and functional impairment in response to particular repetitive sounds usually made by others (e.g., chewing, sniffing, pen tapping) and associated stimuli. To date, researchers have largely studied misophonia using self-report measures. As the field is quickly expanding, assessment approaches need to advance to include more objective measures capable of differentiating those with and without misophonia. Although several studies have used sounds as experimental stimuli, few have used standardized stimuli sets with demonstrated reliability or validity. To conduct rigorous research in an effort to better understand misophonia, it is important to have an easily accessible, standardized set of acoustic stimuli for use across studies. Accordingly, in the present study, the International Affective Digitized Sounds (IADS-2), developed by Bradley and Lang (Bradley MM et al., 2007), were used to determine whether participants with misophonia responded to certain standardized sounds differently than a control group. Participants were 377 adults (132 participants with misophonia and 245 controls) recruited from an online platform to complete several questionnaires and respond to four probes (arousal, valence, similarity to personally-relevant aversive sounds, and sound avoidance) in response to normed pleasant, unpleasant, and neutral IADS-2 sounds. Findings indicated that compared to controls, participants with high misophonia symptoms rated pleasant and neutral sounds as significantly more (a) arousing and similar to trigger sounds in their everyday life, (b) unpleasant and (c) likely to be avoided in everyday life. For future scientific and clinical innovation, we include a ranked list of IADS-2 stimuli differentiating responses in those with and without misophonia, which we call the IADS-M.

The effect of misophonia on cognitive and social judgments

Misophonia, a heightened aversion to certain sounds, turns common cognitive and social exercises (e.g., paying attention during a lecture near a pen-clicking classmate, coexisting at the dinner table with a food-chomping relative) into challenging endeavors. How does exposure to triggering sounds impact cognitive and social judgments? We investigated this question in a sample of 65 participants (26 misophonia, 39 control) from the general population. In Phase 1, participants saw faces paired with auditory stimuli while completing a gender judgment task, then reported sound discomfort and identification. In Phase 2, participants saw these same faces with novel ones and reported face likeability and memory. For both oral and non-oral triggers, misophonic participants gave higher discomfort ratings than controls did-especially when identification was correct-and performed slower on the gender judgment. Misophonic participants rated lower likeability than controls did for faces they remembered with high discomfort sounds, and face memory was worse overall for faces originally paired with high discomfort sounds. Altogether, these results suggest that misophonic individuals show impairments on social and cognitive judgments if they must endure discomforting sounds. This experiment helps us better understand the day-to-day impact of misophonia and encourages usage of individualized triggers in future studies.

A neuropsychological study of misophonia

BACKGROUND AND OBJECTIVES

Misophonia is a recently identified condition characterized by negative emotional responsivity to certain types of sounds. Although progress has been made in understanding of neuronal, psychophysiological, and psychopathological mechanisms, important gaps in research remain, particularly insight into cognitive function. Accordingly, we conducted the first neuropsychological examination of misophonia, including clinical, diagnostic, and functional correlates.

METHODS

A misophonia group (n = 32) and a control group (n = 64) were screened for comorbidities using a formal semi-structured interview and completed a comprehensive neuropsychological battery and self-report measures of depression, anxiety, stress, impulsivity, and functional impairment.

RESULTS

The misophonia group significantly underperformed the control group on only 2 neuropsychological outcomes involving verbal memory retrieval. Subscales of the Misophonia Questionaaire (MQ) were inversely correlated only with measures of attention. The misophonia group reported significantly higher anxiety symptoms, behavioral impulsivity, and functional impairments, and had numerically higher rates of ADHD and OCD.

LIMITATIONS

To facilitate comparability, in lieu of a formal diagnostic algorithm for misophonia, we used a commonly used empirical definition for group allocation that has been utilized in numerous previous studies.

CONCLUSIONS

Misophonia was associated with a reduction in performance on a minority of cognitive tasks and a modest increase in some psychological symptoms and comorbid conditions. Correlational data suggest that difficulties with attention regulation and impulsivity may play a role in misophonia, albeit attention functions were intact. Results should be interpreted with caution given the variability in diagnostic definitions, and more research is needed to understand cognitive functioning under 'cold' conditions in misophonia.

Alterations in attentional processing in youth with misophonia: A phenotypical cross-comparison with anxiety patients

BACKGROUND

Misophonia is a complex condition characterized by extreme emotional distress in response to specific sounds or specific visual stimuli. Despite a growing body of clinical and neuroscientific literature, the etiology of this condition remains unclear. Hyperarousal, that is, a state of heightened alertness and disinhibition, as a core feature of misophonia is supported by behavioral and neuroimaging literature and might represent a viable clinical target for the development of both behavioral and pharmacological interventions. The aim of this study was to investigate how hyperarousal might be linked to neurocognitive processes associated with vigilance and stimulus discrimination in youth with misophonia.

METHODS

We compared 72 children and adolescents with misophonia (13.74 ± 2.44 years) (64 % female) and 89 children and adolescents with anxiety (12.35 ± 2.57 years) (58.4 % female) on behavioral and signal detection performance of the immediate memory task (IMT). Anxiety patients were used as a clinical control group to distinguish attentional processes specific for misophonia.

RESULTS

Both groups demonstrated similar behavioral performance, including response rate and reaction time. However, misophonia was associated with elevated stimulus discrimination (d prime), which in turn was positively correlated with the severity of misophonia trigger reports.

CONCLUSIONS

Our findings are in line with previous cognitive and neuroimaging studies, and support an arousal-based model of misophonia, where individuals with misophonia experience a state of heightened vigilance, being more aware of stimuli in the environment. Our findings provide a neurocognitive basis for future study of neurochemical imaging that might further progress towards clinical targets.

Did Kant suffer from misophonia?

Misophonia is a disorder of decreased tolerance to specific sounds, often produced by humans but not always, which can trigger intense emotional reactions (anger, disgust etc.). This relatively prevalent disorder can cause a reduction in the quality of life. The causes of misophonia are still unclear. In this article, we develop a hypothesis suggesting that misophonia can be caused by a failure in the organization of the perceived world. The perceived world is the result of both the structure of human thought and the many conditioning factors that punctuate human life, particularly social conditioning. It is made up of abstract symbols that map the world and help humans to orient himself in a potentially dangerous environment. In this context, the role of social rules acquired throughout life is considerable. Table manners, for example, are a set of deeply regulated and controlled behaviors (it's considered impolite to eat with the mouth open and to make noise while eating), which contribute to shape the way the perceived world is organized. So it's not surprising to find sounds from the mouth (chewing etc.) among the most common misophonic sound triggers. Politeness can be seen as an act of obedience to moral rules or courtesy, which is a prerequisite for peaceful social relations. Beyond this example, we also argue that any sound can become a misophonic trigger as long as it is not integrated into the perceived ordered and harmonious world, because it is considered an "anomaly," i.e., a disorder, an immorality or a vulgarity.

Mindfulness and cognitive emotion regulation in pediatric misophonia

Misophonia is characterized by decreased tolerance of ordinary human-generated trigger sounds and associated visual stimuli (e.g., chewing, sniffing, lip smacking), coupled with intense affective reactions. The disorder often begins during childhood or adolescence and is associated with impairment and distress in numerous life domains. Research has begun to examine the underlying psychological mechanisms of misophonia in adults, but studies in youth are limited. Trait mindfulness (i.e., nonjudgmental and nonavoidant present-moment awareness) and cognitive emotion regulation (i.e., cognitive processing, or responding to, emotionally arousing situations) are two proposed mechanisms that may underpin pediatric misophonia and associated functional impairment. In the present exploratory cross-sectional study, we examined trait mindfulness and cognitive emotion regulation and their relations with misophonia features and adaptive functioning in 102 youth with misophonia (Mage = 13.7; SD = 2.5; range = 8-17). More severe misophonia was significantly associated with decreased levels of both trait mindfulness and adaptive functioning across domains, in addition to deficits in certain facets of cognitive emotion regulation, particularly self-blame. Neither trait mindfulness nor facets of cognitive emotion regulation moderated the association between misophonia severity and adaptive functioning across domains, with the notable exception that difficulties with adaptive functioning in peer relationships was attenuated in those high in mindfulness. Findings suggest that trait mindfulness- and to a lesser extent cognitive emotion regulation- may be potentially relevant processes in pediatric misophonia. However, more research is needed to uncover the precise nature of these processes to aid future characterization and intervention efforts, especially in light of equivocal findings in the present study.

Toward a Multidimensional Understanding of Misophonia Using Cluster-Based Phenotyping

Misophonia is a condition characterized by hypersensitivity and strong emotional reactivity to specific auditory stimuli. Misophonia clinical presentations are relatively complex and reflect individualized experiences across clinical populations. Like some overlapping neurodevelopmental and neuropsychiatric disorders, misophonia is potentially syndromic where symptom patterns rather than any one symptom contribute to diagnosis. The current study conducted an exploratory k-means cluster analysis to evaluate symptom presentation in a non-clinical sample of young adult undergraduate students (N = 343). Individuals participated in a self-report spectrum characteristics survey indexing misophonia, tinnitus severity, sensory hypersensitivity, and social and psychiatric symptoms. Results supported a three-cluster solution that split participants on symptom presentation: cluster 1 presented with more severe misophonia symptoms but few overlapping formally diagnosed psychiatric co-occurring conditions; cluster 3 was characterized by a more nuanced clinical presentation of misophonia with broad-band sensory hypersensitivities, tinnitus, and increased incidence of social processing and psychiatric symptoms, and cluster 2 was relatively unaffected by misophonia or other sensitivities. Clustering results illustrate the spectrum characteristics of misophonia where symptom patterns range from more “pure” form misophonia to presentations that involve more broad-range sensory-related and psychiatric symptoms. Subgroups of individuals with misophonia may characterize differential neuropsychiatric risk patterns and stem from potentially different causative factors, highlighting the importance of exploring misophonia as a multidimensional condition of complex etiology.

Attention, flexibility, and imagery in misophonia: Does attention exacerbate everyday disliking of sound?

INTRODUCTION

Misophonia is an unusually strong aversion to everyday sounds, such as chewing, crunching, or breathing. Here, we ask whether misophonia might be tied to an unusual profile of attention (and related traits), which serves to substantially heighten an otherwise everyday disliking of sounds.

METHODS

In Study 1, we tested 136 misophonics and 203 non-misophonics on self-report measures of attention to detail, cognitive inflexibility, and auditory imagery, as well as collecting details about their misophonia. In Study 2, we administered the Embedded Figures task to 20 misophonics and 36 non-misophonics.

RESULTS

We first showed that the degree to which sounds trigger misophonia reflects the pattern by which they are (more mildly) disliked by everyone. This suggests that misophonia is scaffolded onto existing mechanisms rather than qualitatively different ones. Compared to non-misophonics, we also found that misophonics self-reported greater attention to detail, cognitive inflexibility, and auditory imagery. As their symptoms worsen, they also become more accurate in an attentional task (Embedded Figures).

CONCLUSIONS

Our findings provide a better understanding of misophonia and support the hypothesis that dispositional traits of attention to detail may be key to elevating everyday disliking of sound into the more troubling aversions of misophonia.

Consensus Definition of Misophonia: A Delphi Study

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, the authors conducted a study 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.

Examining emotional functioning in misophonia: The role of affective instability and difficulties with emotion regulation

Misophonia is a newly described condition characterized by sensory and emotional reactivity (e.g., anxiety, anger, disgust) to repetitive, pattern-based sounds (e.g., throat clearing, chewing, slurping). Individuals with misophonia report significant functional impairment and interpersonal distress. Growing research indicates ineffective coping and emotional functioning broadly (e.g., affective lability, difficulties with emotion regulation) are central to the clinical presentation and severity of misophonia. Preliminary evidence suggests an association between negative emotionality and deficits in emotion regulation in misophonia. Still, little is known about (a) the relationships among specific components of emotional functioning (e.g., emotion regulation, affective lability) with misophonia, and (b) which component(s) of misophonia (e.g., noise frequency, emotional and behavioral responses, impairment) are associated with emotional functioning. Further, despite evidence that mood and anxiety disorders co-occur with misophonia, investigation thus far has not controlled for depression and anxiety symptoms. Examination of these relationships will help inform treatment development for misophonia. The present study begins to disambiguate the relationships among affective lability, difficulties with emotion regulation, and components of misophonia. A sample of 297 participants completed questionnaires assessing misophonia, emotional functioning, depression, anxiety, and COVID-19 impact. Findings indicated that misophonia severity was positively associated with each of these constructs with small to medium effect sizes. When controlling for depression, anxiety, and COVID-19 impact, results from this preliminary study suggest that (a) difficulties with emotion regulation may be correlated with misophonia severity, and (b) misophonic responses, not number of triggers or perceived severity, are associated with difficulties with emotion regulation. Overall, these findings begin to suggest that emotion regulation is important to our understanding the risk factors and treatment targets for misophonia.

["Ear rage": misophonia : Review and current state of knowledge]

Misophonia is a devastating disorder. It is known as an affective sound-processing disorder characterized by the experience of strong negative emotions (e.g., anger, distress) in response to human sounds such as eating/swallowing/breathing. Other sounds produced by humans but not directly by human bodies can also be misophonic triggers (e.g. pen clicking) or environmental sounds (animal sounds/sounds of machines). The type of aversive triggers is individual. The reaction to trigger sounds can depend on many factors, such as assessment of the sound, personal experience, social context or psychological profile. However, there is currently no consensus in defining misophonia. Misophonia is also not yet classified by any official diagnostic system, although it seems to be a separate disorder. There are also associations with other disorders such as activity disorders, tinnitus, hyperacusis, and autism spectrum disorders. In 2013, the first definition criteria were published for the diagnosis of misophonia. Specifically, fMRI showed abnormal activation of the anterior insular cortex (AIC) and other brain areas responsible for the processing and regulation of emotions. To date, no randomized controlled trials evaluating treatments have been published. The use of cognitive and behavioral interventions have been reported as well as external sound systems and sound masking systems as known in the tinnitus retraining therapy. Sufferers try to minimize the trigger sounds by wearing ear plugs or music headphones. Otolaryngologists may also encounter patients with symptoms of misophonia, e.g., when hearing screening is requested or advice should be given on different therapeutic options. This report provides an overview of the current state of knowledge in misophonia and its diagnosis and treatment.

Development and Initial Validation of the Duke Misophonia Questionnaire

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 has 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). Depending on the needs of researchers or clinicians, the DMQ may be use in full form, individual subscales, or with the derived composite scales.