Misophonia, selective sensitivity to sound

By Cristiano Antonino On Oct 18, 2022

Misophonia is a disorder characterised by intolerance, and consequent pathological reactions, to sounds that are commonly present in the environment and that do not normally elicit particular reactions in most people

As with any other psychic disorder, it is such if it significantly affects the life of the sufferer, possibly affecting social and work activities or causing some subjective suffering.

This prevents the term from being used for mild intolerances that are present in many of us, or from being used, for example, for conditions limited in time and to specific circumstances.

Certainly on the third night in a row when an alarm goes off by mistake in the shop next door, it is normal to express anger.

Equally understandable is the reaction of the call centre worker to the phone ringing as soon as he gets home after eight hours of work.

Diagnosis of misophonia

In the same way, a complex of symptoms that, although meeting the criteria for fulfilling the diagnosis, is an expression of a more complex psychological disorder and only manifests itself in the presence of it (major depression, bipolar disorder, obsessive compulsive disorder, etc.) cannot be defined as misophobia.

Referring to etymology and considering that the prefix derives from the Greek misos, meaning hate, perhaps the more appropriate term would be phonophobia, being in fact a phobia and not a hatred of sounds.

But the latter term is reserved for other pathological conditions, including intolerance to all or many sounds, often resulting in headaches, or the annoyance towards sounds that can occur in certain organic manifestations such as headaches or fever.

This is why I would be more in favour of using the term, proposed by others, of ‘selective sensitivity to sound’.

Misophonia occurs as an isolated symptom in 9-15% of cases

For the rest, it is associated with other disorders, the most frequent of which is tinnitus, which accounts for 40-50% of all misophobia cases.

The sounds towards which intolerance is manifested are most often emitted by humans.

They may be emitted by the mouth (brushing teeth, smacking lips, chewing, swallowing), nose (breathing, sniffing, blowing), fingers (tapping fingers on the table, clicking with a pen, tearing paper), footwear (heel noises on the floor), joints during normal movements.

Frequently, sounds emitted by animals (barking, meowing) may also elicit the same reactions.

As a consequence, the subject may develop a real phobia towards those movements, which he often observes out of the corner of his eye, that could potentially lead to the emission of the feared noises.

Those suffering from misophobia may have reactions of anxiety, anger, outbursts, marked discomfort, irritability and, over time, may come to avoid many social situations, where the feared noises are more likely to occur, resulting in true isolation.

Misophonia: the psychological causes

Misophonia is frequently associated with psychological disorders such as anxiety, obsessive compulsive disorder and depression.

However, it is often difficult to establish a cause-effect relationship.

The cause is sometimes to be found in remote situations, experienced in a particularly traumatic way, or in the association of sounds with people or situations towards which one is intolerant or that have negatively affected one’s life.

Other psychological aspects are relational ones.

It is no coincidence that feared noises almost always belong to humans, and frequently to family members.

They therefore have the characteristic of being avoidable.

But for this, it is necessary for the person making them to be able to understand the essence of the disorder and to recognise the sufferer in his pathology.

But very often this is not the case.

On the contrary, it is precisely the affected person’s reactions that are considered hostile acts towards family members.

Thus, the disorder can, in some cases, be inscribed within complex relational mechanisms.

Misophonia: organic causes

One of the causes of misophonia may be a reduced threshold of noise tolerance, as evidenced by its frequent association with tinnitus.

An interesting Brazilian study from 2013, carried out by the University of São Paulo, shows a hereditary origin.

The study was conducted on 15 members from three generations of a family, aged 9 to 73.

The results, in addition to ascertaining the hereditary component, highlighted the origin of the disorder in childhood and the association with other pathologies, in particular anxiety in around 91% of cases, tinnitus (50%), obsessive-compulsive disorder (41.6%), depression (33.3%), and hypersensitivity to sounds (25%).

Neurophysiological aspects

Whatever the prevailing cause, the result is a sort of short-circuit, to put it in unscientific terms, that takes place between the perceptual system of sounds and the limbic system (the area of the brain deputed to emotions, from pleasure to anger), without those necessary passages through other areas of the brain deputed to the control and processing of what we perceive, and in the absence of which coexistence between humans would probably be practically impossible.

A recent study carried out by researchers, using functional magnetic resonance imaging, revealed an abnormal connection between the frontal lobes, deputed to rational and control systems, and the anterior insular cortex, an area belonging to the limbic system.

Therapies and treatment: how to deal with misophonia

Misophonia is a relatively young disorder on the scientific scene and has not yet found its precise place in the nosographic classification.

To date, there are no known effective pharmacological therapies, other than psychotropic drugs, which treat more the co-present psychological reactions or disturbances rather than sound tolerance.

Some psychological therapies have shown some effectiveness.

These include sound therapy, or TRT (tinnitus retraining therapy), aimed at raising the threshold of tolerability to specific sounds.

It consists of subjecting the patient to non-tolerated sound with increasing intensity and duration.

The effectiveness of the therapy is variable and requires further evaluation.

Forms of psychotherapy are also used, including cognitive-behavioural therapy, particularly when the psychological aspect of the problem is prevalent in its causes and manifestations.

Useful, in many cases, is family therapy, at least in that capacity that allows those around the subject a better understanding of the problem.

As always, the correct understanding of a problem is the conditio sine qua non for an initial approach and resolution.

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