What is Misophonia?

• In their literature review, Brout et al, wrote: “Misophonia is a neurobehavioral syndrome phenotypically characterized by heightened autonomic nervous system arousal and negative emotional reactivity (e.g., irritation, anger, anxiety) in response to a decreased tolerance for specific sounds.”
• Easier way to think about it: the brain misinterprets sounds as toxic or threatening and sets off our survival system, better known as the fight/flight response
• Fight/flight: a physiological response involving sweating, rapid heartbeat, and hormonal changes (among other symptoms) that is catalyzed by exposure to stimuli perceived as harmful, in which our body prepares us to “fight” or flee from danger (brain area is the amygdala)
• Problem in misophonia is that this automatic reaction happens within milliseconds
• Another way to think about misophonia is auditory gating
• Like a sleeping dog prick up ears in reaction to sound (alerting), the brain goes through subconscious or preconscious process to determine if a threat exists. In response, dog will do three things:
  • Nothing and fall back to sleep
  • Hide (flee)
  • Bark or more (fight)

The Origin of Misophonia

• Misophonia was termed by Jastreboff and Jastreboff in 2001
• While working in their audiology clinic, the Jastreboffs observed that some people reacted to sounds (such as chewing, pencil tapping, keyboard typing, and coughing) with high levels of irritability related to autonomic nervous system arousal (the fight/flight system)
• Unlike their patients with hyperacusis (a disorder in which individuals perceive sounds more loudly than objective measures), individuals with misophonia appeared to respond to pattern-based sounds with autonomic arousal (later, we see that many sounds are also repetitive in nature)
• Due to the high cost of research, the Jastreboffs did not study their misophonia theory but ventured to begin treatment at their clinic based on methods previously used for tinnitus and hyperacusis

Although the Jastreboffs suggested that misophonia involves negative associations between auditory, cognitive, and emotional areas of the brain, they did not view misophonia as a “psychiatric disorder”.

Want to learn more? Join a Workshop with Dr. Jennifer Brout or Duke CMER at Misophonia Education.