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1. Ramblings#

Can't sleep because of the heat in the middle of the night, so I'll update my blog. Misophonia is still a relatively new concept in the medical field. It was first proposed by Jastreboff and others in the early 21st century. Although there are more and more clinical cases now, misophonia has not yet been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or the International Classification of Diseases (ICD-11). Therefore, there is a lack of a systematic and effective set of diagnostic criteria to evaluate it.

Yes, this thing is not considered a serious and recognized psychological disorder, but 30% to 40% of my mental exhaustion in daily life is caused by this thing - extreme irritability when hearing specific sounds. All my attention is focused on these sounds, and even wearing noise-canceling headphones doesn't help. At least the noise cancellation of AirPods Pro 2 is not able to completely filter out the noise, so the irritability remains.

2. What is Misophonia#

1. Introduction#

The term "misophonia" was first proposed by audiologists Jastreboff and others (2001), referring to a strong aversion or hatred of sounds. It is an emotional disorder caused by everyday sound stimuli and is also known as "selective sound sensitivity syndrome" (Bruxner, 2016).

Some everyday sounds can evoke strong negative emotions in individuals, leading to anger and disgust (Kumar et al., 2017). In some cases, this group of individuals may have a strong urge to escape from the sound environment, and may even experience feelings of rage and engage in aggressive behavior (Kumar et al., 2014; Schröder et al., 2013; Tunc & Basbug, 2017). The reported triggering stimuli usually involve sounds produced by others, including chewing, slurping, swallowing, smacking, sniffing, throat clearing, and heavy breathing (Kumar et al., 2017; Sanchez & da Silva, 2018). Familiar sounds produced by people such as family members and friends are more distressing than sounds produced by strangers (Schneider & Arch, 2017; Taylor, 2017). Once the patients notice these annoying stimuli, it is usually difficult for them to divert their attention from the sounds. Some specific visual stimuli can also trigger distressing reactions in patients. When patients see others' lip movements, even if they cannot hear the chewing sounds, they still feel anger and disgust. Visual information may exacerbate misophonia symptoms, and the simultaneous occurrence of audiovisual stimuli often intensifies the aversion to these sounds (Cox, 2008). In addition, some patients also reported feeling anger when others perform specific actions unrelated to sound (such as leg shaking) (Potgieter et al., 2019).

For me, the sounds I dislike the most are the sound of someone smacking their lips while eating and the sound of my roommate clicking their fingers and making unknown movements with their lips.

2. Prevalence#

A study conducted on Chinese university students found that the prevalence of misophonia is about 6%. The average age of onset reported by the participants was between 12 and 13 years old, and many patients may have experienced misophonia symptoms during childhood and adolescence.

That's so true.

3. Consequences#

Due to the daily nature of the triggering stimuli, patients are prone to experiencing a range of negative emotions, most commonly anger, disgust, and anxiety. Misophonia patients report higher levels of anxiety symptoms compared to the general population (Schröder et al., 2013), and misophonia is significantly correlated with anxiety and depression (Wu et al., 2014; Zhou et al., 2017). Cusack et al. (2018) also found that the stronger the patients' anxiety sensitivity, the more severe their misophonia. In addition to changes in psychological states, misophonia may also lead to increased autonomic arousal, resulting in physiological changes such as sweating, muscle tension, and increased heart rate. Furthermore, misophonia symptoms can be even more severe in individuals with post-traumatic stress disorder (PTSD) (Rouw & Erfanian, 2017). Similar to PTSD, the abnormal physiological arousal in misophonia patients can lead to a range of behavioral reactions aimed at avoiding triggering stimuli. For example, some misophonia patients not only avoid eating with family members but also reduce the frequency of going to public restaurants. They worry about behaving inappropriately and experience guilt, anxiety, and other internalized problems, leading to social avoidance. On the other hand, some individuals may engage in aggressive behaviors to prevent others from continuously producing triggering stimuli, including verbal confrontation (reprimanding, cursing), glaring at others, and physical aggression, resulting in externalized problems (Taylor, 2017). Schröder et al. (2013) further confirmed this point in their study, finding that 29% of misophonia patients engage in verbal attacks against the sound producer, and 17% engage in physical attacks. It is evident that misophonia can significantly affect patients' social functioning and interpersonal interactions, hindering their normal work, study, and daily life.

Three, Mechanisms of Occurrence and Development#

The occurrence and development mechanisms of misophonia manifest as abnormalities in attention systems, perception systems, emotional systems, and perception-action coupling systems.

1. Single Channel Abnormality#

On one hand, misophonia exhibits single channel abnormalities. Misophonia may share similar neural activation and functional connectivity features with Autism Spectrum Disorder (ASD). ASD individuals have heightened perception, attention, memory, and emotional responses to environmental information. This excessive activation of local brain regions amplifies ordinary sensory experiences, putting ASD individuals in an overloaded state and leading to excessive fear and anxiety experiences, which in turn result in social withdrawal (Lin Guoyao, Chen Shunsen, 2015). Although there is currently no research linking misophonia to the intense world theory, reduced sound tolerance is common in individuals with ASD (Danesh et al., 2021; Scheerer et al., 2022), and misophonia shares sensory hypersensitivity and emotional disorder features similar to ASD. Neuroscientific research also provides preliminary evidence for this possible explanation of misophonia (Kumar et al., 2017; Schröder et al., 2019).

1.1 Abnormal Attention System#

Attention refers to the direction and concentration on specific objects. Misophonia patients have different levels of attention to different sounds, and there are differences in triggering stimuli and their intensity among patients, suggesting the presence of attention system abnormalities (Frank et al., 2019).

1.2 Abnormal Perception System#

Misophonia patients may have abnormal perception systems. Although triggering sounds are often not high-frequency or loud, and sometimes even very soft, patients are highly sensitive to them. Edelstein et al. (2013) found that misophonia patients have heightened auditory sensitivity and consider auditory stimuli more anger-inducing and disgusting than visual stimuli in similar contexts. This pattern is consistent with the measurement results of skin conductance response (SCR), indicating that misophonia may be a disease of autonomic hyperreactivity. Neuroimaging studies have further found that misophonia is associated with increased activity in the right superior temporal auditory cortex (Schröder et al., 2015), indicating that their perception system is indeed different from that of the general population.

In addition to being overly sensitive to external stimuli, misophonia patients also have significantly higher sensitivity to internal sensations than the general population (Kumar et al., 2017; Wang et al., 2022). Interoception refers to the perception of bodily physiological conditions and the representation of internal states in different environments (Craig, 2009). Misophonia patients pay special attention to their own internal sensations (McKay et al., 2018), and somatosensory amplification significantly predicts misophonia (Colak et al., 2021). Dozier (2015a) believes that misophonia is a "reflex" to aversive stimuli. The triggering stimuli cause abnormal physiological arousal, leading to extreme emotions and fight/flight responses. The patients' heightened interoceptive sensitivity further defines these somatic symptoms and sensations as more dangerous content, which reinforces the severity of misophonia.

1.3 Abnormal Emotional System#

Misophonia often triggers negative emotions in patients, leading to increased anxiety. Anxiety plays a mediating role between misophonia and anger outbursts (Zhou et al., 2017), and external evaluations can significantly predict emotional outbursts in misophonia (Wang et al., 2022). Emotional processing is a predictive factor for misophonia behavior (Barahmand et al., 2021), and the patients' aggressive and avoidant reactions may be the result of emotional dysregulation. Individual emotional dysregulation is significantly correlated with the severity of misophonia (Guetta et al., 2022), and emotional dysregulation plays a mediating role between disgust sensitivity and misophonia (Barahmand et al., 2021).

2. Perception-Action Coupling Abnormality#

Mirror neurons are neurons that are activated when an individual performs or observes others performing actions, and they play an important role in social cognition. The triggering sounds of misophonia are usually related to oral and facial movements, which may activate the mirror neuron system in misophonia patients, causing them to feel others' actions. This process may be regulated by the anterior insula, which has close connections with the visual, auditory, and motor cortices. Therefore, misophonia may not be a response to the sound itself, but a response to the actions represented by the sound.

Four, More Ramblings#

Well, that's the situation.jpg

My current view is that how others behave is their freedom, after all, you can't say that finger-clicking and eating with a smacking sound violate social norms. My misophonia is my own problem, so since it doesn't align with my current values to ask others not to make sounds that annoy me, I can only focus on myself and find solutions.

• 1. Buy a pair of headphones with better noise-canceling capabilities, such as Sony XM5.
• 2. Make an appointment with a psychologist during the summer break to see how to intervene.

References:
[1] Xu, T., Xu, H., Ping, X., et al. (2023). Clinical Psychological Characteristics and Neural Mechanisms of Misophonia. Applied Psychology, 1-17.