Clinical Intervention

Misophonia (or selective sound sensitivity syndrome) is a disorder of decreased tolerance to specific sounds or their associated stimuli, or cues. These cues, known as "triggers", are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses not seen in most other people. Misophonia and the behaviors that people with misophonia often use to cope with it (such as avoidance of "triggering" situations or using hearing protection) can adversely affect the ability to achieve life goals, communicate effectively, and enjoy social situations. At present, misophonia is not listed as a diagnosable condition in the DSM-5-TR, ICD-11, or any similar manual, making it difficult for most people with the condition to receive official clinical diagnoses of misophonia or medical services. In 2022, an international panel of misophonia experts published a consensus definition of misophonia, and since then, clinicians and researchers studying the condition have widely adopted that definition. When confronted with specific "trigger" stimuli, people with misophonia experience a range of negative emotions, most notably anger, extreme irritation, disgust, anxiety, and sometimes rage. The emotional response is often accompanied by a range of physical symptoms (e.g., muscle tension, increased heart rate, and sweating) that may reflect activation of the fight-or-flight response. Unlike the discomfort seen in hyperacusis, misophonic reactions do not seem to be elicited by the sound's loudness but rather by the trigger's specific pattern or meaning to the hearer. Many people with misophonia cannot trigger themselves with self-produced sounds, or if such sounds do cause a misophonic reaction, it is substantially weaker than if another person produced the sound. Misophonic reactions can be triggered by various auditory, visual, and audiovisual stimuli, most commonly mouth, nose, and throat sounds (particularly those produced by eating and drinking), repetitive sounds produced by other people or objects, and sounds produced by animals. The term misokinesia has been proposed to refer specifically to misophonic reactions to visual stimuli, often repetitive movements made by others. Once a trigger stimulus is detected, people with misophonia may have difficulty distracting themselves from the stimulus and may experience suffering, distress, or impairment in social, occupational, or academic functioning. Many people with misophonia are aware that their reactions to misophonic triggers are disproportionate to the circumstances, and their inability to regulate their responses to triggers can lead to shame, guilt, isolation, and self-hatred, as well as worsening hypervigilance about triggers, anxiety, and depression. Studies have shown that misophonia can cause problems in school, work, social life, and family. In the United States, misophonia is not considered one of the 13 disabilities recognized under the Individual