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At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

Misophonia: A “Rarely Known” Conditioned Aversive Reflex Disorder

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Misophonia: A “Rarely Known” Conditioned Aversive Reflex Disorder

Jill Stoddard

by Annabelle Parr

Most of us can probably agree that it’s very unpleasant to hear nails scraping a chalkboard. Other sounds that tend to make us cringe include a woman’s scream, a disc grinder (think construction site), and a baby crying. This is because we are genetically wired to respond to a baby’s cry, so any other sound similar in frequency tends to be upsetting (Dozier, 2015).

There are sounds that are almost universally annoying, and then there are those sounds that get to each of us individually. But for some of us, a specific sound can be more than simply annoying or unpleasant; it can be intolerable. Do you find yourself experiencing a particularly extreme or adverse reaction to a sound or stimulus that seems strange or out of proportion? If so, you may be encountering a misophonic reaction.

What is misophonia?

Misophonia is a condition characterized by an extreme, immediate, involuntary emotional response accompanied by a reflexive physiological reaction to a specific, commonly occurring sound or visual stimulus (Dozier, 2015).

Tom Dozier, director of the Misophonia Institute, describes misophonia as a Conditioned Aversive Reflex Disorder. Though misophonia is most commonly identified by the emotional response – typically anger, rage, disgust and even hatred - there is almost always a physiological response that occurs as well. Tom’s research suggests that it is actually the physical response that lies at the heart of misophonia. When a person hears (or sees) their trigger, the autonomic nervous system elicits a reflexive physical reaction. It could be contracting of a particular muscle group or it could be an internal reaction, varying from nausea to a numbing sensation to constriction of the esophagus. Because the intense emotional reaction follows so quickly, the physical response often goes unnoticed. But it appears that the emotional reaction is directly related to the physical reaction. In individuals with misophonia, the connection between the autonomic nervous system and the limbic system (emotional center) becomes hypersensitized (Bernstein, Angell, & Dehle, 2013), such that the trigger stimulus elicits the physical reflex which then elicits the extreme emotions and fight or flight response.

What misophonia is NOT.

Misophonia is not a sensitivity to the volume of the sound; it is not a fear of a sound; it is not becoming upset by a continuous, loud, intrusive, irritating sound; and it is not a logical response to the meaning behind a sound (for example, responding to a baby’s cry is a natural response to address the infant’s distress). It IS the emotional and physiological response to a single occurrence of the trigger, regardless of how loud or noticeable the trigger is.

What are some common triggers?

There is an enormous range regarding potential trigger stimuli. However, some common examples include the eating or chewing sound, breathing sounds, coughing, swallowing, pen clicking, whistling, typing, and a dog barking. A trigger can be any repeating sound or sight. Triggers tend to be most strongly associated with one particular person, but they do have the ability to generalize. For example, the original trigger might be the sound of a sibling chewing. This will likely remain the strongest trigger, but it could also generalize to the sound of any person chewing.

How common is misophonia?

Not very many people know about misophonia, doctors and therapists included. Many people with misophonia struggle with feelings of guilt for their reaction, as they are aware that it is both out of proportion and irrational. They may also feel isolated in their experience. But if you struggle with a misophonic reaction, you are far from alone. It is not a rare disorder, but rather a “rarely known” disorder. Based on several studies and surveys, it is estimated that misophonia affects about 15% of the population (Dozier, 2015), compared with Major Depressive Disorder which, according to the Anxiety and Depression Association of America (2016), affects about 6.7% of the population above the age of 18 in a given year.

How does misophonia affect people?

Misophonia can range from manageable to debilitating. If a person’s trigger is fairly uncommon, it may hardly affect him or her at all. However, if a trigger is very common and the reaction is severe, it can lead to avoidance of situations and serious strains on relationships.

Can I get help for misophonia?

If you think that you may be struggling with misophonia, you don’t have to continue to try to handle it alone, particularly if it is something that has begun to impair your day-to-day functioning or affect your relationships. Misophonia can continue to increase in severity if it is left unaddressed, so it is important to know that help is available.  However, because there is not a widespread awareness of misophonia, it can often be misdiagnosed as anything from oppositional defiant disorder to ADHD to anxiety or OCD. So if you are struggling with what sounds like misophonia, it is important to find a professional who understands what you are experiencing and knows how to help.

For more information about misophonia, how it is treated, and related resources, please visit http://misophoniainstitute.org. If you think you or someone you love may be struggling with misophonia, CSAM’s Dr. Michelle Lopez offers specialized treatment at our Rancho Bernardo office. If you would like more information…

CSAM IS HERE TO HELP

Please contact us at (858) 354-4077 or at csamsandiego@gmail.com if you or someone you love might benefit from treatment for misophonia. We also offer acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, and would be happy to provide more information about our therapy services.

References:

Anxiety and Depression Association of America. (2016). Facts & statistics. Retrieved from: https://www.adaa.org/about-adaa/press-room/facts-statistics

Bernstein, R. E., Angell, K. L., & Dehle, C. M. (2013). A brief course of cognitive behavioural therapy for the treatment of misophonia: A case example. The Cognitive Behaviour Therapist, 6(10), 1-13. doi:10.1017/S1754470X13000172

Dozier, T. H. (2015). Understanding and overcoming misophonia: A conditioned aversive reflex disorder. Livermore, CA: Misophonia Treatment Institute.