For most people the sound of chewing, typing, utensil scraping and breathing are background sounds. They are just a part of life and certainly do not produce an emotional response. However, for some people, hearing these sounds lead to feelings of anger. Neuroscientist Jastreboff (2010) introduced the term Misophonia where it is defined as "abnormally strong negative reactions of the autonomic and limbic systems to specific sounds resulting from enhanced functional connections between the auditory and limbic systems’ (Tinnitus and Hyperacusis Clinic, 2010). This condition is not included in the DSM-V (APA, 2013). There is no formal diagnostic formula for the condition. While there is no diagnostic criteria for misophonia, there are a few common symptoms reported by sufferers. All of the individuals experience limited trigger sounds that lead to strong emotional or physical reaction. The trigger sounds are frequently breathing or eating noises. The onset often occurs around puberty. These individuals actually prefer a louder environment and sounds to soft sounds (Cohen, 2014). Upon hearing their trigger sound, these people experience a "flight or fight" response with a release of adrenaline, face flushing, their heart rate increases, they shake, and they want to either flee or attack the person causing the trigger (Novak, 2014).

This condition goes with the person wherever they go and has negative effects on their social, family, and personal life. Friends and family do not understand the condition and just think the person is moody or overly sensitive. They find themselves not wanting to be around the person because they feel like they are walking on eggshells. Most individuals experience the emotion of rage when they hear their trigger sound (Jastreboff & Hazell, 2004). They sometimes experience violent urges toward the person making the sound and there have been reports of assaults. Schwartz (2011) reports that these individuals often become socially isolated have relationship problems and difficulties at work. The individuals feel very tense and on edge when they hear their triggering sound.

Many professionals had never heard of the disorder until 2011 when reports from the Today Show and New York Times (Cohen, 2011) reported on the condition. Celebrities, such as Kelly Ripa, have come forward that they suffer with the condition. During a 20/20 interview the celebrity said, “It could be as simple as just swallowing; the sound of swallowing. Well, I think that my gut reaction is to yell, but I control that. If my husband eats a peach, I have to leave the room.” On the same episode, a young girl admitted that sighing or coughing has angered her so much that she has hit her mother. She claims to have attempted suicide three times because of the difficulty caused by the condition. Adah Siganoff explained on the Today show “It’s all about the reaction. The rage. The anger. For people with this disorder, the sound is like 200 people pulling their fingernails down a chalkboard at the same time. It’s that same intensity and it’s very overwhelming.”

The condition usually occurs suddenly in late childhood or early adolescence. These individuals develop their first trigger sounds and become more sensitive to them over time.  (Cohen, 2011). The people are especially irritated and experience feelings of rage toward family members who are producing these sounds (Kim, 2014). There appear to be a few sounds that are particularly annoying to these individuals: loud breathing, yawning, chewing, sniffling, swallowing, typing, pencil scratching, trickling water, and crinkling paper (Schwartz et al. 2011).

An Explanation for Misophonia

Though the condition is not considered a "mental illness", it does cause daily struggles. Shroeder (2013) recommends that the disorder be diagnosed as a discrete psychiatric disorder.  There is very little research on the disorder and little is known about the cause for the condition. Edelstein (2013) notes that as of 2013, only two case studies and one clinical study have examined this condition. There is a massive need for more research on this condition. Jastreboff and Jastreboff (2004) found that when trigger sounds are played to individuals with the disorder, that the limbic and autonomous nervous system become activated. The auditory system, however, does not. This might mean that misophonia has anatomical origins. This study is important because prior to the finding, it was believed that misophonia was an auditory condition. According to Hall (2013) who is an audiologist, surveys have estimated the prevalence to be around 8-9% of the population, with 2-3% with such an intolerance that professional help is needed. At the website Misophonia.com there is a handout for medical professionals that states, "It is very important to realize that the individual with Misophonia often has little or no control over their reactions. They realize that their sensitivities to these sounds are irrational, but their brains appear to get hijacked and their emotional centers activated, perhaps related to a brain error involving the normal “fight or flight” response that all humans experience in a threatening situation".

Treatment for Misophonia

Misophonia is a popular current event topic and in recent years, several news outlets have done reports on the condition, but there is little research on the disorder. This means many individuals are coming forth for treatment, but the practitioners have little information about how to treat them. Most research involves the tinnitus retraining therapy device (Jastreboff et al. 1996; Jastreboff& Jastreboff, 2003). It helps to manage the symptoms, but it does not treat them. Hall (2013) notes that it is important to rule out a variety of central nervous system disorders as an explanation for the sound intolerance to include multiple sclerosis, Ramsay-Hung Syndrome, Tay Sach's disease, post-traumatic stress disorder, migraines, and depression.

An audiologist, Marsha Johnson, has created a sound-generating program to help with the disorder. The equipment works by "weakening the individual's abnormal connection between certain sounds and the autonomous nervous system, paired with cognitive behavioral therapy".  Johnson noted that these individuals also turn to treatments such as acupuncture, chiropractors, counseling, dietary changes, and a variety of other tactics. Some of the tactics she described include working in a noisy environment, using fans, water fountains, hearing aids that block frequency and headsets that play low frequency noise. Hall (2013) notes that counseling is "essential for any patient with decreased sound tolerance". Hall explains that psychoeducation about the disorder is important and the sufferers need to understand that the reaction is due to parts of the brain that control emotion and fear responses to sound. Hall (2013) particularly recommends counseling with someone who is an expert in cognitive behavioral therapy.

Though, no cure for Misophonia, the community of sufferers have found coping techniques. Many keep ear plugs or white noise headphones handy. Other recommended treatments include Neurofeedback, Tinnitus Retraining Therapy, and Psych-therapeutic hypnotherapy (Misophonia.com). Presently, though this is sparse information or research on the disorder, there are misophonia communities across the internet. There are several online support groups with thousands of members on Facebook and Yahoo Groups. A simple search for the Facebook Misophonia Group found one page with nearly 7,000 members.

Autonomous Sensory Meridian Response

There is an opposite condition that has recently been gaining attention as well, known as Autonomous Sensory Meridian Response (Gibson, 2014). However, SMR is actually a pleasurable tingling throughout the body and lacks any negative experiences. Some of the online videos have 300,000+ subscribers to the "whisper videos". The followers of the videos claim that the calm voices and activities create a tingling sensation in their body. One video features a woman running her fingernails across a hairbrush and seven million people have viewed it. There is not yet any published research studies about SMR though there are some research studies presently being conducted to study the phenomenon. Steven Novella (2012) who is a Yale University neurologist compares ASMR to migraine headaches saying, “We know they exist as a syndrome primarily because many different people report the same constellation of symptoms and natural history". Other professionals are more skeptical such as McGlone, professor of Neuroscience, who tells BBC in an interview: "What worries me is susceptible individuals who want to believe this kind of thing because they really have problems and need some kind of psychological help; that is where I get a little bit annoyed, because people can be led up the garden path by techniques that clearly are snake oil, and do not and will not provide any long term benefit for an underlying condition."

Both conditions involve soft sounds, but produce two entirely different reactions. They are both only recently described. It will be interesting to see the results of research to come for both of the conditions. The first condition, misophonia, is in dire need of research and information regarding its treatment to help end suffering. The second might prove useful in treatment insomnia and anxiety disorders, at least for some people.

________________________________________________________________________________________________________

References

APA (2013). Diagnostic and Statistical Manual of Mental Health Disorders: DSM-5 (5th edn). Washington, DC: American Psychiatric Publishing.

Cohen, J. (2011, September 5). When a Chomp or a Slurp Is a Trigger for Outrage. Retrieved December 16, 2014, from http://www.nytimes.com/2011/09/06/health/06annoy.html?_r=1&

(2011, September 8). [Television broadcast].L. Carroll.TODAY. NBC

(2012, Mary 17). [Television broadcastl. G. Deutsch. 20/20. ABC NEWS.

Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. (2013). Misophonia: Physiological investigations and case descriptions. Frontiers in Human Neuroscience, 7(296), 1-11.

Gibson, C. (2014, December 15). A whisper, then tingles, then 87 million YouTube views: Meet the star of ASMR. Retrieved December 17, 2014, from http://www.washingtonpost.com/lifestyle/style/a-whisper-then-tingles-then-87-millio("Today Show," 2011) n-YouTube-views-meet-the-star-of-asmr/2014/12/12/0c85d54a-7b33-11e4-b821-503cc7efed9e_story.html

Hall, J. (2013, March 1). 20Q: What can be done for patients with hyperacusis and other forms of decreased sound tolerance. Retrieved December 16, 2014, from http://www.audiologyonline.com

Jastreboff, P., & Hazell, J. (2004). Tinnitus retraining therapy: Implementing the neurophysicological model. Cambridge, UK: Cambridge University Press.

Johnson, M. (2009, January 1). Selective Sound Sensitivity Syndrome. Retrieved December 15, 2014, from http://audiology.advanceweb.com/Article/Selective-Sound-Sensitivity-Syndrome.aspx

Kim, M. (N.d.). Misophonia is a newly identified condition for people hypersensitive to sound. Retrieved December 17, 2014, from http://www.washingtonpost.com/national/health-science/misophonia-is-a-newly-identified-condition-for-people-hypersensitive-to-sound/2014/12/01/7c392782-69ba-11e4-a31c-77759fc1eacc_story.html.

Misophonia: Personality Quirk, Symptom, or Neurological Disorder? (N.d.). Retrieved December 16, 2014, from http://www.theneuroethicsblog.com/2013/04/misophonia-personality-quirk-symptom-or.html.

Novak, S. (2014). Misophonia [Interview transcript]. Retrieved from Prezi Web Site: https://prezi.com/jh-6vbnbski7/misophonia/

Schröder, A., Vulink, N., & Denys, D. (2013, January 1). Misophonia: Diagnostic criteria for a new psychiatric disorder. Retrieved December 17, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553052/.

Schwartz, P., Leyendecker, J., & Conlon, M. (2011). Hyperacusis and misophonia: The lesser-known siblings of tinnitus. Minnesota Medicine, 94(11), 42-43.

 Wagenaar O, Wieringa M, Verschuure H.(2010). A Cognitive Model of Tinnitus and Hyperacusis; A Clinical Tool for Patient Information, Appeasement and Assessment. Int Tinnitus 16 (1): 66-72.