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Misophonia - What it is and what it isn't

Updated: Sep 13, 2022

Misophonia is a puzzling thing. A sound processing disorder where common everyday noises trigger extreme emotions such as rage and disgust with a healthy serving of automatic murderous fantasy thoughts on the side. Sound extreme? It is--and most misophones know it--that's why it's so distressing.

Should you be worried? No, misophones rarely act out on these thoughts and emotions, but talking about them to professionals has lead to grievous misunderstandings, invalidation, and erroneous pathology. This comparison of other common disorders listed in the DSM-V and ICD-10 illustrate how Misophonia can be easily confused or conflated with other disorders and how to tell them apart.
A sound processing disorder where common everyday noises trigger extreme emotions such as rage and disgust with a healthy serving of automatic murderous fantasy thoughts on the side.

The following are excerpts from a study published in 2013: "Misophonia: Diagnostic Criteria for a New Psychiatric Disorder" by Schroder, Nienke, and Denys

Misophonia vs Specific Phobia

Specific phobia resembles misophonia because in specific phobia an external acoustic stimulus can also trigger a negative emotional reaction when this stimulus is directly related to the phobic object (i.e. the sound of a dog barking in fear of dogs). As in misophonia, this emotional reaction causes avoidant behavior. However, in specific phobia the perceived emotion is anxiety, whereas in misophonia it is aggression.

Misophonia vs PTSD

As in misophonia and specific phobia, in PTSD acoustic stimuli can cause intense aversive physical arousal with subsequent avoidant behavior. PTSD-related stimuli can arouse a sudden recollection and/or re-enactment of the trauma, or of the original reaction to it, and may even trigger dramatic, acute bursts of fear, panic or aggression. However, in PTSD a life threatening traumatic event has been experienced and the driving emotion is fear, not aggression.

Misophonia vs Social Phobia

Both patients with social phobia and misophonia experience stress or anxiety in social situations and will avoid these. In social phobia the core is a hypersensitivity to negative evaluation by others. However, in misophonia the fear of social situations is secondary to concerns of encountering misophonic stimuli.

Misophonia vs OCD

In misophonia there is a monothematic preoccupation with a specific sound, which resembles obsessionality in OCD. Avoidance is present in both disorders as well as in other anxiety disorders. However, in OCD patients tend to perform compulsive acts to reduce anxiety and aggression is not commonly reported.

Misphonia vs Intermittent Explosive Disorder

Excessive impulsive aggression is seen in various disorders, most notably in intermittent explosive disorder. In this condition there must be several separate episodes of failure to restrain aggressive impulses that result in serious assaults against others or property destruction. Patients with misophonia also report impulsive aggression but very rarely lose control for they feel it is unacceptable and that it should be prevented at all costs.

Patients with Misophonia also report impulsive aggression but very rarely lose control for they feel it is unacceptable and that it should be prevented at all costs.
Misophonia vs Personality Disorders with Compulsive Agression

In various personality disorders impulsive aggression is defined. In emotionally unstable personality disorder (ICD-10), borderline personality disorder (DSM-IV-TR) and antisocial personality disorder (DSM-IV-TR, ICD-10) there is frequent impulsivity

and difficulty controlling anger but this is not related to any specific sound. However, in misophonia aggressive outbursts are rare. Moreover, none of the patients [in this study] met the criteria for these personality disorders.

Misophonia vs Obsessive Compulsive Personality Disorder

People with misophonia show characteristics of OCPD (or anankastic personality disorder, ICD-10). Twenty-two patients (52.4%) [in this study] even met the SCID-II criteria for OCPD. However, not all OCPD patients report misophonic symptoms. Furthermore, aggression is not mentioned as a key symptom of this disorder. This high comorbidity does raise the question of whether OCPD is a predisposing factor in the development of misophonia or a consequence of having misophonia. It has been reported previously that some individuals with impulsive aggressive problems develop OCPD symptoms in an attempt to compensate for an underlying problem with behavioral inhibition. This does not hold for our sample because in misophonia the impulsive aggression is only related to certain sounds. Also, none of our patients noticed a direct association between their misophonia and personality. They suffered most from misophonia, whereas OCPD did not cause them much suffering.

Misophonia vs Autisim Spectrum Disorder/ Sound Processing Disorder

Auditory hyper-responsivity is also observed in ASD. It is even thought that a dysfunction in different sensory modalities is characteristic for ASD. Regarding this sensory dysfunction in ASD there is an overlap with the concept of SPD, a group of

disorders that involve challenges in modulation, integration, organization, and discrimination of sensory input that causes inadequate responses to the input and disruptive emotional and behavioural patterns [20]. Typical auditory sensitivity in ASD and SPD is to unexpected and loud noises, such as vacuum cleaners or a dog barking. This pattern is clearly different from the auditory triggers in the misophonia patients. Furthermore, none of our patients was diagnosed with ASD. Since the validity of SPD is still not widely accepted, further research is needed on this concept.

Misophonia vs General Medical Conditions and Substance Induced Disorders with Impulsive Aggression

Aggression can be related to the consumption of intoxicating substances. However, none of the patients used recreational drugs or excessive amounts of alcohol, so these can be ruled out as a cause. Moreover, none of the patients reported any physical conditions in general or history of brain damage in particular. Although one patient showed hearing loss in the right ear, it is unlikely that an organic cause could explain the symptoms.

Misophonia vs Phonophobia

A strong emotional reaction to sound is also described in phonophobia (i.e. fear of sound). It has been suggested that phonophobia is an extreme form of misophonia. However, if that were the case, the patients would experience anxiety at some stage in the course of their condition. Our patients were therefore explicitly asked about the occurrence of anxiety in relation to the misophonic stimuli. None of them reported experiencing anxiety, therefore this was excluded.

There are many individuals who may have Misophonia AND one or more of the disorders listed above. This will complicate treatment, but knowing what is Misophonia and what is "something else" is crucial to developing self compassion and finding a way forward.

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