Johns Hopkins Psychiatry Guide

Misophonia

Michiel Poorthuis​, M.D., Paul Nestadt, M.D., Damiaan Denys, M.D., PhD.
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DEFINITION

Misophonia refers to an extreme sensitivity to specific sounds produced by human beings, resulting in excessive, unreasonable, or out of proportion anger, disgust, or distress.

  • Possible triggers include eating sounds (smacking, swallowing, apple eating), breathing sounds, finger/hand sounds (typing, pen clicking, nail clipping), foot sounds (footsteps, sound of high heels), and repetitive visual movements (leg rocking).
  • Often the environmental context affects the severity of the reaction (i.e. the same sound in different situations provokes another response).

Episodes follow a typical course:

  • Auditory (and sometimes visual) cues are produced by other human beings
  • The sounds provoke an impulsive aversive physical reaction, which starts with irritation or disgust that immediately becomes anger
  • The anger, recognized by the patient as excessive, initiates a profound sense of loss of self-control
  • Primary coping strategy is avoidance of the misophonic situation, but alternately patients may mimic the trigger, or synchronize self-generated sounds to relieve their response

Misophonia must be distinguished from hyperacusis, wherein the reaction to the aversive sound is directly proportional to sound parameters (frequency and volume) and divorced from the context or meaning associated with the sound.

  • Decreased Sound Tolerence (DST) encompasses both hyperacusis and misophonia.
  • Primary coping strategy is avoidance of the misophonic situation, but alternately patients may mimic the trigger, or synchronize self-generated sounds to relieve their response.

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Last updated: July 31, 2016