Where are we at with misophonia research?
© Lev Golgachov
Misophonia, although now more widely known, is still a condition without a satisfactory therapy. Sufferers endure strong negative feelings (such as disgust), while feeling hyperalert and stressed to the sudden onset of certain noises. Often, the only recourse is to simply escape. Surprisingly, there is also no name given those who suffer from this condition and research papers are riddled with variations of “people with misophonia” or “misophonia in people.” Given that misophonia has a strong impact on a person’s lifestyle, influences their daily choices, and appears irreversible, I would like to propose we recognize the autonomy of these sufferers with the term misophone.
Currently, we do not have a good population estimate for misophones, and estimates can vary broadly. A study from 2024, which recruited 4005 people to resemble the population of the United States, estimated that 4.6% of the group had misophonia and symptoms were higher in women (1 ).
The noises themselves do not appear to be anything too egregious, such as the sound of chewing, yawning, snoring, or the clicking of a pen. However, for the misophone, the noise marks an immediate sense of extreme discomfort and unlike with other aversive noises, there is an inability to habituate or simply get used to it.
While effective therapy is still light on the ground, we should be encouraged that there has been a lot of good research in the last nine years. Neuroscience studies have shown that the auditory cortex in both misophones and non-misophones are functionally comparable when trigger noises are heard (2). This suggests that the problem is not so much the processing of the noise, but higher order functioning.
This has been demonstrated in other studies, where we see that misophones have hyperactivity in the Anterior Insular Cortex (3), increased neural connectivity between the orofacial motor area and the auditory cortex,(2&3) and greater white matter volumes in the fronto-occipital fasciculus, anterior thalamic radiation, and the body of the corpus callosum (4). The recruitment of these areas when the trigger noise is heard, along with functional differences in communication pathways, shows that the misophone is exercising an emotional response that is at least partially based in the consideration of the person making the noise.
The trigger examples listed above are notably all noises made by somebody else, and so it makes sense that the misophonic response recruits areas in the brain that apply a social or personal meaning to the noise. Ironically, this meaning is not obvious, even to the misophone themselves. Most misophones come from loving and supportive families, but they still have to actively avoid family members if there is a chance they could hear the trigger noise. It takes an understanding family to acknowledge this struggle without taking offense to the avoidance - knowing that somebody you care about views a noise you make with disgust is hard not to take personally. So what is going on in the mind of the misophone right before an initial trigger formation? Hopefully, research will one day shed some light on this.
As misophonia, in all likelihood, has impacted people for centuries but has only been recognized recently, there is every possibility that answers about the condition could come from other places. Autists are known to have a high prevalence of misophonia (5), and there is a known difficulty for autists to understand and interpret social situations. So, while misophones might not necessarily meet an autism diagnosis, the wealth of literature attempting to understand how autists approach social situations could provide some clues regarding trigger formation. Autists agonize over interpreting social cues, and so the mere recruitment of more brain areas in an attempt to think through and understand a social cue could itself open up the person to the development of a trigger. This would support the increased connectivity and activity seen in the misophone brain from neuroscience studies. Allists would not need to think too deeply as social situations are more easily understood.
In addition, the desire for the misophone to escape from the noise, which is caused by the actions of an “other”, meets the definition for feelings of intrusion (6). Many studies are available to explore how intrusive memories and thoughts can be ameliorated to maintain a standard of living. Some of these have used transcranial magnetic stimulation (a means of creating temporary local deactivation in the brain) to reduce the impact of brain areas recruited in forming and recreating intrusive memories. We are starting to see how the misophone brain differs, and so this method of therapeutic exploration could hold some promise.
There is hope and I am convinced an effective therapy is not too far away. It may even be as simple as drinking lavender tea (7).
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