While hyperacusis and misophonia can occur concurrently, the subconscious negative evaluation of these sounds is different, so they are separate and distinctly different conditions. Both conditions involve an abnormal perception of loudness and awareness of intolerable sounds, and distress following exposure to these sounds. Both conditions have the potential to escalate, so that an increasing range of sounds become intolerable.
Misophonia is a strongly aversive response or abnormal sensitivity to certain specific sounds, irrespective of their volume and usually made by other people. People with misophonia struggle to tolerate specific sound triggers. Common trigger sounds include:
Exposure to those trigger sounds in people with misophonia involuntarily induces disproportionally high levels of anger or rage, along with strong reactions of irritation or disgust. Misophonia is enhanced by trigger sounds often being perceived as an intolerable intrusion into one’s sense of personal space, as well as by hypervigilance towards trigger sounds and anticipatory anxiety about trigger sound exposure.
Misophonia involves an abnormal perception of loudness and a heightened awareness of trigger sounds.
Misophonia is not listed in the current DSM-5 or ICD-10 systems but is currently being investigated with regard to classification as a discrete psychiatric disorder. While misophonia overlaps with many features of obsessive-compulsive disorder (OCD), as the immediate involuntary post trigger sound exposure response is anger/rage, misophonia differs to anxiety disorders such as OCD and phobias.
Misophonia often stems from a specific instance in childhood or teenage years where a sound made by a family member elicited a strongly negative reaction of irritation and/or disgust. This reaction has the potential to escalate, at both a conscious and subconscious level, so that those everyday sounds begin to appear unnaturally prominent and increasingly annoying/disgusting, and an increasing range of trigger sounds can become increasingly intolerable.
Exposure to those trigger sounds in people with misophonia involuntarily induces disproportionally high levels of anger or rage, along with strong reactions of irritation or disgust.
Those affected can feel overwhelmed, embarrassed, ashamed and guilty by the intensity of these emotions and fear their ability to control them or resent being exposed to their trigger sounds.
Misophonia is enhanced by trigger sounds often being perceived as an intolerable intrusion into one’s sense of personal space, as well as by hypervigilance towards trigger sounds and anticipatory anxiety about trigger sound exposure.
People with ADHD, autistic spectrum disorder (ASD) and sensory processing disorders are neurologically vulnerable towards the development of misophonia. In these groups, misophonia can develop in childhood, often as a result of being readily distracted or overwhelmed by multiple sounds heard simultaneously or having auditory processing difficulties filtering out unimportant sounds.
Online forums, support groups and media attention in the last few years have raised awareness of misophonia, suggesting it is more widespread and can potentially encompass a more severe level of a reaction than was originally considered.
While there are predisposing factors increasing vulnerability, misophonia is an acquired condition, not hardwired from birth. The important element to consider is that our brain is a highly plastic organ, constantly reorganising and developing new neural connections. This means that we are able to retrain our brain to, at least partially, reverse the process which has led to misophonia.
Misophonia desensitsation involves: