Inge Jager, Pelle de Koning, Tim Bost, Damiaan Denys, Nienke Vulink

The Brief: “Analyze a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition.”

Results:

“148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder…
58 (10%) mood disorders…
31 (5%) attention-deficit (hyperactivity) disorder…
14 (3%) autism spectrum conditions…

Two percent reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects we performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity…”

Interesting Excerpts:

“72% of subjects diagnosed with misophonia had no comorbid Axis I psychiatric disorder, 22% had one comorbid disorder, and 6% had two or more comorbid disorders…”

“Common comorbid disorders were major depressive disorder (6.8%) and obsessive-compulsive disorder (2.8%). Another 5% of the sample had comorbid AD(H)D and 3% was diagnosed with a comorbid ASC…”

“The majority (59%) had no comorbidity on Axis II. Most prevalent were OCPD (2.4%) and borderline personality disorder (BPD, 1.7%). Obsessive-compulsive personality traits were found in 26%. Subjects exhibited especially high morality and clinical perfectionism…”

“Almost all subjects reported to be triggered by eating sounds (96%) followed by nasal and breathing sounds (85%). Subjects were also regularly disturbed by sounds of repetitive tapping or mouth/throat sounds.Misophonia triggers…”

“Visual triggers were often reported, e.g., repetitive movements (68%). We found visual triggers were often directly associated with auditory triggers (e.g., grinding teeth) in clinical interviews. When visual triggers were reported, they occurred secondary to auditory triggers and had less impact than the auditory triggers. When visual and auditory stimuli occurred simultaneously (e.g., hearing and seeing someone chewing gum), subjects reported a more intense response. 59% were bothered by ambient sounds, particularly by sounds of neighbors…”

“Nature of the response: Subjects reported extreme irritation, anger, and disgust as primary emotional responses (see Table 3). Aggressive outbursts were seldom reported at psychiatric interviews; verbal aggression was common, but physical aggression was rare…”

“In clinical interviews, all subjects reported confrontations with triggers as stressful events. Subjects worried about misophonic triggers and their capacity to cope. A perceived loss of control was seen in 81% of the subjects and 90% reported severe to extreme powerlessness. In clinical interviews, most subjects expressed shame or guilt. Anticipatory anxiety and preoccupation with misophonic triggers appeared simultaneously. Two different scales showed 86 to 91% experienced serious preoccupation…”

“Most used coping was turning on music (99%) and walking away (99%). Making noise or making noise in the same rhythm, e.g., chewing or typing, was also used frequently, 86% and 77%, respectively. Finally, 86% described using earplugs; the majority of these subjects used them in the last week (73%)…”

“From a psychological perspective, misophonia can be seen as an independent construct. No association was found between misophonia symptoms and ASC, disgust sensitivity, or clinical perfectionism. Clinical perfectionism, however, was seen in 66 to 97% of the subjects. Severity of misophonia symptoms is negatively correlated with quality of life…”

Limitations: “This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used.”

Conclusion: “This study with 575 subjects is the largest misophonia sample ever described. Based on these results we propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder.”