Auditory Over Responsivity and Misophonia: Diagnostic Confusion Continues for these two disorders that are not in the DSM-5
Misophonia describes a neurologically based disorder in which auditory stimuli (and sometimes visual) is misinterpreted within the central nervous system. Individuals with misophonia are set off or “triggered” by very specific patterned sounds, such as chewing, coughing, pencil tapping, sneezing etc. Pawel and Margaret Jastreboff termed the disorder in 2001, in an effort to distinguish it from hyperacusis. Hyperacusis and Misophonia are both disorders related to “decreased sound tolerance”. However, hyperacusis is a condition in which auditory information is unbearably and painfully loud. In Misophonia, it is repeating (or patterned sounds) that are intolerable, and context plays a role in responsivity.
Adding to the diagnostic confusion related to Misophonia is its remarkable symptom overlap to Sensory Processing Disorder (SPD), specifically the subtype Sensory Over-Responsivity. Individuals with Sensory Over-Responsivity react to all types of sensory information as though it were dangerous, and are propelled into the fight/flight response when met with stimuli they find noxious. In both disorders, auditory stimuli may set off fight/flight, leaving the sufferer feeling angry, fearful, disgusted and/or “generally out of control” as the Jastreboff’s originally suggested. The Sensory Over-Responsivity research is decades ahead of the misophonia research, which has just begun. One hopes these two bodies of research will inform each other.
However, most researchers are not used to working in a cross-disciplinary model. While the National Institute of Health is trying to change that model, we are used to the old paradigm. That is, audiologists don’t usually study the research of Occupational Therapists. Psychiatry is often slow to accept research from a field such as Occupational Therapy, where the most of SPD research has been built. As a result, SPD and Misophonia share more than symptoms. They share neglect from the medical and psychiatric community. Neither disorder has been accepted into the DSM-5, or the ICD-10 and so, the additional problem of diagnostic confusion between these two disorders continues.
Understanding the similarities and differences between conditions informs treatment, and treatment of course alleviates suffering. In addition, without a disorder gaining entry into either the DSM-5 or the ICD-10, insurance will not reimburse any kind of treatment for the disorder. Despite studies estimating that up to 20% of children are affected by SPD, and regardless of the tens of thousands of people who have gathered on social media platforms to form support groups for misophonia, medical acceptance eludes these disorders with overlapping symptoms. As the many groups of Misophonia sufferers grow on social media platforms, a search for Misophonia in the National Institute of Mental Health database yields little.
Sensory Over Responsivity A person with SOR experiences the world as threatening, painful, and/or as a scary place. These individuals are often hyper-vigilant continually stressed, and may experience frequent meltdowns (Miller, 2006).
Misophonia: Misophonia is a neurophysiological condition that causes autonomic nervous system arousal and even a fight/flight/freeze response to otherwise normal auditory and visual stimuli. As of now, there is no official consensus on what exactly causes the disorder.
Where do you stand on this issue?
If you are interested in my presentation on this subject (as well as many other experts in the field), feel free to sign up for the online conference sponsored by the SPD Parent Zone http://www.spdparentzone.org/product/sensory-awareness-month-online-conference-for-parentscaregivers/?ap_id=JJBcounseling