Format chosen : Miscellaneous : presenting the brochure we did last year.
Mrs. A. cannot stand the chewing noises of her husband or those of strangers eating chewing gum. Her psychological assessment revealed no psychopathology, no cognitive impairment and a stable psychological structure. However, she is disturbed by these sounds on a daily basis in a very vivid way. Like Ms. A, some people are affected by a specific disorder : misophonia.
This disorder is different from hyperacusis (of auditory or neurological origin) and phonophobia (fear of hearing due to an unbearable auditory sensation produced by surrounding sounds). It does not correspond to any formal nosography. Misophonia is a syndrome of selective sensitivity to sound that triggers a negative and disproportionate reaction to certain sounds. It results in anger, distress or anxiety. These reactions may be accompanied by physical manifestations such as tightness in the chest, muscle tension, dyspnoea, hypertension or tachycardia. They may cause a strong feeling of disgust, accompanied by a massive need to stop the noise immediately. These sounds have a specific meaning for the subject who has identified them since childhood.
Disturbing sounds are reported to be produced by adults and not children (chewing, nose sniffing, breathing, pen snapping, certain gestures such as pointing, etc.). They can also be sounds from the environment (ticking clock, train, plane, animal noises, etc).
At present, the etiology of this disorder is not defined. Hypotheses concern neurological causes or conditioning processes. The prevalence is not precisely defined but is estimated at 10% among tinnitus sufferers.
The various clinical studies indicate that misophonia is not gender or age specific. Comorbidities are reported such as Tourette’s syndrome, obsessive-compulsive disorder, anxiety or depressive disorder or eating disorders.
The repercussions are emotional, social and professional. Affected individuals often suffer from deterioration in social relationships, reduced work performance and experience/ have feelings such as shame and guilt. As in the case of social phobias, misophonia sufferers often use avoidance strategies. They also implement certain self-preserving behaviours (wearing noise-cancelling headphones, eating in separate rooms or at different times, drowning out the noise by talking to each other or listening to music, etc.). As a result, their social, professional and family functioning can be disrupted and their quality of life degraded. For example, Eva, an architect interviewed in the television programme “Ça commence aujourd’hui” (France 2, April 2018) describes the violent anger that chewing or breathing noises provoke in her. She has difficulties at work, with her family, her partner and experiences daily tension due to this matter.
The treatment of misophonia is still under investigation. A self-report scale is used to assess the severity of symptoms: the Amsterdam Misophonia Scale (Cavanna & Seri, 2015). Several therapeutic techniques report benefits for patients, particularly in the field of cognitive and behavioural therapies that aim to reduce the behavioural, cognitive and emotional components of misophonia. Tools such as cognitive restructuring, exposure therapy, schema therapy and assertiveness training (the ability to express one’s emotions to another person) led to an improvement in symptoms in 74% of cases. This improvement is maintained 12 months later (Jager et al., 2021). Counter-conditioning, which consists of associating a powerful and positive stimulus (music) with a conditioned triggering stimulus, has also been shown to be effective. For calming intense emotional reactions (violent outbursts), emotion regulation therapy such as mindfulness methods, Dialectical Behaviour Therapy or Acceptance and Commitment Therapy (ACT) seem to be useful, but there have not yet been large-scale clinical trials to certify this. There are therefore many tools to help these particular patients and there is no single protocol: clinical psychology is the science of singularity.
Bibliography
* Cavanna, A. E., & Seri, S. (2015). Misophonia : Current perspectives. Neuropsychiatric Disease and Treatment, 2117. https://doi.org/10.2147/NDT.S81438
* Dozier, T. H. (2015). Counterconditioning Treatment for Misophonia. Clinical Case Studies, 14(5), 374 387. https://doi.org/10.1177/1534650114566924
* Jacot, C. R., Eric, T., & Sentissi, O. (2015). La misophonie ou l’aversion pour le bruit : À propos d’un cas clinique. Rev Med Suisse, 11, 466 469.
* Jager, I. J., Vulink, N. C. C., Bergfeld, I. O., Loon, A. J. J. M., & Denys, D. A. J. P. (2021). Cognitive behavioral therapy for misophonia : A randomized clinical trial. Depression and Anxiety, 38(7), 708 718. https://doi.org/10.1002/da.23127
* Potgieter, I., MacDonald, C., Partridge, L., Cima, R., Sheldrake, J., & Hoare, D. J. (2019). Misophonia : A scoping review of research. Journal of Clinical Psychology, 75(7), 1203 1218. https://doi.org/10.1002/jclp.22771
* Schröder, A. E., Vulink, N. C., van Loon, A. J., & Denys, D. A. (2017). Cognitive behavioral therapy is effective in misophonia : An open trial. Journal of Affective Disorders, 217, 289 294. https://doi.org/10.1016/j.jad.2017.04.017