Specificity of Affective Responses in Misophonia Depends on Trigger Identification

Abstract

Individuals with misophonia, a disorder involving extreme sound sensitivity, report significant anger, disgust, and anxiety in response to select but usually common sounds. While estimates of prevalence within certain populations such as college students have approached 20%, it is currently unknown what percentage of people experience misophonic responses to such “trigger” sounds. Furthermore, there is little understanding of the fundamental processes involved. In this study, we aimed to characterize the distribution of misophonic symptoms in a general population, as well as clarify whether the aversive emotional responses to trigger sounds are partly caused by acoustic salience of the sound itself, or by recognition of the sound. Using multi-talker babble as masking noise to decrease participants' ability to identify sounds, we assessed how identification of common trigger sounds related to subjective emotional responses in 300 adults who participated in an online study. Participants were asked to listen to and identify neutral, unpleasant and trigger sounds embedded in different levels of the masking noise (signal-to-noise ratios: −30, −20, −10, 0, +10 dB), and then to evaluate their subjective judgment of the sounds (pleasantness) and emotional reactions to them (anxiety, anger, and disgust). Using participants' scores on a scale quantifying misophonia sensitivity, we selected the top and bottom 20% scorers from the distribution to form a Most-Misophonic subgroup (N = 66) and Least-Misophonic subgroup (N = 68). Both groups were better at identifying triggers than unpleasant sounds, which themselves were identified better than neutral sounds. Both groups also recognized the aversiveness of the unpleasant and trigger sounds, yet for the Most-Misophonic group, there was a greater increase in subjective ratings of negative emotions once the sounds became identifiable, especially for trigger sounds. These results highlight the heightened salience of trigger sounds, but furthermore suggest that learning and higher-order evaluation of sounds play an important role in misophonia.

Does context matter in misophonia? A multi-method experimental investigation

“…The results of the study are consistent with the role of context of the sounds on evaluation of misophonia trigger sounds found in other studies ( Frank and McKay, 2019 ; Edelstein et al, 2020 ; Natalini et al, 2020 ; Wiese et al, 2021 ; Cowan et al, 2022 ; Heller and Smith, 2022 ; Samermit et al, 2022 ; Savard et al, 2022 ). Put simply, the misophonic reaction is reduced when it is perceived as something apart from a human mouth sound.…”

“…Nonetheless, among nonmisophonic participants, similar effects were observed (with an exception for dominance rating). Although such a result does not support a part of our hypothesis which states that the eating sound's context will not affect the control group, it is in line with three studies (Heller and Smith, 2022;Samermit et al, 2022;Savard et al, 2022) published after our study had begun, showing that the same orofacial or unpleasant sounds are assessed more positively when perceived or presented as something else, in participants without misophonia as well. In our study, however, controls, on average, assessed stimuli as neutral to somewhat positive in the audio-video condition.…”

“… Heller and Smith (2022) showed that misidentification of the sounds’ context (e.g., chewing food misidentified as stirring cereal) decreased their “aversiveness” rating among people with and without misophonia. Results pointing to the significance of the cognitive assessment of common trigger sounds were also found by Savard et al (2022) . In this study, the 20% with the most severe misophonia symptoms and the 20% with the least severe misophonia symptoms from a group of 300 individuals sampled from the general population were asked to assess and recognize sounds presented against multi-talker babble at various levels of signal-to-noise ratio.…”

“…As a result, it is possible that participants in these studies were not significantly impaired by misophonia symptoms in everyday life, or could have other sound intolerance conditions, such as hyperacusis or phonophobia. For example, in Savard et al (2022) only 6 out of 66 participants from the group with high misophonia symptoms met the cut-off for misophonia on the MisoQuest ( Siepsiak et al, 2020 ). Similarly, in Samermit et al (2022) , 14 out of 101 participants met the cut-off for moderate or higher impairment misophonia on the Misophonia Questionnaire ( Wu et al, 2014 ).…”

Misophonia: A Systematic Review of Current and Future Trends in This Emerging Clinical Field

“…We also consider necessary the construction of a database of sound, visual, kinesthetic, and/or olfactory stimuli triggering misophonia for a faster and better identification of potential stimuli, and personalized interventions to prevent, alleviate, and relieve them from the experience. In addition, it may also be of general interest because, as Savard indicated in a recent study, the specificity of affective responses in misophonia depends on the identification of the trigger [ 112 ].…”