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  • (Dozier et al., 2020)
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Dv Initial Source Misophonia MOC
Dv Status #status/Bare-bones-review
Dv Limitations • Small sample (n=3). • Participants selected based on self-reported physical reflex → limited generalizability. • EMG detection inconsistent across participants. • Surface EMG may not detect deep muscle activity. • EMG coded dichotomously (present/absent) rather than quantitatively. • Participants informed of stimulus prior to exposure (possible expectancy effects). • No formal diagnostic interview administered. • Psychometric properties of MAQ and A-MISO-S not established.
Dv Future Directions • Larger samples with clinically diagnosed misophonia. • Quantitative EMG analysis. • Needle EMG to detect deep muscle activity. • Investigate classical conditioning mechanisms longitudinally. • Examine role of expectancy and cognitive processes. • Explore interaction between initial reflex and emotional escalation.
Dv Relevance • gives a smalls scale example of observations supporting the Dozier model

Misophonia: Evidence for an Elicited Initial Physical Response

Status:: #status/Bare-bones-review

Metadata

Abstract

Misophonia is an understudied condition that is commonly viewed as an extreme sensitivity to specific soft sounds and visual stimuli which elicit strong negative emotions and physiological arousal. Recent research using self-report measures indicates that misophonia includes an elicited physical respondent (e.g. skeletal muscle flinch). Using electromyography (EMG) and direct observation, an immediate physical response to trigger stimuli was verified in three misophonic participants. Consistent movement of the body was observed in each subject when the subject reported having a moderate to strong response, though the location was unique for each subject. The response appeared to be immediate with the onset of a brief auditory stimulus and occurred at the start and throughout longer visual trigger stimuli. Additionally, an EMG measured response was consistent in one participant, and occurred in another participant when there was a strong self-reported response. Response latency for the EMG measured response was several hundred milliseconds, indicating the responses were elicited by the misophonic trigger stimulus and not general physiological arousal. This provides empirical evidence of an elicited physical response to misophonic stimuli in these individuals with misophonia. This supports conceptualization of misophonia as a condition which includes a respondent behavior (e.g. muscle flinch) elicited by the misophonic trigger stimulus. This highlights the need for additional research on the elicited physical response to misophonic stimuli and classical conditioning as a mechanism for the development of such a response.

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Article Review table
Background/Purpose Background-
• contemporary self-report research suggests Misophonia includes an elicited physical respondent, such as skeletal muscle flinch. This study aimed to see if this was true.

Purpose-
• This study aimed to expand on the results of Dozier And Morrison (2017). Specifically looking to confirm the findings of immediate physical response with direct trigger exposure and look into any temporal relationship between triggers and responses. Also aimed to address a limitation of Dozier and Morrison (2017), that being the lack of measures for temporal relationships between trigger and response, and the use of self-reports.
Participants/samples Misophonia Participants (n = 3; selected from 11 screened)
• Abby (50, female)
• Bonnie (18, female)
• Dave (37, male)
• All Caucasian.

• Inclusion criteria:
• Self-reported misophonia symptoms.
• Consistent, distinct physical response to low-intensity trigger.
• Anger response and functional impairment.

• Severity:
• MAQ: Moderate to extreme (32–61).
• A-MISO-S: Moderate to extreme (11–23).

Control Group (n = 3)
• 2 women (age 60), 1 man (age 69).
• No reported triggers or misophonia symptoms.
Measures Assessment Scales
• Misophonia History Survey (trigger categories + symptom profile).
• MAQ (0–63).
• A-MISO-S (0–24).
Behavioral Responses
• Participant self-report:
• Physical response severity (0–10).
• Emotional distress (0–10).
• Direct visual observation of muscle movement:
• Rated 0–3 by two observers.
• 100% agreement on presence/absence when viewing same area.

Physiological Measures
• Surface EMG (J&J Engineering I-330-C2+ system).
• Electrodes placed on:
• Right posterior deltoid
• T-2 paraspinals
• Lateral gastrocnemius
• EMG response classified as “present” if visually distinct from pre/post baseline.
• Timing pulses embedded for synchronization (auditory; visual timing failed in session 2).
Procedures
 Study consisted of two sessions per participant.

• Session 1- goal was to determine electrode placement for EMG/ physical movement response to triggers. Laying face down in a massage table, subjects had electrodes tested in multiple locations. They were then subjected to both auditory and visual triggers that had previously been reported as triggering to the subject. Subjects self-reported the physical/emotional response to each trigger on a 10-point scale. Duration of triggers started short then increased until  self-reports of 1-4 was achieved. The location of the highest EMG activity was used for the second session. This procedure was repeated 3 times total, 2 auditory and one visual trigger.   

• Session 2- goal was to expose subjects to triggers and neutral stim while measuring EMG of the 3 muscle groups measured in session 1. Visual observations for muscular reactions were simultaneously conducted. Subjects were exposed to 4 auditory stim ( 2 unique to each participant). Three visual stimuli were used ( 1 unique to each subject). First the auditory stimulus was presented in random order, 3 times per stimulus. Then the same was done for the visual stimulus, with the name of the stimulus being communicated before each presentation. respondents reported severity of physical and emotional response on a 10-point scale immediately after reach presentation. Subjects were told to relax muscles between each presentation. Auditory

• Auditory stimuli- auditory triggers consisted of typical triggering sounds that were either recorded by the author or found on YouTube. Neutral auditory stimuli consisted of white noise sounds from the application “TMsoft”. The duration for neutral stim was 1.0 seconds. Duration of triggers varied from 0.38 seconds to 0.83 seconds based on the results of the first testing session. Volume of recordings was adjusted to -20 db. RMS; computer volume was set to 0%

• Visual stimuli- all stimuli were recorded on smartphones. Visual triggers consisted of video of dog licking a carpet, and two different videos of a man chewing. Neutral visual stimulation included video of dogs doing tricks, man rubbing face with his hands, and man reading off the back of a box. All visual stim was presented for 3.0 seconds, presented via the Trigger tamer application on a smartphone
Results Observed Physical Response
• All three misophonic participants demonstrated visible, tic-like muscle contractions in response to trigger stimuli.
• Locations were individualized (neck, mid-back, calves/shoulder blades).
• When self-reported physical response severity ≥ 4 (0–10 scale):
• Visible muscle movement occurred 100% of the time.
• No observed physical responses occurred:
• When participants reported no response.
• In any control participant.
• Neutral stimuli rarely elicited weak responses.

EMG Findings
• Bonnie: Consistent EMG response to all trigger stimuli.
• Calf muscle: 100% detection.
• Deltoid: 77.8%.
• Paraspinals: 27.8%.
• Different trigger types activated different muscle patterns.
• Abby: EMG response only when self-reported severity was high (≥ 4).
• Dave: No detectable EMG response despite visible movement.
• Controls: No EMG responses.

Response Latency
• Auditory trigger latency:
• Bonnie: Mean 195 ms (106–352 ms).
• Abby: Mean 166 ms.
• Visual trigger latency (Bonnie): Mean 301 ms.
• Latencies (~150–200 ms auditory) suggest a reflexive, stimulus-elicited response, not secondary emotional arousal.

Core result: The study provides objective evidence (observation + EMG + latency) that misophonic triggers can elicit an immediate, individualized skeletal muscle reflex in affected individuals.
Discussion/Limits Conclusion-
The study provides empirical evidence of an elicited physical response to misophonic stimuli in individuals with misophonia.
Limitations:: • Small sample (n=3).
• Participants selected based on self-reported physical reflex → limited generalizability.
• EMG detection inconsistent across participants.
• Surface EMG may not detect deep muscle activity.
• EMG coded dichotomously (present/absent) rather than quantitatively.
• Participants informed of stimulus prior to exposure (possible expectancy effects).
• No formal diagnostic interview administered.
• Psychometric properties of MAQ and A-MISO-S not established.
Future Directions:: • Larger samples with clinically diagnosed misophonia.
• Quantitative EMG analysis.
• Needle EMG to detect deep muscle activity.
• Investigate classical conditioning mechanisms longitudinally.
• Examine role of expectancy and cognitive processes.
• Explore interaction between initial reflex and emotional escalation.
Relevance:: • gives a smalls scale example of observations supporting the Dozier model

My notes

Misc Notes

Individualized Muscle Patterns

Expectancy Effects

Distinction from Autonomic Arousal

Clinical Implications

Zettelkaten

Dozier 2020 small scale findings supporting an initial physical response in Misophonia

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