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Consensus Definition of Misophonia: A Delphi Study
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- Item Type: #journalArticle
- Authors: Susan E. Swedo, David M. Baguley, Damiaan Denys, Laura J. Dixon, Mercede Erfanian, Alessandra Fioretti, Pawel J. Jastreboff, Sukhbinder Kumar, M. Zachary Rosenthal, Romke Rouw, Daniela Schiller, Julia Simner, Eric A. Storch, Steven Taylor, Kathy R. Vander Werff, Cara M. Altimus, Sylvina M. Raver
- Date: 2022-3-17
- Date Added: 2022-07-14
- URL: https://www.frontiersin.org/articles/10.3389/fnins.2022.841816/full
- DOI: 10.3389/fnins.2022.841816
- Cite key: undefined
- Topics: ../Misophonia MOC
- Tags: #Misophonia, #seminal-work
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Abstract
Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.
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| Background/Purpose | Background- • Misophonia has been variably defined across disciplines (audiology, neuroscience, psychiatry, psychology). • Lack of a common definition limits cohort comparability, psychometric validation of tools, and treatment evaluation. • Published literature recently exceeded 100 peer-reviewed papers but remains methodologically heterogeneous. • Purpose- • Determine whether experts could develop a consensus definition of misophonia. • Produce a foundational, inclusive definition based on available scientific and clinical evidence using a modified Delphi process. • |
| Participants/samples | • 15-member Misophonia Consensus Committee (MCC). • Experts across audiology, auditory neuroscience, psychology, psychiatry, cognitive neuroscience. • Rounds 1–2: 15 participants; Round 3: 13–14 participants; Round 4: 14 participants. • Consensus defined as ≥80% agreement of members present. • |
| Measures | • Systematic literature review (PubMed, Google Scholar, PsyArXiv, bioRxiv, medRxiv; 2001–September 2020; English; “misophonia” in title/keywords/abstract). • Extraction of verbatim definitional statements. • Classification into 12 Primary Domains of Criteria. • Survey instruments (SurveyMonkey; Zoom polling in Round 3) with structured response options (Agree/Disagree/Insufficient Information; Always/Sometimes/Insufficient Information; forced-choice formats). |
| Procedures | • 68 references identified. • 551 individual definitional statements extracted verbatim. • Statements categorized into 12 Primary Domains. • Round 1: 199-question survey evaluating all statements. • Round 2: 108-question survey reassessing non-consensus statements. • Round 3: Virtual meeting; discussion and voting on 19 near-consensus or integral statements. • Round 4: 6-question survey to finalize phrasing/location. • Draft definitions iteratively revised (Versions 1–4). • Final definition incorporated statements meeting ≥80% consensus. • |
| Results | Literature extraction • 68 references yielded 551 definitional statements. • Twelve thematic domains identified. Round 1 • 54 statements reached consensus to include. • 12 statements reached consensus to exclude. • 133 statements did not reach consensus. Round 2 • 26 additional statements reached consensus to include. • 12 statements reached consensus to exclude. • Remaining statements reduced to 19 for Round 3 discussion after removing low-support or redundant items. Round 3 • 8 statements incorporated (6 as written; 2 revised). • 5 statements excluded (consensus exclusion or lack of support). • 6 statements advanced for Round 4 clarification. • Round 4 • 5 additional statements incorporated. • 1 statement removed despite majority vote due to conceptual concerns. Final outcome • 93 individual statements met ≥80% consensus and were integrated into the final definition. • Misophonia defined as a disorder characterized by decreased tolerance to specific auditory and associated stimuli, strong negative emotional, physiological, and behavioral reactions, contextual modulation, functional impairment, variable severity, childhood/early adolescent observation, and non-explanation by other disorders. |
| Discussion/Limits | Conclusion- • The authors conclude that a consensus definition of misophonia can be developed from existing literature using a structured Delphi process. • The findings indicate that misophonia is best described as a “disorder” rather than a “condition” or “syndrome.” • The authors conclude that current evidence is insufficient to classify misophonia as specifically medical or psychiatric. • The data support excluding proposed biological, genetic, reflex, or mechanistic explanations from the definition. • The authors conclude that prevalence, specific age of onset, and typical longitudinal course should not be defined due to insufficient validated evidence. • The findings indicate that misophonia can co-occur with auditory, neurological, or psychiatric conditions but should not be better explained by them. • The authors conclude that the consensus definition should function as a working definition subject to validation and revision. |
| Limitations:: | • Potential influence of expert composition on consensus outcome. • Absence of individuals with lived misophonia experience on the committee. • Dependence on existing heterogeneous literature. • Measurement tools largely not psychometrically validated. • Inherent circularity in deriving definition from prior definitions. |
| Future Directions:: | • Validate, reevaluate, and revise the definition as evidence evolves. • Clarify mechanisms underlying misophonia. • Differentiate misophonia from hyperacusis and other overlapping conditions. • Develop and psychometrically validate diagnostic tools. • Conduct longitudinal and prospective studies on onset and course. |
| Relevance:: | • first widely agreed definition of misophonia and various components of it( triggers, responses, etc.) |
Notes
key terms and concepts:
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Misophonia – a disorder of decreased tolerance to specific sounds or stimuli associated with such sounds.
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Triggers – specific stimuli associated with misophonic responses; experienced as unpleasant or distressing and evoke strong negative emotional, physiological, and behavioral responses.
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Modified Delphi method – a structured, iterative consensus-building process involving multiple rounds of expert evaluation and voting.
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Consensus threshold – ≥80% agreement among Committee members to include or exclude a statement in the definition.
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Primary Domains of Criteria – twelve thematic categories used to classify definitional statements about misophonia.