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Id 905ccfaf-7723-4ae0-bf49-006516fce06a
Year 2024
Abstract
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- Clinical characteristics of a treatment seeking sample of adults with misophonia
- (Woolley et al., 2024)
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Dv Authors Mercedes G. Woolley, Leila K. Capel, Emily M. Bowers, Julie M. Petersen, Karen Muñoz, Michael P. Twohig,
Dv Initial Source Misophonia MOC
Dv Limitations • Sample primarily composed of White women in Western United States limits generalizability. • Lack of consensus definition of misophonia across studies. • Absence of inter-rater reliability data for DMI scoring. • DIAMOND does not assess personality disorders or autism spectrum disorder, which have been linked to misophonia in prior research. • Small sample size limited ability to examine whether specific psychiatric disorders (vs. any comorbidity) predict severity. • Treatment-seeking sample may have uniformly high severity regardless of symptom progression history.
Dv Future Directions • Larger samples needed to investigate whether specific psychiatric comorbidities (e.g., OCD, panic disorder, borderline personality disorder) predict misophonia severity. • Comprehensive diagnostic tools including SCID-5 and SCID-5-PD should be employed to assess personality disorders and autism spectrum disorder. • Longitudinal studies needed to understand why symptoms worsen for some individuals but improve for others. • Multiple raters needed to establish inter-rater reliability for DMI. • Research should explore differences between individuals with person-specific versus generalized trigger responses to inform personalized treatment. • Studies should refine diagnostic criteria in clinical samples and develop targeted interventions considering unique triggers and contextual factors.
Dv Relevance • describes a randomized clinical control trial with a great background section on the progression of Misophonia, issues around etiology and diagnostics, and other clinical focused topics
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Clinical characteristics of a treatment seeking sample of adults with misophonia: Onset, course, triggers, context, and comorbidity
Status:: #status/reviewed
Metadata
- Item Type: #journalArticle
- Authors:: Mercedes G. Woolley, Leila K. Capel, Emily M. Bowers, Julie M. Petersen, Karen Muñoz, Michael P. Twohig,
- Date Added: November 1, 2024
- URL: https://linkinghub.elsevier.com/retrieve/pii/S2211364924000599
- DOI: 10.1016/j.jocrd.2024.100915
- Cite Key: woolleyClinicalCharacteristicsTreatment2024
- Tags:: #Misophonia, #Bare-bones-review-🦴, #clinical, #comorbidity, #Onset, #Contextual-Factors,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia is a multidisciplinary problem with audiological and psychological features; prevalence of moderate to severe symptoms estimated at 2.1–12.8% of population-based samples. • Symptoms typically emerge in childhood and fluctuate in severity over time. • Trigger sounds and contexts vary significantly between individuals; some report reactions only to sounds from loved ones while others report distress from any source. • Psychiatric comorbidities remain underexplored, with prior studies relying primarily on self-reports of prior diagnoses rather than structured clinical interviews. • Large-scale phenotyping studies often lack structured interviews to confirm clinically elevated misophonia. Purpose- • Characterize onset, symptom progression, trigger noises, and psychiatric comorbidities in treatment-seeking adults with misophonia. • Investigate relationships between clinical characteristics and severity of self- and clinician-rated misophonia symptoms. |
| Participants/samples | • N=60 adults seeking treatment for misophonia; 90% women; 98.3% White; 76.7% heterosexual; mean age 33.80 years (SD=12.18). • Inclusion: age ≥18; seeking misophonia treatment; DMI total score ≥20. • Exclusion: psychological/neurological impairments precluding participation; conditions exceeding misophonia as primary difficulty (e.g., current mania). |
| Measures | • Duke Misophonia Interview (DMI): 18-item semi-structured clinical interview; assesses triggers, severity, impairment currently and over lifetime; total score range 0–72; cutoff ≥20 for clinical significance. • Diagnostic Interview for Anxiety, Mood, OCD, and Neuropsychiatric Disorders (DIAMOND): structured diagnostic interview for DSM-5 disorders except personality disorders and autism spectrum disorder. • Misophonia Questionnaire (MQ): 18-item self-report; three subscales (symptoms, emotions/behaviors, severity); total score range 0–68; severity item range 1–15 with ≥7 indicating clinical significance. |
| Procedures | • Recruitment via local flyers and social media advertising treatment for misophonia (November 2022–November 2023). • Online screener including MQ; eligibility required MQ severity item >5 and interest in treatment. • Clinical interview (DMI) administered by trained doctoral student clinician; first 10 interviews reviewed with principal investigator for scoring calibration. • Psychiatric comorbidities diagnosed using DIAMOND by graduate student clinical assessor. • Comprehensive audiological assessment to identify peripheral hearing deficits. |
| Results | Onset and Course– • Most participants (79%) reported onset in childhood/early adolescence: 43% ages 6–10; 23% ages 10–13; 13% before age 6; 13% ages 14–18; 7% early 20s. • Symptoms worsened over time for 63%; remained steady for 27%; improved for 5%. • New triggers developed over time for 85%. • Triggers– • All participants bothered by human-produced sounds. • Most common: eating mouth sounds (97%); non-eating mouth sounds (85%); nasal sounds (82%); human-produced repetitive sounds (82%); throat sounds (67%). • Non-human repetitive noises reported by 43%. • Seeing silent sound production least common (23%). • 33% bothered exclusively by human-produced sounds; 67% also bothered by animal- and/or environmental sounds. Context– • Sounds from known people (family, friends) most exacerbating (85%). • Internal factors (stress, fatigue, trying to focus/relax) worsened symptoms (80%). • Quiet environments problematic (70%). • Visual triggers (seeing sound occur) reported by 35%. • Noisy places less problematic (30%). • Context matters for 97%; only 3% reported context irrelevant. • 60% reported reactions specific to certain people/situations; 40% reported reactions generalized to all individuals. Comorbidity– • 52% met no criteria for another psychiatric disorder. • Most common comorbidities: ADHD (23%); generalized anxiety disorder (17%); social anxiety disorder (8%); premenstrual dysphoric disorder (7%); persistent depressive disorder (7%). • OCD, hoarding disorder, body dysmorphic disorder each 3%. • Tic disorder, somatic symptom disorder, PTSD, panic disorder, bipolar II disorder each ≤2%. Severity Predictors– • Course over time (worsening vs. steady/improving): no significant association with MQ or DMI total scores. • Trigger type (human-only vs. human+animal/environmental): no significant association with MQ or DMI total scores. • Person-specific context (matters who vs. anyone): generalized reactions significantly predicted higher MQ total scores (β=4.78, p=.024, R²=.08); no significant association with DMI total. • Psychiatric comorbidity (any vs. none): no significant association with MQ or DMI total scores. |
| Discussion/Limits | Conclusion- • The authors conclude that misophonia typically emerges during childhood to early adolescence (ages 6–14), paralleling early-onset psychiatric disorders rather than later-onset anxiety or mood disorders. • The findings indicate that symptoms worsen over time for most individuals (63%) and new triggers commonly develop (85%). • The data support that human-produced sounds, particularly eating sounds, are universal triggers in this sample; however, presence of additional non-human triggers does not increase symptom severity. • The authors conclude that generalized reactions to triggers (anyone can trigger vs. specific individuals) are associated with higher self-reported severity on the MQ, potentially due to increased hypervigilance and triggering frequency. • The findings indicate that quiet environments are more triggering than loud ones, distinguishing misophonia from hyperacusis. • The authors conclude that internal factors (stress, fatigue, focus/relaxation efforts) significantly influence symptom intensity for most participants (80%), consistent with patterns in other psychopathology. • The data support that ADHD (23%) and generalized anxiety disorder (17%) are the most common comorbidities in treatment-seeking adults with misophonia. • The findings indicate that OCD and PTSD are no more prevalent in misophonia than in the general population, challenging historical speculation linking these conditions. • The authors conclude that psychiatric comorbidity in general does not predict misophonia severity, though heterogeneity in comorbid conditions may obscure specific disorder relationships. |
| Limitations:: | • Sample primarily composed of White women in Western United States limits generalizability. • Lack of consensus definition of misophonia across studies. • Absence of inter-rater reliability data for DMI scoring. • DIAMOND does not assess personality disorders or autism spectrum disorder, which have been linked to misophonia in prior research. • Small sample size limited ability to examine whether specific psychiatric disorders (vs. any comorbidity) predict severity. • Treatment-seeking sample may have uniformly high severity regardless of symptom progression history. |
| Future Directions:: | • Larger samples needed to investigate whether specific psychiatric comorbidities (e.g., OCD, panic disorder, borderline personality disorder) predict misophonia severity. • Comprehensive diagnostic tools including SCID-5 and SCID-5-PD should be employed to assess personality disorders and autism spectrum disorder. • Longitudinal studies needed to understand why symptoms worsen for some individuals but improve for others. • Multiple raters needed to establish inter-rater reliability for DMI. • Research should explore differences between individuals with person-specific versus generalized trigger responses to inform personalized treatment. • Studies should refine diagnostic criteria in clinical samples and develop targeted interventions considering unique triggers and contextual factors. |
| Relevance:: | • describes a randomized clinical control trial with a great background section on the progression of Misophonia, issues around etiology and diagnostics, and other clinical focused topics |
Notes
key terms and concepts
- misophonia – disorder characterized by intense emotional reactions (anger, hatred, disgust) and physiological arousal in response to specific repetitive sounds.
- disorder of decreased sound tolerance – current framing of misophonia by experts pending further evidence for psychological, neurological, or audiological classification.
- functional impairment – avoidance or distress interfering with daily activities (e.g., avoiding restaurants to prevent exposure to eating sounds).
- Duke Misophonia Interview (DMI) – semi-structured clinical interview assessing presence, severity, triggers, and functional impairment from misophonia.
- comorbidity – co-occurrence of another psychiatric disorder alongside misophonia.
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contextual statement
In a 2024 study, Woolley attempted to characterize the onset, symptom progression, triggers, and psychiatric comorbidities in treatment-seeking adults with misophonia by conducting structured clinical interviews (Duke Misophonia Interview and DIAMOND) and administering self-report questionnaires to 60 adults meeting clinical criteria for misophonia.
summary statement
In a 2024 study, Woolley attempted to characterize the onset, symptom progression, triggers, and psychiatric comorbidities in treatment-seeking adults with misophonia by conducting structured clinical interviews (Duke Misophonia Interview and DIAMOND) and administering self-report questionnaires to 60 adults meeting clinical criteria for misophonia. They found that 79% reported childhood/early adolescent onset with symptoms worsening over time for 63%, all participants were bothered by human-produced sounds (especially eating sounds at 97%), and generalized reactions to triggers (not person-specific) predicted higher self-reported severity; the most common comorbidities were ADHD (23%) and generalized anxiety disorder (17%). From this they concluded that misophonia's developmental trajectory resembles early-onset psychiatric disorders rather than later-onset anxiety/mood disorders, that the generalization of trigger responses to all individuals (versus specific people) may increase severity through heightened hypervigilance, and that psychiatric comorbidity is common though does not predict overall misophonia severity. They emphasized that contextual factors and individual clinical histories are critical for understanding misophonic reactions and that personalized, flexible treatment approaches should address unique triggers, internal state influences, and comorbid conditions.
zettlekasten
Childhood Onset with Progressive Worsening and Trigger Expansion
Generalized Trigger Responses (vs. Person-Specific) Predict Higher Severity
ADHD and GAD Most Common Comorbidities; OCD and PTSD Rare
Context-Dependent Reactions Require Personalized Treatment Approaches