Monday 16 February 2015

The Horrible Anger You Feel at Hearing Someone Chewing Is Called Misophonia

There's nothing more gruesome than hearing someone eat an apple, carrot, or sandwich featuring even a moderately crunchy filling. Ugh. The shivers are running down my spine just thinking about it.

I'm know I'm not alone. As a quick, informal survey suggested, plenty of my peers are disgusted by mastication too. But is it a genuine affliction or just general auditory distaste?

Misophonia, which means "hatred of sound," is rarely diagnosed. According to the Academic Medical Center (AMC) in Amsterdam, sufferers of misophonia have feelings of disgust, anger, or frustration brought on by certain sounds.

The AMC describes the reviled sounds as typically innocent ones like chewing or heavy breathing, but I truly don't understand the use of the word "innocent" here. Case in point:

Isn't that the most ghastly thing you've ever heard?

If a Google search is anything to go by, mine is far from a rare aversion. There are countless forums filled with with experiences and tips written by people who suffer daily from the atrocious sounds produced by their fellow humans. 

But the ubiquity of these sites is contrasted sharply by a lack of scientific consensus on whether or not misophonia is an actual psychological disorder, and not just a shared annoyance. In 2013, AMC researchers published a case for diagnosing misophonia, but it is not recognized in either the DSM-5 or ICD-10.

Worldwide, there are only a handful of institutions that that take misophonia seriously enough to do empirical research, which includes the AMC. I called up Arjan Schröder, a psychiatrist at the Center who's currently doing research on the cause, effects, and possible treatments of misophonia. 

His work is a collaboration with Professor Damiaan Denys, the very first person to describe the illness in psychiatric literature. Their team also published a questionnaire to facilitate diagnosis. But we'll get to that later.

"We've been working on this for four years, and every week two or three people come in seeking help," Schöder told me. These are mainly people that have been driven to find help by the severity of their misophonia. 

The AMC in Amsterdam is currently the only place in the Netherlands and Europe where treatment is offered, and one of the few places worldwide to acknowledge misophonia as a medical condition.

Almost anyone recognizes the aversion to sounds people make, but as Schröder said, "for the people that come here, the symptoms are so severe that they are clearly suffering. They can't eat together with others, sleep in the same room, or even go to work. Misophonia has so much effect on them, that they start avoiding places. And that only makes it worse."

The majority of people arriving at the AMC are grateful for the recognition of their burden. I mean, it would be overwhelming to have things like coughing, nail clipping, toothbrushing, chewing crunchy stuff, eating, slurping, breathing, snorting, yawning, chewing gum, laughing, snoring, typing, or whistling (cross out the ones that don't apply) lead to intense emotions. As such, there is little known about the cause.

"It usually starts around 13 or 14, when most psychiatric disorders start occurring. It occurs in families, so there's probably also a genetic component. And finally, it's a problem in which a connection is made between a neutral sound and an aversive emotion," Schröder said. "It's a conditioning process: if you're in a problematic situation regularly enough, and start avoiding that situation, it gets worse and worse."

Despite the lack of knowledge about the cause, treatment is possible—pretty intense treatment, based on what Schröder told me. "The treatment consists of group therapy based on different techniques used by cognitive behavioral therapists," he explained. During the group sessions, which take place every other week, patients are taught how to disconnect the sounds from negative emotions.

"It's a lengthy process, people have to work at it for months," Schröder said. And that's necessary, because the brain is basically being reprogrammed. The behavior that reinforced itself over the years has to be completely disconnected.

To make things harder, everything they're trying at the AMC is new. Until Schröder and Denys published their article on diagnosing misophonia, it hadn't been the subject of much clinical focus, even though people had been actively sharing their struggles online. Scientists were largely trying to categorize misophonia by comparing it to other known psychiatric disorders.

The renowned American neurologist Vilaynur Ramachandran compared misophonia to synesthesia in a paper from 2013. But according to Schröder this comparison is unlikely to be accurate, or at least not directly correlated. Misophonia an emotion being triggered by specific sounds, not the sense of hearing in general. His team is exploring misophonia as a part of the spectrum of obsessive-compulsive disorders.

Denys's research group is currently using fMRI to determine where differences in the brain occur in people with misophonia. They're also preparing experiments using EEG and working on refining the behavioral therapy. Finally, the team is also improving the Amsterdam Misophonia Scale (A-MISO-S), a questionnaire used to diagnose the severity of misophonia.

A majority of the people who develop misophonia, have a bit of a rigid and compulsive personality
Just like every other disorder, misophonia exists on a scale ranging from mild to severe. Most people around you who complain about you eating an apple too close to their ear (like me), or hide in their headphones when someone pulls out a bag of carrots (like me), are probably not afflicted to the point that they need therapy. But other factors can come into play.

"It also has to do with a feeling of control," Schröder said. "When you hear someone chewing loudly it's also a moral review: 'You should close your mouth when you eat' or 'You shouldn't type so loudly.' A majority of the people who develop misophonia, have a bit of a rigid and compulsive personality."

Do you recognize these thoughts? Do you hide or flee when someone makes a sound that doesn't please you? Then you can always walk in to the AMC, where they're constantly working on better treatments. For the people who don't live near Amsterdam, misophonia is gradually being recognized internationally, so with a bit of luck there will soon be a place near you.

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