Misophonia is a perceptual disorder that is gaining increased awareness across the fields of neuroscience, psychiatry, behavioral psychology, and audiology. However, conclusions as to the underlying etiology and effective management of misophonia suffer from inconsistent definitions of this disorder in the literature. For instance, some authors define misophonia as “hatred of sound” resulting in anger,[1] while others consider it to be a reaction to patterns of sound in certain settings.[2] To clarify the definition of this disorder for research and clinical purposes, the Misophonia Research Fund, an organization supported by The REAM Foundation and in partnership with the Milken Institute's Center for Strategic Philanthropy, invited a panel of 15 professionals with specialties in the fields of neuroscience, psychology, neuropsychology, behavioral psychology, psychiatry, and audiology to develop a consensus definition of misophonia.[3] Consensus was achieved using a modified Delphi method, which consisted of four rounds of voting on misophonia-related statements drawn from 68 references in the literature. Eighty percent agreement among the consensus team was required for the inclusion of identifiers and descriptors in the definition. The general description of the consensus definition is included below:

Misophonia is a disorder of decreased tolerance to specific sounds or stimuli associated with such sounds. These stimuli, known as “triggers,” are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people. Misophonic responses do not seem to be elicited by the loudness of auditory stimuli, but rather by the specific pattern or meaning to an individual. Trigger stimuli are often repetitive and primarily, but not exclusively, include stimuli generated by another individual, especially those produced by the human body. Once a trigger stimulus is detected, individuals with misophonia may have difficulty distracting themselves from the stimulus and may experience suffering, distress, and/or impairment in social, occupational, or academic functioning. The expression of misophonic symptoms varies, as does the severity, which ranges from mild to severe impairments. Some individuals with misophonia are aware that their reactions to misophonic trigger stimuli are disproportionate to the circumstances. Misophonia symptoms are typically first observed in childhood or early adolescence.[3]

Notably, the consensus definition characterizes misophonia as a sound tolerance disorder in which distinct sounds and/or related sensory input (such as visual imagery) elicit strong negative emotional, physiological, and behavioral reactions not typically observed in the general population. This designation differs from the opinion of other experts, who have stated that misophonia should be classified as a psychiatric disorder, with diagnostic criteria as such.[1] [4] [5] According to the consensus definition, sensory input that evokes atypical negative responses to sound is termed a “trigger” and is usually generated by another entity (e.g., a family member), specifically but not limited to the human body (e.g., chewing versus mechanical sounds). Triggers may initiate intense emotional responses of distress and subsequent difficulty functioning in everyday life,[6] with such responses lying along a spectrum of severity. Please refer to Swedo et al,[3] for the complete consensus definition.

This expert definition clarifies several points concerning triggers, associated symptomatology, and resulting behavioral impairments in individuals with misophonia, as well as emphasizes the importance of differential diagnosis from similar pathologies (e.g., obsessive, compulsive-related disorders and hyperacusis). For instance, misophonic responses may be triggered by auditory inputs and other sensory stimuli present concurrent with the auditory event. These emotional responses can include many different manifestations, such as anger, irritation, and disgust.[5] Responses may also be moderated by external factors or context, including the environment in which the trigger is presented, the patient's relationship with the source of the trigger, and the sense of control over the aversive stimulus.[7] [8] Finally, it is important to consider misophonia in relation to comparable disorders, particularly for therapeutic intervention purposes. Patterns of psychiatric disorders across a varied range have been found to be highly comorbid with misophonia.[9] The most reported have been mood disorders, such as anxiety and depression.[5] [6] [9] These conditions may require medication and/or specific behavioral therapy that is outside of the audiologist's scope of practice. Within the audiologist's scope of practice, it is critical that misophonia be differentially diagnosed from the auditory disorders of hearing loss, tinnitus, recruitment, phonophobia, and, most of all, hyperacusis.[2] [10] For example, the general description of the Misophonia Consensus Definition could also characterize hyperacusis, as both are sound tolerance disorders and involve an intense emotional, behavioral, and physiologic response to sound. Intervention options for sound tolerance disorders include cognitive behavioral therapy, sound therapy, and tinnitus retraining therapy.[2] [11] Clearly, diagnosis and management of misophonia requires a multidisciplinary approach in which psychiatrists, psychologists, and audiologists come together. However, little guidance is provided in the literature regarding the audiological diagnostic criteria for misophonia.

Received: 26 January 2023

Accepted: 04 July 2023

Accepted Manuscript online:
10 July 2023

Article published online:
29 October 2024

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