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 Medical Hypotheses 103 (2017) 109–117

Contents lists available at ScienceDirect

Medical Hypotheses
journal homepage: www.elsevier.com/locate/mehy

Misophonia: A new mental disorder?

Steven Taylor ⇑
University of British Columbia, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Misophonia, a phenomenon first described in the audiology literature, is characterized by intense emo-
Received 6 March 2017 tional reactions (e.g., anger, rage, anxiety, disgust) in response to highly specific sounds, particularly
Accepted 1 May 2017 sounds of human origin such as oral or nasal noises made by other people (e.g., chewing, sniffing, slurp-
ing, lip smacking). Misophonia is not listed in any of the contemporary psychiatric classification systems.
Some investigators have argued that misophonia should be regarded as a new mental disorder, falling
Keywords: within the spectrum of obsessive-compulsive related disorders. Other researchers have disputed this
Misophonia
claim. The purpose of this article is to critically examine the proposition that misophonia should be clas-
Selective sensory intolerance
Selective sound sensitivity syndrome
sified as a new mental disorder. The clinical and research literature on misophonia was examined and
Nosology considered in the context of the broader literature on what constitutes a mental disorder. There have
Psychiatric classification been growing concerns that diagnostic systems such as DSM-5 tend to over-pathologize ordinary quirks
and eccentricities. Accordingly, solid evidence is required for proposing a new psychiatric disorder. The
available evidence suggests that (a) misophonia meets many of the general criteria for a mental disorder
and has some evidence of clinical utility as a diagnostic construct, but (b) the nature and boundaries of
the syndrome are unclear; for example, in some cases misophonia might be simply one feature of a
broader pattern of sensory intolerance, and (c) considerably more research is required, particularly work
concerning diagnostic validity, before misophonia, defined as either as a disorder or as a key feature of
some broader syndrome of sensory intolerance, should be considered as a diagnostic construct in the psy-
chiatric nomenclature. A research roadmap is proposed for the systematic evaluation as to whether miso-
phonia should be considered for future editions of DSM or ICD.
Ó 2017 Elsevier Ltd. All rights reserved.

Introduction The question of whether misophonia, or some syndrome in

We live in an era in which the major psychiatric classification
systems, such as the successive editions of DSM, have been steadily
expanding in the number of phenomena that are considered to be
mental disorders. This has led to a growing concern that common-
place quirks, eccentricities, or problems of living are becoming
over-pathologized and over-diagnosed as mental disorders [1–3].
Accordingly, there is good reason to be skeptical when some new
psychiatric disorder is proposed. The purpose of this article is to
critically examine the evidence for a purportedly new mental dis-
order, misophonia, characterized by marked distress from hearing
particular sounds. Misophonia is not listed in any of the major psy-
chiatric classification systems and, until recently, has received little
attention from psychiatric researchers, having been described
almost exclusively in the audiology literature.
⇑ Address: Department of Psychiatry, University of British Columbia, 2255
Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
E-mail address: Steven.Taylor@ubc.ca
which misophonia is a prominent feature, should be classified as
a mental disorder is important for several reasons. The recognition
of misophonia as a distinct mental disorder, if indeed it is a disor-
der, could facilitate recognition of the condition to health-care pro-
viders, raise public awareness, provide information and validation
to sufferers (i.e., the positive effects of labeling), and could facili-
tate research and treatment. A disadvantage in classifying miso-
phonia as a mental disorder is the possibility of stigmatizing and
over-pathologizing possibly benign eccentricities (i.e., negative
effects of labeling). Accordingly, it is important to carefully con-
sider whether misophonia meets criteria for a mental disorder,
and whether there is sufficient evidence for clearly specifying its
essential features and delineating the boundaries of any syndrome
of which it might be a part.
This article begins by defining misophonia and related concepts,
and by distinguishing it from other phenomena, particularly
phenomena arising from dysfunctions of the primary auditory
system. This is followed by a review of the common features of
misophonia, as described by case studies, case series, and larger

http://dx.doi.org/10.1016/j.mehy.2017.05.003
0306-9877/Ó 2017 Elsevier Ltd. All rights reserved.
110 S. Taylor / Medical Hypotheses 103 (2017) 109–117
investigations. Theories of misophonia are also discussed. Such
theories are relevant to the question of whether misophonia is a
mental disorder because if it is such a disorder, then it should arise
from a psychobiological dysfunction as opposed to some other
(e.g., purely audiological) dysfunction. General considerations for
diagnosing mental disorders are considered followed by a critical
review of the proposals regarding the diagnostic classification of
misophonia. Finally, a roadmap for further research is discussed,
including research strategies for evaluating the clinical utility of
misophonia, or some variant thereof, as a mental disorder.
Definition of concepts
Originally described in the audiology literature, misophonia
(literally ‘‘hatred of sound”) refers to a strong dislike of sounds—
particularly oral and nasal sounds produced by other people—
accompanied by unusually intense, distressing emotional reactions
[4]. Misophonia has also been called ‘‘selective sound sensitivity
syndrome” and ‘‘soft sound sensitivity syndrome” [5]. The latter
term emphasizes the finding that some of the distressing sounds
in misophonia are soft rather than loud.
Misophonia can be distinguished from hyperacusis and tinnitus.
Although there is some confusion in the literature regarding the
precise definition of these concepts [6], hyperacusis is commonly
defined as a reduced tolerance of loud sounds. Hyperacusis is an
auditory disorder where sounds of normal volume are perceived
as uncomfortably loud [7]. Unlike misophonia, in hyperacusis the
sound’s meaning and the context in which it occurs is irrelevant
[8]. The perception of excessive loudness in hyperacusis depends
only on the physical characteristics of the sound (i.e., its spectrum
and intensity).
Tinnitus refers to the perception of a sound (commonly ringing
or hissing) in one or both ears, or seeming to originate from inside
the head, in the absence of an external acoustic source [9]. In com-
parison to tinnitus, misophonia is characterized by intolerance of
highly specific sounds from an external source. Although they are
distinguishable phenomena, misophonia, tinnitus, and hyperacusis
can co-occur, particularly in samples obtained from audiology clin-
ics [5,6].
Features of misophonia
Empirical studies
Descriptive data for the present article were obtained from pub-
lished case studies, case series, and experimental investigations
reporting data on cases classified as having misophonia, as identi-
fied in searches of PsychInfo and Medline up to March 1, 2017,
using the search terms ‘‘misophonia”, ‘‘selective sound sensitivity”
and ‘‘soft sound sensitivity syndrome”. Reference lists of source
articles were also searched, along with review articles.
A total of 19 misophonia clinical investigations (case studies or
case series) with relevant data were identified, for a total of N = 247
cases [5,10–27]. Studies were from the United States (10 studies),
the United Kingdom (3 studies), Australia (2 studies), Brazil (2
studies), Canada (1 study), and the Netherlands (1 study). The
studies ranged from single case investigations to studies of larger
groups of individuals, recruited from audiology clinics or from
mental health settings in which the person was seeking treatment
for misophonia or for some other clinical problem (e.g., obsessive-
compulsive disorder). None of the cases were diagnosed with aut-
ism spectrum disorder. The relevance of the latter is discussed
later. Given the way in which the data were reported, it was not
possible to extract statistical information (e.g., percentages) for
the relevant clinical variables. However, it was possible to identify
patterns in terms of the nature of distressing stimuli and common
reactions to those stimuli. In the sections appearing below, these
19 studies will be collectively referred to as the clinical studies.
In addition to these studies, another relevant investigation [8]
included 318 cases of misophonia, but provided little descriptive
information about the sample. What relevant information that
was provided is discussed later in this article. Another potentially
relevant study [28] reported secondary analyses on a sample that
was described in an earlier investigation [15]. An analogue study
of college students was also identified [29]. Here, questionnaires
assessing misophonia and other phenomena were administered
to 483 college students.
In the following sections the results from the 19 clinical studies
and other investigations are summarized. Emphasis is on the clin-
ical studies of misophonia patients although the findings from the
analogue study are also relevant.
Triggering sounds
Almost all of the distressing triggering sounds reported by peo-
ple with misophonia involved oral or nasal sounds produced by
other people, and were typically more distressing when the sounds
where produced by familiar others (e.g., family members) than by
strangers. The sounds could be loud or soft. The following were the
most commonly reported distressing sounds: Chewing (especially
with mouth open), crunching of foods, slurping, swallowing, lip
smacking, sniffing, throat clearing, and heavy breathing. Other
sounds were also sometimes reported as distressing: Pen clicking,
dogs barking, babies crying, bus brakes, noisy neighbors, cutlery
clinking on plates, clinking glasses, keyboard typing, finger tap-
ping, high-pitched or loud voices, the sound of nail clipping, and
the sound of footsteps. Once an offending sound was noticed, peo-
ple with misophonia typically reported difficulty distracting them-
selves from the sound. Sounds such as bird song, running water,
the ocean, and rain were rarely reported as distressing in these
studies and in other clinical accounts [8].
Consistent with the findings of clinical studies, an analogue
study using college students [29] found that oral and nasal sounds
produced by others tended to be the most distressing, in addition
to repetitive pen or foot tapping. For a minority of participants
(4%), distressing sounds included particular consonants or vowels
(e.g., ‘‘k” sounds) and 15% were distressed by particular environ-
mental sounds (e.g., clock ticking, refrigerator humming).
Visual triggers
Some people with misophonia also reported that non-auditory
stimuli were distressing. These included visual cues to eating; for
example, the sight of lips moving or seeing someone chewing
gum, even though the chewing noise was inaudible. Unpleasant
sounds tend to be rated as most aversive when accompanied by
an image corresponding to the sound (e.g., watching a person
chewing loudly while also hearing the chewing sounds) [30].
Accordingly, visual information (e.g., watching someone chewing
with their mouth open) appears to be an amplifying factor for
misophonia. A number of misophonic people also reported that
specific movements unrelated to sounds, made by other people,
were distressing; for example, the sight of someone jiggling or
swinging their legs, shaking their foot, or twirling their hair.
Emotional reactions
The most common emotional reactions were anger and irrita-
tion, with these emotions being particularly intense when the
sufferer believed that the person making the offending noise was
doing so deliberately or was being inconsiderate or had poor
 S. Taylor / Medical Hypotheses 103 (2017) 109–117
manners. Some people experienced intense rage in response to the
triggering sounds. Anxiety and panic were also common reactions,
and some people reported feeling disgust in response to the
triggering stimuli. Given these emotional reactions it is not
surprising that the triggering sounds were associated with
elevated autonomic arousal, as indicated by heightened skin
conductance responses [24].
Behavioral responses
Common behavioral reactions involved avoidance or escape
from the triggering stimuli. For example, some people with miso-
phonia avoided having meals with family members and avoided
places where other people would be eating (e.g., cafeterias). The
use of sound-dampening methods was also reported (e.g., earplugs,
listening to music on headphones, or the use of an electric fan to
generate white noise).
Some people with misophonia confronted the person making
the offending noise, such as by glaring at the individual or by ver-
bal confrontation (e.g., berating, yelling, or, in the case of children
and adolescents, tantrums). This led, in some cases, to family
accommodation in which family members made efforts to avoid
producing the offending sounds or ensured that they did not eat
in front of the person. Some cases of physical aggression were
reported (e.g., throwing objects). To illustrate, in Schröder et al.’s
[15] sample of 42 misophonic patients, 29% became verbally
aggressive on occasion in response to triggers, 17% directed phys-
ical aggression toward objects, and 12% had hit a partner who had
produced an offending noise.
A number of people with misophonia reported that they delib-
erately mimicked the offending sound as a means of coping. By
producing the offending sound themself, the person was unable
to hear the same sound produced by others (e.g., eating foods in
synchrony with another person). Given that the self-production
the sound was typically not distressing, mimicry apparently served
to mask the offending sound made by others, at least in some
cases. In other cases, people with misophonia mimicked the
sounds as a means of retaliation against the offending person pro-
ducing the sounds [24].
Insight
People with misophonia were typically aware that their reac-
tions were excessive [15,24]. They regarded their loss of control
(e.g., angry outbursts) as being excessive and morally unacceptable
[15], and yet they also regarded the person producing the offend-
ing noises as being rude, inconsiderate, and acting inappropriately
[24].
Functional impairment
People with misophonia reported strained relationships with
housemates and family members, and other forms of strained
interpersonal relationships, especially in regard to eating. Social
isolation was also reported in some cases as a consequence of
avoiding triggering stimuli. Concentration difficulties and distress
at work and school settings were described, including dropping
out of school in order to avoid distressing sounds. Similar findings
were reported in the analogue study [29]. For the latter, the sever-
ity of misophonia, as measured by a questionnaire, was associated
with impairments in work, school-related functioning, social func-
tioning, and family and home functioning.
111
Psychiatric comorbidity
The clinical studies described a range of findings. A number of
studies reported no comorbidity whereas other studies, particu-
larly those drawn from psychiatric settings, reported cases of miso-
phonia comorbid with a number of disorders, including anxiety
and mood disorders, obsessive-compulsive disorder (OCD),
obsessive-compulsive personality disorder, tic disorders, and
attention-deficit hyperactivity disorder (ADHD). In contrast, for a
sample drawn from an audiology clinic [8], the prevalence of psy-
chiatric comorbidity was low; ‘‘we have seen 318 misophonic
patients . . . all evaluated by physicians, and in only 7 cases (2.2%)
did patients exhibit psychiatric problems” (p. 381). Little further
information was presented in that report, making it difficult to
interpret the findings. For example, it is not known whether the
physicians were psychiatrists or whether a structured diagnostic
interview was used. It is also unclear why the patients, presenting
to an audiology clinic, were selected for an assessment of mental
disorders by a physician.
Wu et al.’s (2014) analogue study of college students [29] found
that misophonia was correlated with obsessive-compulsive (OC)
symptoms, anxiety, and depressive symptoms, along with general
sensory sensitivities (e.g., distress triggered by innocuous tactile,
auditory, visual, gustatory, or olfactory stimuli).
Clearly more research is needed to better understand the psy-
chopathologic correlates of misophonia. At present, all that can
be concluded is that misophonia seemingly can occur as a stand-
alone clinical condition but also can be associated with a range
of psychiatric symptoms and disorders.
Demographics, onset, and course
Based on data from the 19 clinical studies, the cases were
approximately balanced in terms of gender (55% female) and were
either adult or pediatric cases at the time of assessment. The ana-
logue study found that the severity of misophonia symptoms was
unrelated to age and ethnicity [29]. Onset of misophonia was typ-
ically in childhood or adolescence. Some people with misophonia
reported an early triggering event (e.g., noises of family members
eating triggering feelings of disgust). However, it is not clear
whether such events were etiologically significant as triggers or
were simply the earliest recollections of misophonic distress.
The course of misophonia varied. Some sufferers reported that
the problem abated over time, others reported no change over
time, and still others reported that it had gradually worsened in
terms of an increasing aversiveness to triggering sounds and a
growing number of triggers.
Prevalence
Little is known about the prevalence of misophonia. Some com-
mentators claimed that it is relatively common [31]. This is consis-
tent with the many websites and social media support fora
devoted to misophonia. The analogue study reported that 20% of
participants had ‘‘clinically significant” misophonia symptoms
[29]. That is, symptoms causing significant interference in their
lives. The high proportion might have been due to some degree
of self-selection in participants choosing to enrol in a study on
misophonia. Other estimates, based on extrapolations from cases
presenting to audiology clinics, suggest a point prevalence of about
3% in the general population [32]. Population-based epidemiologic
studies are needed in order to draw firm conclusions about the life-
time and point prevalence of misophonia.
112 S. Taylor / Medical Hypotheses 103 (2017) 109–117
Etiological hypotheses
If misophonia is to be classified as a mental disorder, then this
carries the assumption that the disorder arises from some type of
psychobiological dysfunction. Accordingly, etiological hypotheses
are relevant as to how misophonia should be classified.
Audiological versus psychiatric disorder
If misophonia is to be classified as a disorder, should it be clas-
sified as an audiological or a psychiatric disorder? Misophonia does
not have any relation to hearing thresholds; it can present in peo-
ple with normal hearing [4] and can occur in cases of hearing loss
[8]. Although misophonia can be comorbid with tinnitus and
hyperacusis, it often occurs in the absence of any identifiable
pathology to the peripheral or central auditory system [33]. Given
the highly specific nature of the disturbing sounds (e.g., distur-
bance specific to soft chewing sounds made by family members),
misophonia seems unlikely to arise from some simple disturbance
to the auditory system. According to Jastreboff and Jastreboff [8],
who coined the term misophonia and pioneered the original work
on the topic:
The proposed mechanisms of misophonia involve a high level of
activation of the limbic and autonomic nervous systems due to
enhanced functional connections between the auditory system
and other systems in the brain (mainly the limbic and auto-
nomic nervous systems for specific patterns of sound only) . . .
At the same time the auditory system functions normally. (p.
383)
Consistent with this proposal, neuroimaging research suggests
that the amygdala plays a role in modulating the auditory cortex
[34]. Anatomical regions implicated in misophonia are also conjec-
tured to include structures that are activated by highly processed
sounds; that is, located after auditory information has been sub-
jected to considerable processing and selection, such as the inferior
temporal lobe [35].
The intensity of the misophonic emotion reaction is said to
depend ‘‘predominantly on a patient’s previous experience with a
given sound (or type of sounds), the context in which sound is pre-
sented, as well as a patient’s psychological profile” ([36], p. 27).
In summary, the available evidence and current conjectures
suggest that misophonia is better regarded as a psychiatric prob-
lem rather than a simple audiological problem.
Is misophonia simply an exaggerated response to inherently aversive
sounds?
Some sounds are widely regarded as pleasant (e.g., the sound of
rain or the roar of the ocean) whereas other sounds are widely con-
sidered to be aversive (e.g., screaming infants, squeaking Styro-
foam packaging, or screeching nails on a chalkboard) [37–39].
For a wide range of everyday sounds, people show considerable
agreement as to what constitutes an annoying sound. Three prop-
erties characterize sounds that are widely regarded as annoying:
Loudness, sharpness, and roughness [40]. People differ in their toler-
ance for loud sounds, but extremely loud sounds are almost uni-
versally perceived as aversive, and are damaging to the auditory
system. The sharpness of a sound refers to the proportion of sound
energy at high-frequencies, with sharper sounds (2–4 kHz) being
generally perceived to be less pleasant. The perceptually annoying
effects of sharpness are thought to be because the ear is particu-
larly sensitive to sounds in the range of 2–4 kHz and can be dam-
aged by loud sounds at in this frequency range [41]. Roughness,
which is a characteristic of many scraping and screeching sounds,
is a complex concept that refers to the rapid (20–200 Hz) fluctua-
tions in frequency intensity. It is less clear why the scraping and
screeching sounds associated with roughness are widely perceived
as unpleasant.
Is misophonia is simply some kind of exaggerated response to
inherently aversive sounds; that is, sounds characterized by some
combination of loudness, sharpness, and roughness? In other
words, are people with misophonia simply those individuals who
have especially aversive reactions to the sound of nails scraping
a chalkboard? Some of the distressing sounds reported by people
with misophonia are consistent with this possibility, such as
sounds of eating popcorn, crunching on toast, and gum snapping,
which have rough and sharp properties. Other lines of evidence
suggest that misophonia is more than simply a heightened sensi-
tivity to sounds that are loud, sharp, or rough. As illustrated by
the clinical examples presented earlier in this article, misophonia
is not limited to an aversion to sounds that are loud, sharp, or
rough; some people report that they are distressed only by highly
specific sounds, including soft sounds such as the sound of slurping
and lip smacking.
Heightened disgust sensitivity and misophonia
Some of the distressing sounds for people with misophonia are
disgust related; for example, chewing, lip smacking, belching,
There are individual differences in disgust sensitivity; that is, some
people have more aversive reactions than other people in response
to disgust related stimuli [42]. Accordingly, this suggests that
heightened disgust might play a role in misophonia. Disgust sensi-
tivity is indeed correlated with misophonia and might be a con-
tributing factor [43]. However, disgust sensitivity is in itself
insufficient to explain misophonia in general, because many people
with misophonia do not have elevated disgust sensitivity [43].
Learned associations and interpretations
The importance of psychological factors in misophonia has been
suggested in several investigations [6,15,26,44]. Misophonia is
characterized as a negative reaction to sounds with a specific pat-
tern and meaning to the person; the reactions to the sound are
thought to depend on non-auditory factors such as the person’s
previous evaluation of that sound and the context in which the
sound is presented, and beliefs about social decorum regarding
eating-related sounds [6]. Cultural factors may play a role in shap-
ing the meaning attributed to sounds. The slurping of foods, for
example, is considered a sign of bad manners in Western cultures
but is socially acceptable in Asian cultures [45].
Reid et al. [26] argued that ‘‘misophonia may be better concep-
tualized as a psychological condition rather than a pure sensory
sensitivity when . . . clear behavioral triggers, cognitive distortions,
and operantly reinforced maladaptive behaviors exist” (p. 7). From
this perspective, a person’s interpretation of the meaning of partic-
ular sounds is important (e.g., ‘‘Eating with your mouth open is bad
manners and a sign that you are a disgusting pig”). Interpretations
influence the person’s emotional reactions (e.g., anger) and behav-
ioral responses (avoidance, escape, confrontation). Moral judg-
ments, possibly fueled by heightened disgust sensitivity, may be
relevant in triggering distressing responses to some nasal and mas-
ticatory stimuli. It is less clear why other particular stimuli would
be distressing, such as the sound of breathing or the sounds of key-
board typing.
Schröder et al.’s [15] patients commonly reported that the onset
of the problem was associated with a profound disgust of hearing
family members eating during childhood. This lead Schröder and
colleagues to speculate that ‘‘a process of recurrent conditioning
following these repetitive annoying events that eventually results
 S. Taylor / Medical Hypotheses 103 (2017) 109–117
in misophonic symptoms” (p. 4). It is unclear, however, as to why
such events would lead to distress. A more typical response to
recurrent minor stressors, as demonstrated clinically and in exper-
imental learning studies, is for habituation to occur [46]. In other
words, recurrent exposure to the sounds of family members eating
should lead to less rather than more distress.
Comment
It appears unlikely that misophonia arises from some simple
dysfunction in the primary auditory system. Higher-level auditory
processing seems important, in which the meaning of the acoustic
stimulus is important. This has led several investigators to argue
that psychobiological factors play an important role. This is consis-
tent with the view that misophonia, or some syndrome in which
misophonia is a prominent feature, should be considered as a pos-
sible mental disorder.
Diagnostic considerations
There are several important considerations in deciding whether
or not a particular diagnostic construct should be included in a
diagnostic classification system.
General criteria for defining mental disorders: ICD-10 and DSM-5
According to ICD-10, a mental disorder defines the existence of
a clinically recognizable constellation of signs or symptoms that
tends to be associated with distress and interference in personal
functioning [47]. DSM-5 expands on this definition to specify three
cardinal features of a mental disorder [48]: (a) clinically significant
signs and symptoms (i.e., clinically significant disturbances in cog-
nition, emotion, or behavior), (b) evidence suggesting that the
signs and symptoms arise from some type of psychobiological dys-
function, and (c) the signs and symptoms are associated with sig-
nificant distress or disability (e.g., social or occupational).
Clinical utility
The developers of modern classification systems have stressed
the importance of clinical utility. For example, the introductory
text in DSM–5 [48] stresses that clinical utility was one of the main
considerations in making changes to the fourth edition of the DSM.
That is, a diagnosis should imply (a) a prognosis if the disorder is
not treated (e.g., is the disorder likely to be transient or chronic?),
(b) implications about treatment plans (e.g., what types of treat-
ments will or will not be appropriate?), and (c) imply information
about likely outcomes of treatment. That is, a diagnostic label
should convey information to clinicians about what the present
problems are (or aren’t) and how they might best be treated. Diag-
nostic classifications also have clinical utility if they facilitate com-
munication among users of the system (professionals, researchers,
patients, families, administrators, etc.), and facilitate the conceptu-
alization and understanding of psychiatric disorders [49].
Diagnostic validity
An issue of ongoing debate is whether the current diagnostic
categories in ICD-10 and DSM-5 describe etiologic entities that
exist in nature or whether they simply describe patterns of signs
and symptoms for which a given pattern might or might not have
a specific etiology. Various criteria have been proposed for validat-
ing psychiatric diagnostic classifications. Among the most influen-
tial systems for establishing diagnostic validity was proposed by
Robins and Guze in 1970 [50]. They proposed five types of
113
investigation to establish the diagnostic validity of a given disorder.
Here, the goal was to identify homogeneous clinical groups:
1. Clinical description of the disorder, which might be a single fea-
ture or combination of features that defines a given disorder.
Demographics, age of onset, and chronicity can be used to
define the clinical picture more precisely.
2. Laboratory studies, including biological and psychological stud-
ies, can be used to define a disorder more precisely (e.g., neu-
ropsychological tests can be used to diagnose neurocognitive
disorders). The ultimate goal is to develop laboratory tests that
can be used to diagnose psychiatric disorders. Few such tests
are currently available for the disorders listed in ICD-10 and
DSM-5.
3. Distinction from other disorders (e.g., evidence that a given dis-
order can reliably distinguished from other disorders).
4. Followup studies to determine whether outcome is homoge-
neous or heterogeneous (e.g., do some cases of a given disorder
resolve over time while other cases show a deteriorating
pattern?)
5. Family studies. Here, the assumption is that ‘‘the finding of an
increased prevalence of the same disorder among the close rel-
atives of the original patients strongly indicates that one is deal-
ing with a valid entity” ([50], p. 984).
Despite over four decades of research, it has proven difficult to
establish the diagnostic validity of many diagnostic categories in
ICD and DSM [51]. Some diagnoses might not refer to real entities
but yet still serve a pragmatic, clinically useful function [52]. An
alternative to ICD and DSM has been recently proposed, called
the Research Domain Criteria (RDoC; [53]). The goal here is to iden-
tify and investigate the mechanisms of basic systems, circuits, and
processes that may underlie various types of psychopathology
(e.g., brain reward systems, threat processing systems).
Diagnostic considerations for misophonia
RDoC and misophonia
If the promise of RDoC is fulfilled and it becomes viable as a
clinical diagnostic system, the most likely result is that misophonia
(and perhaps many other disorders classified in ICD and DSM)
would not be diagnostic classifications. Instead the diagnosis
would be based on the underlying mechanisms; for example, a
diagnostic formulation might be ‘‘Mr. A. presents with intense dis-
tress when he hears other people chewing. Biometric assessment
reveals dysregulation in brain circuits x, y, and z.”
Currently, the relative merits of RDoC over ICD and DSM remain
to be demonstrated, and RDoC presently exists as a research frame-
work under construction, not a clinical tool. Although RDoC might
eventually prove useful for understanding misophonia, for the time
being a classification scheme based on clinical descriptions (i.e., a
system based on ICD or DSM) is clinically more useful for identify-
ing and treating misophonia.
Schröder’s diagnostic criteria for misophonia
Using an approach to diagnosis based on clinical description,
Schröder et al. [15] proposed that misophonia should be regarded
as a new, discrete psychiatric disorder. ‘‘Discrete” refers to the pro-
posal that misophonia be classified as a stand-alone disorder and
not simply an associated feature of some other disorder. This claim
was based on the finding that in Schröder et al.’s sample of 42
patients, misophonia was distressing, associated with functional
impairment, could occur in the absence of other forms of
114 S. Taylor / Medical Hypotheses 103 (2017) 109–117

psychopathology, and was not attributable to psychiatric disorders Breadth of syndrome

described in DSM and ICD. Schröder’s diagnostic criteria for miso-
phonia are listed in Table 1. Note that these criteria exclude cases
in which misophonia can be attributed to some other disorder,
such as autism spectrum disorder, which can be associated with
various forms of sensory intolerance [54].
Schröder’s diagnostic criteria were proposed in order to ‘‘offi-
cially” recognize patients with the disorder, to improve identifica-
tion of misophonia by health care professionals, and to encourage
scientific research. A further reason for defining misophonia as a
distinct mental disorder was that if it was diagnosed according
to the current classificatory systems, the resulting diagnosis would
be vague and uninformative. In DSM-5, for example, misophonia
would most likely be diagnosed as Other Specified Mental Disorder
(code 300.9). This vague diagnostic category applies to ‘‘presenta-
tions in which symptoms characteristic of a mental disorder that
cause clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning predominate but do
not meet the full criteria for any specific mental disorder” ([48], p.
708).
Criticisms of Schröder’s criteria
Schröder’s criteria have been subject to several criticisms:
1. The triggering sounds need not be of human origin, as discussed
earlier in this article; the sounds can sometimes be produced by
animals (e.g., dogs barking) or by machines [31].
2. The criteria overemphasize anger as an emotional reaction.
Anxiety and panic are often reported [21], as noted above.
3. Only a fraction of people with misophonia experience a ‘‘pro-
found sense of loss of self-control”; most report considerable
distress at the triggering sounds and try to cope by means of
escape or avoidance. Aggressive outbursts are more commonly
found in younger samples, such as children or adolescents [31].
4. Although the person may recognize that his or her emotional
reaction is excessive, some people with misophonia regard their
reactions are justified because they believe that the person
making the offending sound is behaving in a rude or disrespect-
ful manner [31].
5. Schröder’s criteria may have been based on an unrepresentative
of people with misophonia. Their sample, recruited from a psy-
chiatric clinic, had a high degree of psychiatric comorbidity
(e.g., 52% had comorbid obsessive-compulsive personality dis-
order). In comparison, such comorbidity is reportedly rare in
audiological clinics. For example, Jastreboff and Jastreboff [55]
reported that only 5% of their 184 misophonia patients had
comorbid psychopathology.
If misophonia is regarded as a key feature of some clinical psy-
chiatric syndrome, then the question arises as to the breadth of the
syndrome. Is misophonia the only form of sensory intolerance, as
implied by the Schröder’s criteria, or is it part of a broader pattern
of intolerance for sensory stimuli (in people who do not have an
autism spectrum disorder)?
In a recent study we used latent class analysis to investigate
whether misophonia, sampled from people in the general popula-
tion, represents a distinct category [43]. As part of this research we
conducted a preliminary investigation as to the breadth of the syn-
drome. A statistical method known as latent class modeling was
implemented, using variables assessing intolerance of sounds
(e.g., chewing) and intolerance of tactile sensations (e.g., sticky or
greasy substances, or tactile sensations from clothing tags). The
sample (N = 534) was drawn from the general population. Results
indicated two classes of individuals; the first class (n = 150) con-
sisted of people who were intolerant of both auditory and tactile
stimuli, and the second, larger class (n = 384) consisted of people
who were relatively undisturbed by these stimuli. Sensory-
intolerant individuals, compared to those who were comparatively
sensory tolerant, had greater scores on indices of general psy-
chopathology, more severe OC symptoms, a higher likelihood of
meeting caseness criteria for OCD, a greater tendency to report
OC-related phenomena (e.g., a greater frequency of tics), higher
scores on measures of disgust sensitivity, and greater impairment
on indices of social and occupational functioning. Sensory-
intolerant individuals had significantly higher scores on OC
symptoms even after controlling for general psychopathology.
The categorical nature of misophonia (i.e., present vs. absent) is
consistent with the prototypic conceptualization of mental
disorders as diagnostic categories. Overall, the findings provided
suggestive evidence for a sensory intolerance syndrome in which
misophonia is a cardinal feature. Although the sensory intolerant
latent class combined two types of sensory intolerance, both types
of intolerance were associated with OC symptoms. The findings are
consistent with Schröder’s et al.’s [15] proposal that misophonia be
classified as an OC-related (spectrum) disorder. The latter is a
group of disorders that include OCD, hoarding disorder, body
dysmorphic disorder, trichotillomania, and other disorders [48].
However, our results also suggest that misophonia is not so
narrowly defined as in the Schröder criteria; the result suggest that
misophonia is part of a broader pattern of sensory intolerance.
Further research is needed to firmly establish the boundaries of
the syndrome.
A related issue is whether misophonia is different from Sensory
Over-Responsivity (SOR). The latter is a clinical condition seen in
childhood and is associated with autism spectrum disorder [56].
The question is whether misophonia in non-autistic children and

Table 1
Schröder et al.’s (2013) diagnostic criteria for misophonia.

A. The presence or anticipation of a specific sound, produced by a human being (e.g. eating sounds, breathing sounds), provokes an impulsive aversive physical reaction
which starts with irritation or disgust that instantaneously becomes anger
B. This anger initiates a profound sense of loss of self-control with rare but potentially aggressive outbursts
C. The person recognizes that the anger or disgust is excessive, unreasonable, or out of proportion to the circumstances or the provoking stressor
D. The individual tends to avoid the misophonic situation, or if he/she does not avoid it, endures encounters with the misophonic sound situation with intense
discomfort, anger or disgust
E. The individual’s anger, disgust or avoidance causes significant distress (i.e. it bothers the person that he or she has the anger or disgust) or significant interference in
the person’s day-to-day life. For example, the anger or disgust may make it difficult for the person to perform important tasks at work, meet new friends, attend
classes, or interact with others
F. The person’s anger, disgust, and avoidance are not better explained by another disorder, such as obsessive-compulsive disorder (e.g. disgust in someone with an
obsession about contamination) or post-traumatic stress disorder (e.g. avoidance of stimuli associated with a trauma related to threatened death, serious injury or
threat to the physical integrity of self or others)

Source: Schröder et al. (2013), doi:10.1371/journal.pone.0054706.t002.

 S. Taylor / Medical Hypotheses 103 (2017) 109–117
adults is part of a SOR syndrome. SOR is characterized by intense
distress (e.g., irritability or anger outbursts) by sensory stimula-
tion, such as tactile stimuli (e.g., certain fabrics or tags in clothing)
and particular auditory stimuli (e.g., sirens) [57]. Clinically signifi-
cant SOR (i.e., at a severity in which it interferes with daily activi-
ties), is reportedly found in 5–21% of school-age children [58,59].
SOR, like misophonia, can be comorbid with OCD [60] but also
can be a stand-alone disorder [59]. Problems with the concept of
SOR have been described, including the lack of firmly established
criteria for diagnosis and differential diagnosis, and concerns about
its diagnostic validity [59,61].
It is not clear whether the trigger stimuli associated with SOR
are the same as those of misophonia (i.e., oral or nasal sounds). A
problem is that many studies have described sensory over-
responsivity only in general terms, without providing sufficient
information to determine whether participants with SOR were dis-
tressed by the oral and nasal triggering sounds that typify miso-
phonia. However, prototypic descriptions of SOR suggest a
general hypersensitivity to loud sounds, rather than a sensitivity
to the often soft sounds associated with misophonia. In this regard,
SOR resembles the concept of ‘‘sensory-processing sensitivity”, in
which highly sensitive people become overaroused and over-
whelmed by sensory inputs such as strong smells, loud noises,
bright lights, and strong tastes [62]. Further research is needed to
address the distinction between SOR and misophonia.
Diagnostic threshold
The case studies indicate that misophonia ranges in severity
from mild annoyance or distress about triggering sounds, to
intense anger or panic, sometimes accompanied by verbal or phys-
ical aggression. Regardless of the specific criteria for diagnosing
misophonia, the question arises as to the threshold of severity that
should be used to diagnose misophonia as a clinically significant
condition. Lenient thresholds for conditions such as, for example,
social anxiety disorder have been criticized because they over-
pathologize commonplace problems of living (e.g., (2)). Accord-
ingly, before misophonia can become a serious candidate as a cat-
egory of mental disorder there needs to be empirical studies of
severity thresholds; for example, is there an empirically definable
threshold (as determined, for example, by latent class analysis)
for which people who are above a particular severity of misophonia
are at heightened risk for adverse events such as job loss, social iso-
lation, or contact with the legal system as a result of angry out-
bursts in response to triggering sounds?
Diagnostic threshold can be defined in a variety of ways. Empir-
ical research is needed to determine the most useful criteria for
defining a threshold, using criteria such as the above-mentioned
adverse events. For misophonia, the diagnostic threshold could
be defined in terms of any or all of the following: (a) the severity
of the emotional response (e.g., anger, rage, panic, intense disgust),
(b) severity of behavioral reactions (e.g., complete avoidance of
social situations in which people are eating, or aggressive behav-
ioral responses to people making the triggering sounds), or (c)
number of situations or stimuli that trigger distress (e.g., distress
evoked only by family members eating vs. distress evoked by a
wide range of sounds).
Clinical utility of misophonia as a diagnosis
Regardless of how it is precisely defined, there is anecdotal evi-
dence that misophonia may have clinical utility as a diagnostic
construct. Sufferers may find it reassuring that they are not alone
in their problems with triggering sounds, that this problem is
known to at least some clinicians, and that the problem has a
name. As suggested by the following personal account from one
115
sufferer, the naming of the problem as ‘‘misophonia” may help suf-
ferers to better understand their problem, and with this insight
they may be better able to cope with, or tolerate, triggering sounds.
For me, one of the most frustrating aspects of misophonia is
what I call the ‘‘incredulity factor.” For years, I could not believe
that my friends and relatives were not getting as upset at what I
considered rude behaviors. They were getting frustrated with
me for focusing on sounds they did not really hear. One of the
advantages of defining misophonia is that it reminds those with
the condition that only a small percentage of the population—
no one knows the exact number—is affected. As one commenta-
tor wrote online, ‘‘I had to learn this is MY problem, not the
problem of other people.”
[63]
To have clinical utility, a diagnosis of misophonia should imply
some form of treatment. So far this issue has been discussed only
in a poorly described report of an uncontrolled trial. The treatment
involved counseling (education) about the nature of misophonia
combined with systematic exposure to triggering sounds (i.e., a
form of desensitization therapy) [55]. In an open trial of 184 miso-
phonia patients, 83% were rated as being significantly improved
after receiving this form of therapy [8]. Unfortunately, little infor-
mation was provided about the methodology of the open trial. No
information was presented on the outcome measures, on the crite-
ria for defining a patient as being ‘‘significantly improved”, or
about whether the assessors were blind as to whether patients
were being assessed before or after they had received treatment.
Despite the limited information provided in the report of the open
trial, the results are encouraging and provide a justification for
conducting randomized controlled treatment studies.
Summary
Theory and research suggests that misophonia, or some syn-
drome in which misophonia is a key feature, may represent a
new mental disorder. At this stage, however, there are several
important areas of uncertainty, which make it premature to pro-
pose diagnostic criteria. Important areas of uncertainty involve
the essential features (e.g., key emotional reactions to triggers),
syndromal breadth, and severity threshold of a syndrome in which
misophonia is a key feature. Other issues concerning diagnostic
validity and clinical utility also need to be further investigated.
A roadmap for future research
Development and refinement of assessment instruments
In order to establish whether misophonia is a stand-alone disor-
der or part of a broader syndrome of sensory intolerance, it is
important to develop reliable, valid measures of misophonia and
other forms of sensory intolerance. Questionnaire measures have
been developed for research purposes [29,43], and a structured
clinical interview has been developed, adapted from a measure of
OC symptoms [15]. The psychometric properties of these instru-
ments have yet to be firmly established. Most measures have
focused fairly narrowly on misophonia, without providing a
detailed assessment of other kinds of sensory intolerance. To
accomplish the task of determining the breadth of a syndrome in
which misophonia might play a part, it is important to develop
reliable, valid measures of many different forms of sensory intoler-
ance, including auditory and tactile intolerance, along with visual
intolerance (e.g., distress evoked by witnessing someone fidget-
ing), and olfactory intolerance (e.g., distress evoked by common-
place odors).
116 S. Taylor / Medical Hypotheses 103 (2017) 109–117
Future studies of diagnostic validity
The diagnostic validity of misophonia, based on Robins and
Guze’s five types of studies [50], remains to be investigated. The
following sections discuss each of these as they apply to misopho-
nia. They are relevant to establishing diagnostic validity, if a DSM-
like system is used, and are relevant for understanding etiology,
which is relevant to RDoC.
Clinical description: studies of syndrome boundary and breadth
With the development of reliable and valid assessment instru-
ments, researchers can delineate the breadth and nature of a syn-
drome in which misophonia is a key feature. That is, it will be
possible to determine whether misophonia is a discrete clinical
entity or whether it is part of a broader syndrome of sensory intol-
erance. Statistical methods, such as latent class analysis, can be
used to investigate this issue, as was done in our preliminary
investigation of this issue [43].
Studies are also required to investigate the psychopathological
and demographic correlates of misophonia. The prevalence of
misophonia remains unknown and it is also not know whether
the prevalence varies with age, gender, or cultural background.
Given the evidence of cultural differences concerning the social
acceptability of oral sounds (e.g., sounds of food slurping), the
question arises as to whether misophonia is a relatively culture-
bound syndrome, being more common in Western cultures.
Laboratory studies
The role of audiological testing also requires further investiga-
tion. Misophonia can be comorbid with tinnitus and hyperacusis
[8]. The question remains as to whether there are subtypes of
misophonia (i.e., with or without hearing impairment) and
whether there are important implications in terms of etiology
and treatment.
Distinction from other disorders
As noted above, research is needed to determine how misopho-
nia is related to, or differs from, SOR.
Followup and family studies
Little is known about the pattern (or patterns) of long-term out-
come of misophonia. Research is required to investigate this issue
and to investigate patterns of family aggregation. If misophonia is
an OC-spectrum disorder, as suggested by Schröder and colleagues
[15], then behavioral-genetic (twin) studies should show that
misophonia and OC symptoms have genetic factors in common.
Behavioral-genetic studies have found that the major types of OC
symptoms (e.g., washing, checking) have genetic and environmen-
tal etiological factors in common with one another, and that these
factors may also be common to other OC-like phenomena [64].
Accordingly, the question arises as to whether misophonia is
shaped by the same genetic and environmental etiologic factors
that also influence OC symptoms. If this is found to be the case,
then it would support Schröder et al.’s conjecture that misophonia
is an OC-related disorder.
Studies of clinical utility
Further research is needed to firmly establish the clinical utility
of misophonia as a diagnostic construct. Anecdotal evidence sug-
gests that labeling a person’s problems as ‘‘misophonia” might
have a positive effect, but this needs to be empirically established.
Clinical utility can also be investigated by conducting randomized,
controlled treatment studies. The clinical utility of a diagnosis of
misophonia would be demonstrated, for example, by showing that
it is most effectively treatment by an intervention that specifically
targets misophonic symptoms, such as the intervention consisting
of counseling (education) and graduated exposure developed by
Jastreboff and Jastreboff [55].
A diagnosis of misophonia would still have clinical utility even
if treatment research was to show that misophonia is simply one of
many distressing clinical conditions that respond to generic treat-
ments such as selective serotonin reuptake inhibitors (SSRIs) or
transdiagnostic cognitive-behavior therapy (TCBT). SSRIs are useful
in treating a range of different emotional disorders [65]. Similarly,
TCBT has been shown to be efficacious for treating a range of emo-
tional disorders. Here, patients with ostensibly different mental
disorders can be efficaciously treated with the same basic
cognitive-behavioral protocol [66]. If misophonia can be success-
fully ameliorated with these generic, nonspecific therapies, then
misophonia might still have clinical utility, similar to the way in
which the diagnoses for some infections (e.g., pharyngitis) have
clinical utility even though the corresponding treatment is non-
specific (e.g., broad-spectrum antibiotics). Randomized controlled
trials are needed to investigate the treatment of misophonia,
including comparisons of treatments that are specific to misopho-
nia versus generic or transdiagnostic interventions.
Conclusion
Misophonia meets many of the general criteria for a mental dis-
order and there is preliminary evidence as to its clinical utility.
Schröder et al. [15] proposed that misophonia be regarded as a
new diagnostic category, related to OC disorders. A review of the
evidence indicates that this proposal is premature, and that
Schröder’s proposed diagnostic criteria overstate the importance
of anger, to the relative neglect of other emotional reactions, and
fail to adequately capture the clinical phenomena that fall under
the rubric of misophonia, as described in the empirical literature.
Before misophonia can be serious considered as a possible new
mental disorder, several important uncertainties need to be
resolved, including questions concerning the syndromal bound-
aries and breadth of a disorder in which misophonia is a key fea-
ture, and the question of whether misophonia is merely a feature
of some broader syndrome such as SOR. The diagnostic validity
and clinical utility of a diagnosis of misophonia also require further
investigation. Before adding yet another putative disorder to the
ever-growing list of psychiatric diagnoses, it is important to care-
fully consider whether such an addition is warranted.
Declaration of interests
The author declares no conflict of interest.
References
[1] Horwitz AV, Wakefield JC. The loss of sadness: how psychiatry transformed
normal sorrow into depressive disorder. New York: Oxford University Press;
2007.
[2] Lane C. Shyness: how normal behavior became a sickness. New Haven, CT: Yale
University Press; 2008.
[3] McNally RJ. What is mental illness? Cambridge. MA: Belknap Press; 2012.
[4] Jastreboff MM, Jastreboff PJ. Decreased sound tolerance and tinnitus retraining
therapy (TRT). Aust NZ J Audiol 2002;24:74–81.
[5] Bruxner G. ‘‘Mastication rage”: a review of misophonia—An under-recognised
symptom of psychiatric relevance? Aust Psychiat 2016;24:195–7.
[6] Aazh H, McFerran D, Salvi R, et al. Insights from the First International
Conference on Hyperacusis: Causes, evaluation, diagnosis and treatment. Noise
Health 2014;16:123–6.
[7] Sheldrake J, Diehl PU, Schaette R. Audiometric characteristics of hyperacusis
patients. Front Neurol 2015;6. 105.
[8] Jastreboff PJ, Jastreboff MM. Decreased sound tolerance: hyperacusis,
misophonia, diplacousis, and polyacousis. Handbook Clin Neurol
2015;129:375–87.
[9] Hayes SH, Radziwon KE, Stolzberg DJ, et al. Behavioral models of tinnitus and
hyperacusis in animals. Front Neurol 2014;5:179.
 S. Taylor / Medical Hypotheses 103 (2017) 109–117
[10] Dozier TH. Counterconditioning treatment for misophonia. Clin Case Studies
2015;14:374–87.
[11] Hazen EP, Reichert EL, Piacentini JC, et al. Case series: sensory intolerance as a
primary symptom of pediatric OCD. Ann Clin Psychiatry 2008;20:199–203.
[12] Webber TA, Johnson PL, Storch EA. Pediatric misophonia with comorbid
obsessive–compulsive spectrum disorders. Gen Hosp Psychiatry 2014;36:
e1–2.
[13] Veale D. A compelling desire for deafness. J Deaf Stud Deaf Ed
2006;11:369–72.
[14] Schwartz P, Leyendecker J, Conlon M. Hyperacusis and misophonia: the lesser-
known siblings of tinnitus. Minnesota Med 2011;94:42–3.
[15] Schröder A, Vulink N, Denys D. Misophonia: diagnostic criteria for a new
psychiatric disorder. PLoS ONE 2013;8(1):e54706.
[16] Neal M, Cavanna AE. Selective sound sensitivity syndrome (misophonia) in a
patient with Tourette syndrome. J Neuropsychiatry Clin Neurosci 2013;25.
E01-E.
[17] McGuire JF, Wu MS, Storch EA. Cognitive-behavioral therapy for 2 youths with
misophonia. J Clin Psychiatry 2015;76:573–4.
[18] Kumar S, Hancock O, Cope T, et al. Misophonia: a disorder of emotion
processing of sounds. J Neurol Neurosurg Psychiatry 2014;85:1 (Article e3).
[19] Kuehn S. Misophonia: An exploration of the experience, symptoms, and
treatment of selective sound sensitivity. Doctoral dissertation: John F.
Kennedy University; 2016.
[20] Kluckow H, Telfer J, Abraham S. Should we screen for misophonia in patients
with eating disorders? A report of three cases. Int J Eating Disord
2014;47:558–61.
[21] Johnson PL, Webber TA, Wu MS, et al. When selective audiovisual stimuli
become unbearable: a case series on pediatric misophonia. Neuropsychiatry
2013;3:569–75.
[22] Hadjipavlou G, Baer S, Lau A, et al. Selective sound intolerance and emotional
distress: what every clinician should hear. Psychosom Med 2008;70:739–40.
[23] Ferreira GM, Harrison BJ, Fontenelle LF. Hatred of sounds: misophonic disorder
or just an underreported psychiatric symptom? Ann Clin Psychiatry
2013;25:271–4.
[24] Edelstein M, Brang D, Rouw R, et al. Misophonia: Physiological investigations
and case descriptions. Frontiers Hum Neurosci 2013;7:1–11.
[25] Bernstein RE, Angell KL, Dehle CM. A brief course of cognitive behavioural
therapy for the treatment of misophonia: a case example. Cog Beh Ther 2013;6
(e10):1–13.
[26] Reid AM, Guzick AG, Gernand A, et al. Intensive cognitive-behavioral therapy
for comorbid misophonic and obsessive-compulsive symptoms: a systematic
case study. J Obsessive-Compulsive Rel Disord 2016;10:1–9.
[27] Prado-Barreto VM, Salvatori R, Santos RC, et al. Hearing status in adult
individuals with lifetime, untreated isolated growth hormone deficiency.
Otolaryngology 2014;150:464–71.
[28] Schröder A, van Diepen R, Mazaheri A, et al. Diminished n1 auditory evoked
potentials to oddball stimuli in misophonia patients. Front Beh Neurosci
2014;8:123.
[29] Wu MS, Lewin AB, Murphy TK, et al. Misophonia: incidence, phenomenology,
and clinical correlates in an undergraduate student sample. J Clin Psychol
2014;70:994–1007.
[30] Cox TJ. The effect of visual stimuli on the horribleness of awful sounds. Appl
Acoust 2008;69:691–703.
[31] Cavanna AE, Seri S. Misophonia: current perspectives. Neuropsychiatr Dis
Treat 2015;11:2117–23.
[32] McFerran D. Misophonia and phonophobia. In: Baguley DM, Fagelson M,
Baguley DM, et al., editors. Tinnitus: clinical and research perspectives. San
Diego: Plural Publishing; 2016. p. 245–59.
[33] Duddy DF, Oeding KA. Misophonia: an overview. Sem Hearing 2014;35:84–91.
[34] Kumar S, von Kriegstein K, Friston K, et al. Features versus feelings: dissociable
representations of the acoustic features and valence of aversive sounds. J
Neurosci 2012;32:14184–92.
[35] Møller AR. Misophonia, phonophobia, and ‘‘exploding head” syndrome. In:
Møller AR, Langguth B, De Ridder D, et al., editors. Textbook of
tinnitus. NY: Springer; 2011. p. 25–7.
[36] Jastreboff PJ, Jastreboff MM. Tinnitus retraining therapy: a different view on
tinnitus. J Oto-Rhino-Laryngology Rel Specialties 2006;68:23–9.
[37] Boyd GF. Auditory irritants and impalpable pain. J Gen Psychol
1959;60:149–54.
117
[38] Ely DJ. Aversiveness without pain: potentiation of imaginal and auditory
effects of blackboard screeches. Bull Psychonomic Soc 1975;6:295–6.
[39] Halpren DL, Blake R, Hillenbrand J. Psychoacoustics of a chilling sound. Percept
Psychophys 1986;39:77–80.
[40] McDermott JH. Auditory preferences and aesthetics: Music, voices, and
everyday sounds. In: R. J. Dolan, Sharot T, editors. Neuroscience of
preference and choice. London: Elsevier; 2012. p. 227–56.
[41] Henoch MA, Chesky K. Ear canal resonance as a risk factor in music-induced
hearing loss. Med Probs Perf Artists 1999;14:103–6.
[42] Olatunji BO, Broman-Fulks JJ. A taxometric study of the latent structure of
disgust sensitivity: converging evidence for dimensionality. Psychol Assess
2007;19:437–48.
[43] Taylor S, Conelea CA, McKay D, et al. Sensory intolerance: latent structure and
psychopathologic correlates. Compr Psychiatry 2014;55:1279–84.
[44] Webber TA, Storch EA. Toward a theoretical model of misophonia. Gen Hosp
Psychiatry 2015;37:369–70.
[45] Kushner B. Slurp! A social and cultural history of Ramen – Japan’s favorite
noodle soup. The Netherlands: Brill; 2012.
[46] Bouton ME. Learning and behavior. MA: Sinauer; 2007.
[47] WHO. ICD-10 classification of mental and behavioural disorder: Clinical
descriptions and diagnostic guidelines. Geneva: Author; 1992.
[48] American Psychiatric Association. Diagnostic and statistical manual of mental
disorders. 5th ed. Arlington, VA: Author; 2013.
[49] Keeley JW, Reed GM, Roberts MC, et al. Developing a science of clinical utility
in diagnostic classification systems field study strategies for ICD-11 mental
and behavioral disorders. Am Psychol 2016;71:3–16.
[50] Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness:
its application to schizophrenia. Am J Psychiatry 1970;126:983–7.
[51] Zachar P, Jablensky A. The concept of validation in psychiatry and psychology.
In: P. Zachar, D. St. Stoyanov, M. Aragona, et al., editors. Alternative
perspectives on psychiatric validation. New York: Oxford University Press;
2015. p. 3–24.
[52] Rodrigues AC, Banzato CE. Reality and utility unbound: An argument for dual-
track nosologic validation. In: P. Zachar, D. St. Stoyanov, M. Aragona, et al.,
editors. Alternative perspectives on psychiatric validation. New York: Oxford
University Press; 2015. p. 47–59.
[53] Cuthbert BN. Research domain criteria: toward future psychiatric nosologies.
Dialogues Clin Neurosci 2015;17:89–97.
[54] Reynolds S, Lane SJ. Diagnostic validity of sensory over-responsivity: a review
of the literature and case reports. J Autism Dev Disord 2008;38:516–29.
[55] Jastreboff PJ, Jastreboff MM. Treatments for decreased sound tolerance
(hyperacusis and misophonia). Sem Hearing 2014;35:105–20.
[56] Robertson AE, Simmons DR. The relationship between sensory sensitivity and
autistic traits in the general population. J Autism Dev Disord 2013;43:775–84.
[57] Miller LJ, Anzalone ME, Lane SJ, et al. Concept evolution in sensory integration:
a proposed nosology for diagnosis. Am J Occup Ther 2007;61:135–40.
[58] Ben-Sasson A, Carter AS, Briggs-Gowan MJ. The development of sensory over-
responsivity from infancy to elementary school. J Abnorm Child Psychol
2010;38:1193–202.
[59] Carter AS, Ben-Sasson A, Briggs-Gowan MJ. Sensory over-responsivity,
psychopathology, and family impairment in school-aged children. J Am Acad
Child Adol Psychiatry 2011;50:1210–9.
[60] Lewin AB, Wu MS, Murphy TK, et al. Sensory over-responsivity in pediatric
obsessive compulsive disorder. J Psychopathol Beh Assess 2015;37:134–43.
[61] Rogers C, Luby J. Sensory over-responsivity: a diagnosis whose time has come?
J Am Acad Child Adol Psychiatry 2011;50:1205–7.
[62] Aron EN, Aron A. Sensory-processing sensitivity and its relation to introversion
and emotionality. J Pers Soc Psychol 1997;73:345–68.
[63] Lerner B. Please stop making that noise. New York Times. 2015;http://well.
blogs.nytimes.com/2015/02/23/please-stop-making-that-noise/ (retrieved
September 2, 2016).
[64] Taylor S, Asmundson GJG, Jang KL. Etiology of obsessive–compulsive
symptoms and obsessive–compulsive personality traits: common genes,
mostly different environments. Depress Anxiety 2011;28:863–9.
[65] Taylor S, Stein MB. The future of selective serotonin reuptake inhibitors (SSRIs)
in psychiatric treatment. Med Hypoth 2006;66:14–21.
[66] Newby JM, McKinnon A, Kuyken W, et al. Systematic review and meta-analysis
of transdiagnostic psychological treatments for anxiety and depressive
disorders in adulthood. Clin Psychol Rev 2015;40:91–110.