This is a sample letter of accommodations for Misophonia.
Dr. Jennifer Jo-Brout has generously allowed for a sample letter for disability accommodations. Please note that this was written for a university student. Since Misophonia has no cure or official diagnosis this letter can be brought to your doctor to help formulate an accommodation plan based on your own person needs.
THIS LETTER IS FOR A SAMPLE ONLY. IT CANNOT BE USED ON ITS OWN, WITHOUT A DOCTOR RE-WRITING.
If you are unsure if your doctor will provide a letter, and would like advice, please contact Jennifer.
The term Misophonia literally means “hatred of sound. Rather, they have highly aversive reactions to specific patterned-based sounds, and some are also over-responsive to visual stimuli.
Individuals with these kinds of auditory and visual over-responsivity (similar to what has been known as Sensory Processing Disorder, subtype, SOR) have demonstrated autonomic arousal and decreased habituation in neuroscience and physiologic studies since 1999. What does this mean for [Name Omitted]?
When [Name Omitted] encounters everyday auditory (and visual stimuli) that most people would not notice, her brain misperceives, or processes this stimuli as though it were dangerous. As a result, she experiences physiological arousal up to and including what we all know of as the flight/flight reaction. This is not something that is within [Name Omitted]’s control, and is part of an involuntary autonomic nervous system response. This happens in milliseconds without conscious mediation.
As such, sufferers, feel bombarded by both noise and visual stimuli. Once this bombardment occurs [Name Omitted] may feel a variety of physical discomforts such as nausea, dizziness, as well as what one might describe as increasing mental and physical tension and a more subjective need to “flee” (or more simply stated) leave the place in which offending stimuli exists. Again, this is a fight/flight reaction that is beyond [Name Omitted]’ control. If she is unable to “flee” or leave the environment in order to get away from the aversive stimuli, her adrenaline level continues to elevate, and other hormonal and physiological changes related to the fight/flight response occur, culminating in what many people describe as experience, “a severe anxiety attack”, “rage”, or “panic”.
In addition, 15 years of research on individuals with Sensory Over-Responsivity has also shown a deficit in habituation. That is, once the fight/flight system is set off, the part of the nervous system that is normally activated in order to put the “brakes” on fight/flight does not act efficiently. Thus, for [Name Omitted], normal everyday sensory stimuli is overloading and causes her to become severely dysregulated, but also the way her particular nervous system works disables her ability to calm down.
Unfortunately, it is impossible to predict what auditory or other sensory stimuli might cause reactivity. Often the stimuli vary, and change over time. In addition, levels of reactivity may vary from day to day and in association with stress, rest and other daily living factors. To date, there is no cure for this condition. Occupational Therapy has helped in regard to some elements of Sensory Processing Disorder. However, there is as of yet no treatment for auditory of visual over-responsivity, or most certainly not for the condition now described as Misophonia.
As such, it is extraordinarily difficult for people with this condition to lead functional lives. The problem is not simply one of dealing with the continually overloaded and dysregulated system. The problem extends to the toll this takes on one’s body. Individuals with this problem often become extremely tired, or conversely develop sleep difficulty. They may also suffer from depression because this is a difficult condition with which to live, with no treatment and little understanding within even the medical community as of yet.
There are times that exposing oneself to an environment full of sensory stimuli is both physically and psychologically overwhelming to the extent that recent research describes many sufferers living very isolated lives, and others often feeling the need to stay at home where they can control the sounds and light levels (for example).
Both SPD/SOR research and the new Misophonia research both suggest that severity of the disorder runs on a continuum, with some people experiencing it as much more severe than others and with possible variations throughout the lifespan.
At this point in time there are no validated severity measures from which a doctor can determine an individuals’ level of life impairment or functioning, and most sufferers (as well as psychologists) are using practical daily living skills and management plans to try to assist until further research on the etiology and treatment of this disorder is developed.
[Name Omitted] should to take quizzes and tests in a room separate from others. This will allow her to minimize sensory stimuli to which she may react.
[Name Omitted] should be allowed to leave the classroom for small breaks when needed. Sensory stimuli is cumulative and therefore frequent breaks can be helpful
However, she should also be given the following options whenever
[Name Omitted] should also be allowed to digitally record her classes. This would ensure that she would benefit from all class lecture if she is unable to attend class, needs to leave class frequently and/or misses educational opportunity during class due to the distraction often caused by her condition
Considering the sensory and misophonia issues coupled with her history of anxiety and depression (and the ways in which these disorders interact and overlap) [Name Omitted] is going to need advocacy from within the school in regard to explaining her condition to her professors. Given the physical and mentally impairing effects of this condition and related anxiety and depression, considerations should be given to [Name Omitted] if she is unable to attend class.
Following are suggestions for this:
In the event that [Name Omitted] misses class her note-taker should give her class note and ideally that same person would be responsible for also recording the class so that [Name Omitted] can keep up with class discussions
Dr. Jennifer Jo-Brout, IMRN
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