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Misophonia and ASMR

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Misophonia and ASMR: The Similarities

by Mercede Erfanian

Misophonia, a neurobehavioral condition characterized by highly emotional magnitude and aberrant physiological hyperactivation in results to the sensitivity and reactivity to a range of soft, repetitive, and pattern-based sound triggers (Brout et al., 2018; Rouw & Erfanian, 2017). According to the body of research, chewing, lip-smacking, and crunching are examples of the most disturbing triggers, eliciting heightened physiological symptoms such as diaphoresis, hypertension, and tachycardia and/or emotional responses like irritation, anger, and disgust (Wu et al., 2014; Schröder et al., 2013). Visual and tactile triggers also have been reported but to less degree related and also unrelated to the auditory triggers (Rouw & Erfanian, 2017). The previously limited body of research shed light on the brain basis underlying the mechanisms of misophonia (Kumar et al., 2018; Schröder et al., 2014; Edelstein et al., 2013). Edelstein et al., 2013 study findings highlighted the increment of electrodermal activity in individuals suffering from Misophonia in reaction to typical misophonic triggers in compare with non-misophonic participants (Edelstein et al., 2013).

Autonomous Sensory Meridian Response (ASMR) or ‘brain tingles’ is a cross-modal condition, defined by a tingling static-like sensations, frisson (goosebump) or aesthetic chills which start from the back of the skull (scalp) spreads through the spine, and/or sexual arousal, in response to a range of soft sounds such as whispering, tapping, and hand movements or even excerpts of music (Barret & Davis, 2015). The research on ASMR and the underpinnings mechanisms is far from understood. However, Poerio et al. showed a decline in heart rate while there was an augmentation in electrodermal activity measured by Skin Conductance Response (Poerio et al., 2018).

Misophonia and ASMR are known to be associated, with similar physiological reponses. Yet the underlying neurological mechanism is neither fully investigated nor known. Rouw and Erfanian study indicated that half of their participants, clinically (12%) and non-clinically diagnosed, (n=301) reported experiencing ASMR (49%), still, they could not find any difference between the severity of misophonia symptoms with and without ASMR groups (Rouw & Erfanian, 2017). Comparing to individuals without ASMR, ASMR individuals seem to develop more severe misophonia complaints (McErlean & Banissy, 2018). Due to the potential neurological correlated, some researchers compare misophonia and ASMR relating to two components which explain the resembles between the two. These two components are called inducer and concurrent. In theory, the stimulation of one sensory or cognitive region or pathway (inducer) leads to simultaneous and autonomic stimulation of the other region or pathway (concurrent). In misophonia, the inducer is a triggers sound such as swallowing that evokes a certain emotion such as anger (concurrent), while in ASMR, the inducer is a sound, manifesting a tactile sensation (concurrent). Having said that, the available findings on the link between misophonia and ASMR are based on subjective investigation and warrants further research.

All in all, misophonia and ASMR are both underrated conditions that appear to be related, being on two opposite ends of a spectrum. Although the fundamental correlates seem to be resemble, there is no finding supporting this claim. A comprehensive examination is needed to look into these similarities in the brain level and the possibility if ASMR can be allocated as an alternative therapy for misophonia through randomized clinical trials.


● Barratt, E. L., & Davis, N. J. (2015). Autonomous Sensory Meridian Response (ASMR): a flow-like mental state. ​PeerJ,​ ​3​, e851.

● Brout, J. J., Edelstein, M., Erfanian, M., Mannino, M., Miller, L. J., Rouw, R., … & Rosenthal, M. Z. (2018). Investigating misophonia: A review of the empirical literature, clinical implications, and a research agenda. ​Frontiers in Neuroscience,​ ​12​, 36.

● Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: physiological investigationsandcasedescriptions.​FrontiersinHumanNeuroscience,​ ​7​,296.

● Kumar, S., Tansley-Hancock, O., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., … & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology, 27(4), 527-533.

● McErlean, A. B. J., & Banissy, M. J. (2018). Increased misophonia in self-reported Autonomous Sensory Meridian Response. ​PeerJ​, ​6​, e5351.

● Poerio, G. L., Blakey, E., Hostler, T. J., & Veltri, T. (2018). More than a feeling: Autonomous sensory meridian response (ASMR) is characterized by reliable changes in affect and physiology. PloS one,​ ​13​(6), e0196645.

● Rouw, R., & Erfanian, M. (2018). A Large​-S​ cale Study of Misophonia. ​Journal of clinical psychology​, ​74(​ 3), 453-479.

● Schröder, A., van Diepen, R., Mazaheri, A., Petropoulos-Petalas, D., Soto de Amesti, V., Vulink, N., & Denys, D. (2014). Diminished N1 auditory evoked potentials to oddball stimuli in misophonia patients. ​Frontiers in behavioral neuroscience​, ​8,​ 123.

● Schröder, A., Vulink, N., & Denys, D. (2013). Misophonia: diagnostic criteria for a new psychiatric disorder.​PLoS One,​ 8​ ​(1), e54706.

● Wu, M. S., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2014). Misophonia: incidence, phenomenology, and clinical correlates in an undergraduate student sample. ​Journal of clinical psychology​, ​70(​ 10), 994-1007.

Want to learn more? Join a Workshop with Dr. Jennifer Brout or Duke CMER at Misophonia Education.

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