SPD and Misophonia: Two disorders neglected by Medicine & Mental Health

SPD and MisophoniaMisophonia describes a neurologically based disorder in which auditory stimuli (and sometimes visual) is misinterpreted within the central nervous system. Individuals with misophonia are set off or “triggered” by very specific patterned sounds, such as chewing, coughing, pencil tapping, sneezing etc. Pawel and Margaret Jastreboff termed the disorder in 2001, in an effort to distinguish it from hyperacusis. Hyperacusis and Misophonia are both disorders related to “decreased sound tolerance”. However, hyperacusis is a condition in which auditory information is unbearably loud. In Misophonia, it is repeating (or patterned sounds) that are intolerable. The Jastreboff’s (2001) originally hypothesized that in Misophonia pattern-based noises trigger an over reaction in the limbic system (where emotions are mediated in the brain). Therefore, auditory stimuli leads to an emotional response that causes the sufferer to feel anger, fear, disgust, or a generally “out of control”. While the Jastreboff’s distinguished between hyperacusis and misophonia via their symptoms, the confusion between the two disorders is far from resolved.

Adding to the diagnostic confusion related to Misophonia is its remarkable symptom overlap to Sensory Processing Disorder (SPD), specifically the subtype Sensory Over-Responsivity. Individuals with Sensory Over-Responsivity react to all types of sensory information as though it were dangerous, and are propelled into the fight/flight response when met with stimuli they find noxious. In both disorders, auditory stimuli may set off fight/flight, leaving the sufferer feeling angry, fearful, disgusted and/or “generally out of control” as the Jastreboff’s originally suggested. The Sensory Over-Responsivity research is decades ahead of the misophonia research, which has just begun. One hopes these two bodies of research will inform each other.

However, most researchers are not used to working in a cross-disciplinary model. While the National Institute of Health is trying to change that model, the damage has already been done. That is, audiologists don’t usually study the research of Occupational Therapists. Psychiatry is often loath to accept research from a field such as Occupational Therapy, where the most of SPD research has been built. As a result, SPD and Misophonia share more than symptoms. They share neglect from the medical and psychiatric community. Neither disorder has been accepted into the DSM-V, or the ICD-10 and so, the additional problem of diagnostic confusion between these two disorders continues.

Understanding the similarities and differences between conditions informs treatment, and treatment of course alleviates suffering. In addition, without a disorder gaining entry into either the DSM-V or the ICD-10, insurance will not reimburse any kind of treatment for the disorder. Despite studies estimating that up to 20% of children are affected by SPD, and regardless of the tens of thousands of people who have gathered on social media platforms to form support groups for misophonia, medical acceptance eludes these disorders with overlapping symptoms. As the many groups of Misophonia sufferers grow on social media platforms, a search for Misophonia in the National Institute of Mental Health database yields nothing.

This confusion is harmful and the Hippocratic oath ethically binds medical doctors. This is an excerpt from a modern version which was written by Louis Lasagna (1964) Academic Dean of the School of Medicine at Tufts University, and is used in many medical schools today:

I swear to fulfill, to the best of my ability and judgment, this covenant:stethescope-1

“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery……

Is any part of this covenant practiced by your doctor? Does any part of this covenant apply to the institutionalized system of research that created and continues to perpetuate confusion between Misophonia and SPD, or any conditions? There are countless economic problems in the United States that may pragmatically inhibit our physicians and researchers from being able to uphold this oath. However, sharing information about disorders in the age of information isn’t one of them. The ability to do that is free, and will accelerate treatment by decades. The information is free. The price sufferers’ pay for this institutionalized acceptance of passive neglect of the use of this information is immeasurable.