This article was originally written for Physician’s Weekly and can be sent to your doctor to help explain misophonia to them.
As an advocate for Misophonia, I have met several doctors that have been approached by patients with Misophonia but are not sure what to do – or what the disorder even is. This isn’t the fault of medical professionals because there simply isn’t enough information out there for them in medical journals or conferences. While this will likely change within the next decade, for now, doctors with Misophonia patients are likely to be confused by what to do with their patients. The first instinct of many GPs might be to find an audiologist, neurologist, or a psychiatrist/psychologist, but these professionals might also be uncertain of Misophonia.
If you have a patient with Misophonia, you should first know that this is not simply in their head. Current Misophonia research suggests that Misophonia is a neurophysiological disorder. More research is necessary to determine the exact functioning of Misophonia. Since research is still minimal, it is important that doctors and medical professionals are not quick to jump the gun on treatment for their patients. You can read the literature review for Misophonia research to get a basic idea of Misophonia research and future directions here.
Currently, there is no treatment for Misophonia. There have been no studies that test Misophonia treatment rigorously, and some patients have reported that CBT and other therapies have made their Misophonia worse, not better. For doctors and professionals, a multidisciplinary approach that addresses coping skills and quality-of-life is important to help patients struggling with sound over responsivity. Some of these patients may also have visual “triggers”.
Commonly, patients of Misophonia are triggered by whistling, chewing, coughing, sneezing, and other repetitive noises. Some visual triggers include chewing gum, legs shaking, bouncing, and the action (and noise) of clicking pens. While more research is necessary, there could be a relationship between Misophonia and Sensory Processing Disorder (SPD). It is likely that the amygdala and the fight/flight system is over responsive in patients with Misophonia.
While doctors may feel that there is little hope for treating patients with Misophonia, this is where being empathetic can be your greatest tool. Most sufferers of Misophonia have been told that this is all in their head and that they are simply imagining these symptoms. Empathizing with your patient and assuring them that you believe them is an important step in helping Misophonia sufferers cope with this disorder. You may also want to suggest coping methods such as reducing over-all life stress with patients or help by developing an accommodations plan for patients that are still in school.
You might enjoy reading this HuffPost article “What I Wish My Doctor Knew About Misophonia”. In this article, I make the following point on helping patients when no treatment exists.
“I want my doctor to know that if he acknowledges my suffering and asks me how I think we should go about things that he is doing what he can. I want him to know that I do not expect miracles, I merely expect his patience. I want my doctor to know that if he does not know about my disorder, that is okay. I want him to know that I will be happy to work with him on this discovery.”
For doctors that are interested in potential future treatments of Misophonia, the International Misophonia Research Network (IMRN) has proposed research.
Memory re-consolidation is a therapy that may be extremely promising for misophonia. Memory re-consolidation therapy has been explored mostly in rodents, and is in the beginning stages with regard to humans. Memory re-consolidation study began at the LeDoux Lab at NYU in 2000, with Joseph E. LeDoux, Karim Nader and Daniela Schiller.
In order to explore the possibilities of memory re-consolidation for misophonia, IMRN Director (Dr. Jennifer Brout) provided resources to the LeDoux lab to study learning and habituation in rodents who were highly sensitive to auditory stimuli. The rodents that were initially more responsive to sound, demonstrated an impaired ability to extinguish the association between repetitive auditory stimuli and sympathetic nervous system arousal (fight/flight) that had been paired in memory. A follow up to this study would include trials of memory re-consolidation therapy in rodents who also displayed the inability to unlearn this associated response, and to replicate this paradigm in humans. For more specific information about memory re-consolidation you can watch this youtube video.
A provider network for doctors interested in helping patients with Misophonia is dictated by the IMRN. You can also use this resource to find multidisciplinary practitioners that are able to help your patients with psychology, psychiatry, audiology, occupational therapy, etc. If you are interested in joining please do not hesitate to use the form on site to apply to be listed. A CEU credit can be obtained through Drexel that provides the basics on Misophonia for those interested. You can find the provide network here.
A free guide for doctors has been released by the IMRN (through Misophonia International) that helps overview Misophonia for clinicians. You can download it here.
Want to learn more? Join a Workshop with Dr. Jennifer Brout or Duke CMER at Misophonia Education.