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Misophonia Classification

by Sensory Diversity March 22, 2017
written by Sensory Diversity

misophonia classification Misophonia classification is not necessarily an easy topic. This is particularly not easy because research for the disorder is still in its infancy. However, there may be classifications that are more or less likely based on the current research, and the proposed directions for the disorder.

It is important to note that the way researchers and doctors look at the brain is ever-evolving. Classification of disorders is becoming, as time moves on, less factored on specific labels and more focused on all aspects of the body. Many conditions can have a psychological and physiological component, as well as characteristics that would suit either a neurological or psychiatric condition. It has also been asked as to whether misophonia is genetic or a mental illness. These questions are answered in greater length on their pages.

A recent misophonia study by Dr. Sukhbinder Kumar has made waves in regard to questions about misophonia classification. Because of research like this, we are ever-closer to solving the debate of “whereever in the brain” this condition is. Though the study does not specifically aim to classify the condition, it does prove that research is moving forward, and that answers are just around the corner.

Dr. Zachary Rosenthal of the Duke University Sensory Processing and Regulation Program explains why categorizing misophonia has been challenging.

“Disorders and syndromes characterized by emotional responses are sometimes said to be “brain-based.” This is sometimes confusing to people, but the basic idea is that emotions include biological, behavioral, and cognitive responses to stimuli, and these responses all require brain systems. Other brain-based systems related to emotion also are probably involved in misophonia. For example, trigger sounds are sensory-based cues associated with a prior learning history that are attended to over other sounds and elicit emotional responses that include both behavior and cognition. This means misophonia may be a brain-based condition that involves neural systems that govern our sensation, perception, attention, memory, learning, cognition, behavior and emotion. That is a lot of complexity, and that is why we need much more science done to shed light on the nature of misophonia.”

Official misophonia classification will depend upon science that simply does not exist yet. While there is interesting theory as to why the disorder is neurological, there is no concrete classification as of yet.  Furthermore, the program at Duke concludes:

“There are less than 20 studies that directly evaluate Misophonia.
Much of the existing research has not interpreted individual findings on Misophonia to important and related basic and applied research across disciplines. As such, we believe a more comprehensive approach to the study of Misophonia is needed that includes researchers, methods, and measures used across fields (e.g., occupational therapy, audiology, neurology, psychiatry, psychology, cognitive neuroscience, neurobiology). A multi-disciplinary approach to research on Misophonia has the promise to offer insights about the causes and treatments for this condition.”

If a person or organization claims that misophonia is 100% anything, there is reason to be skeptical. Our best cause for answers going forward is to support the facilitation of research.

March 22, 2017 0 comments
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Is Misophonia Psychological?

by Sensory Diversity March 22, 2017
written by Sensory Diversity

Many persons ask the question, “Is Misophonia psychological?”

misophonia psychologicalWhile the answer to this question is largely based on a small body of research, the answer is none-the-less important . This question is particularly challenging not because of misophonia, but because of the ever-changing field of research and theory. In modern times it has become increasingly difficult to categorize disorders in this way because disorders overlap, and exact cause often remains unknown. This, of course, adds to the confusion.

While a research paper has declared misophonia a psychiatric disorder, there is perhaps little evidence to support this claim. While the paper asserts that Misophonia is not only psychiatric, but related to OCD, little more is offered than a case study of 2 children. Furthermore, findings were self-reported and small scale. Dr. Jennifer Jo Brout explains the limitations of the study.

“[A]s limitations to their study, the authors note that most study participants were female and that only self-report measures were used. However, in a case study of two children, the researchers report that Misophonia appears to be a psychiatric disorder that is highly correlated with OCD. In addition, due to accommodations parents have made so that children may avoid “trigger sounds” at home, trigger sounds may have in fact worsened. That is, lack of exposure to these particular noises have worsened the severity of the response. In general, the OCD researcher/clinicians agree that patients would benefit from by re-conditioning therapy similar to that of the Jastreboff’s.”

But, aside from this research, is misophonia psychological?

Compelling evidence has arisen that points misophonia in a different direction. Instead of psychological, the condition may in-fact be neurological. Not only this, it takes part in the center of the brain that regulates fear, the limbic system. As explorations continue, it seems less likely that misophonia is merely a psychological predicament. However, this does not mean that a cross-disciplinary approach will not be beneficial for the eventual treatment of the disorder.

Miren Edelstein, researcher and author of, “Misophonia: physiological investigations and case descriptions” advocates for better communication in the research world, particularly for brain conditions.

“I think it would be extremely beneficial to have neuroscientists and audiologists, as well as clinical psychologists, psychiatrists, and physicians, all collaborating together to conduct Misophonia research. Right now, a major problem for Misophonia research that needs to be addressed is the lack of communication between various fields of study. Researchers from different disciplines all have unique and valuable perspectives on the topic, but this information is not being communicated in an effective manner across groups. I believe that an interdisciplinary research environment, while simultaneously promoting a more unified dissemination of knowledge, will be the most effective at fostering breakthroughs in the field.”

The complexity of misophonia is important. While the disorder does some psychological symptoms it does not entirely pertain to psychological processes, “In addition to reporting psychological symptoms, all of our misophonics reported physical symptoms synonymous with autonomic arousal in response to trigger sounds.” (Edelstein)

While an exact answer on whether or not misophonia is psychological is not yet possible, there is great cause for concern when the condition is absent-mindlessly labelled as psychological.

March 22, 2017 0 comments
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Is Misophonia Mental Illness?

by Sensory Diversity March 21, 2017
written by Sensory Diversity

Is Misophonia Mental Illness? What are the facts and theories?

is misophonia mental illness The important question to ask when determining the misophonia mental illness debate is to define, at least quickly, what a mental illness is, because a lot of people are unsure what constitutes mental illness. There is a general consensus within the medical and advocacy communities that mental illnesses are psychiatric and psychological in nature. According to the American Psychiatric Association, mental illness:

  • refers collectively to all diagnosable mental disorders — health conditions involving
  • Significant changes in thinking, emotion and/or behavior
  • Distress and/or problems functioning in social, work or family activities

Why is there confusion as to whether misophonia is psychiatric?

Misophonia is probably not psychiatric and “psychiatry has a way of coopting medical/neurological conditions that are not easily explained. Physicians are often complicit in this victim-blaming process. For those of you who are unfamiliar with one of the worst disorder classification faux pas, allow me to introduce you Autism…formerly known as the Refrigerator Mothering Disorder” (Dr. Brout) When research isn’t conducted to properly find what causes a condition, psychiatry can be quick to slap a label on the condition. In her article in the NY Observer, Dr. Jennifer Brout discusses her conversation which psychiatrists that were ‘hell-bent’ on labeling, diagnosing, and essentially “treating” misophonia.

“I asked the author of many of these studies why he and his colleagues were doing therapy for misophonia when there was absolutely no consensus as to what the disorder was (and when none of their therapies had been trialed). During his transparent explanation, he slipped up and referred to misophonia sufferers as potential “consumers”.”

So, does this mean misophonia is not a mental illness?

Misophonia is most likely to be neurological, but this does not mean that it is not a mental illness. Some researchers have begun to tip the tradional theory of “illness” upside down. There are emerging ideas and evidence that support a new definition of mental illness. While not a mental illness as stricly defined by iron-clad definitions, in the future there may be a thinner line between disorders that have origins in the brain. An academic paper from 2015 talks about this changing perception.

“The results may be taken as a slap in the face to the distinction-abolitionists, yet such individuals might take heart in them in that there is no implicit hierarchy in what emerges as the brain-based hallmark of neurological versus psychiatric conditions; they both involve the functionally interesting parts of the brain, it is just that they are, quite subtly, different.”

While confusing to some, this has positive implications for the world of research. Under a paradigm that strips away the strictly worded diagnostics codes of the DSM-5 treatment and research can move past set expectations and work-together for cross-disiplinary approaches. The IMRN has advocated for this approach of research. Whether or not misophonia is a mental illness depends upon who you ask. Its basic components are in the brain, more specifically the limbic system. As classifications of disorders continue to change, we may find the definition of mental illness itself will be put into question. However, for now, misophonia is not a mental illness in the sense that it is a diagnosable mental disorder, in-fact, sufferers may have trouble obtaining a misophonia diagnosis.

March 21, 2017 0 comments
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Personal Stories

I Hate Whistling

by Sensory Diversity March 21, 2017
written by Sensory Diversity

“I hate whistling”

Weird. I’ve had a love-hate relationship with that word my entire life. On one hand, it made me who I am today. On the other, I’ve been hearing it since childhood. “You’re so weird, Kim.” Sometimes it would be followed with a sneer and an eye roll, and others, an affectionate ribbing. But I always retort the same way.

“I know…”

Besides my over-active imagination and bizarre sense of humor, it didn’t help matters that I had an idiosyncrasy that most people–family and friends included–found, well, weird.

I don’t talk about this little idiosyncrasy of mine often. Hell, there are very few people who actually know this about me. Mainly because I know it makes me sound crazy and most people can’t understand why I am the way I am (It’s okay…neither do I). Yet, here I am, spilling my guts to the one, hopefully, two people that may read this. Maybe, just maybe, it’s because I’m ready to let my Weird Flag Fly. Or maybe because I’m actually hoping a fellow weirdo will step forward and say those four little words we all long to hear: YOU ARE NOT ALONE.

Deep breath.

Ready? Here it goes….

I hate whistling.

There. I said it.

Felt so good I’m going to say it again. I.HATE.WHISTLING.

And I don’t mean I hate whistling the way some people hate–oh? I don’t know?–nails on a chalkboard. It’s not just an unpleasant sound that makes me flinch for 1.5 seconds and then I’m over it. I mean that the sound of whistling has ruined my life (Okay, I’m bit dramatic, but it can feel that way sometimes).

I can see you. Your eyebrow is arched, your eyes narrowed. You’re giving me that perfect what the fuck? face from across the internet. But before you shrug me off as another weirdo, let me explain.
I’m not sure of the exact moment my brain red-flagged the sound of whistling to be my trigger sound. There is no early memory of some significant happening, some terrible thing that caused my immense hatred of the sound. But I do know it started as far back as I remember.

I can recall being at my childhood friend’s home around the age of eight or nine. Her older brother’s incessant whistling sent me into a fit of anger before I burst into tears and fled up the stairs to hid away in her room. Although she found it odd herself, Lauren did what any friend would do (even at the tender age of eight), and punched her brother for upsetting me. I couldn’t be all that mad at her brother. It’s not like he knew how badly the sound affected me. Sure, I told him to shut up a few times, but he was only doing his brotherly duties: to aggravate and tease his sister and her friend at all costs.

Being so young at the time, I wasn’t good at controlling the anger the sound brought on. I would tell anyone–even strangers–to shut up. Slap. Punch. Hit. Cry. Cover my ears and shout. Or run as far as I could from that God awful sound. Now, that I’m older–much older–and we, as human beings, are expected to act in a somewhat normal, sane fashion–I have learned to control myself in public. In fact, besides my boyfriend, family, and a few in between–no one knows my secret.

Sure, on the outside, I look normal enough. When my co-worker passes my cubicle every morning, loudly whistling some obnoxious tune, he’ll stop for a second to give me a smile and a wave. “Good morning, Kim,” he’ll say happily before he continues his whistling rampage over to the Keurig machine. He’ll whistle while he waits for his coffee; while he stirs in his creamer. He’ll whistle all the way back to his desk (far, far away from me, thank God). And there I am, sitting at my computer, typing away, staring at the screen, concentration like a good little employee. I give him a warm smile and exchange pleasantries. But on the inside–I want to tear his face off. On the inside, I’m imagining myself leaping off the swivel chair and dumping that cup of coffee over his head, and then stuffing the Styrofoam cup into his wet, O-shaped mouth. On the inside, I want to smash the computer on the ground and scream my lungs off. Anything, anything to shake off the rage that comes over me when I hear that dreadful sound.

The worst part about it is: the sound doesn’t leave me when it stops. It has this odd power over me. It, like, lingers within. I can’t focus. I can’t concentrate on what people are saying around me. All I can hear in my head is that damn, crippling noise.

My mother always asks me, “How can you hate such a happy sound?” Simple, ma. Because I secretly want to destroy every ounce of joy that is left in this world…Okay, that’s not true at all. Truth is: I have no damn idea why I hate whistling or why it causes me to feel the way it does. It’s not like I want to hate it. It’s not like I love feeling overwhelmed, anxious, and enraged when I hear it. It’s not like I love giving people an extra reason to call me a weirdo, that’s for sure.

I just…do. It’s that simple and it’s that complex.

Over time, my hatred of certain sounds has gotten worse. Somehow, someway, it’s progressed from whistling to other bodily noises. Loud sniffing. Incessant throat clearing. Lip smacking. All of these noises trigger fury. And the more noises added to my Hate Plate, the more I started isolating myself.

Ah, but why has this ruined my life, you ask? Maybe ruined is a strong word, but it has certainly put a damper on things. The sound causes me such incredible discomfort, that I isolate myself from others almost completely (or try to at least). If I know someone who is an incessant whistler–I’ll avoid them at all costs. I will avoid socializing with family and friends just because I fear I’ll have to encounter that sound. Even watching television is a feat for me. I leave the commercials on mute. (Seriously though, the amount of whistling in commercials is ridiculous. If you haven’t noticed it already, you will now. It’s like no one wants to pay royalties so they just replace songs with that shrilly hell-noise. No, really. Listen the next time a block of commercials comes on. At least three out of five will have whistling.)

But I digress…

My hatred of certain noises also causes me embarrassment and shame, further leading me to disconnect. The people closest to me are often the ones who make fun of me the most or do it more to get a rise from me. Trust me, I would never expect a stranger to know what goes on inside my mind. I can’t blame someone who doesn’t know me for whistling or sniffing or clearing their throat in front of me. I just have to suck it up, pretend, and smile. What hurts the most is when the people that should love you the way you are–idiosyncrasy and all, no matter how weird–show no respect or understanding. Sure, okay, you slipped up and sucked the snot back in your nose as loud as humanly possible two inches from my eardrums. You have a cold. You can’t help it. I get that. But following up your sniff with a snide comment or a quip in my direction is adding insult to injury, and that’s what gets me almost more than the sound itself.

When people cannot understand or relate to something, they often disregard the seriousness of it or they disregard the feelings of the person going through it. They often think it’s a joke. I found that people responded in three ways when I told them about my little–shall we say–peculiarity:

1.) They whistle more. Usually to be funny, but I’ll tell you right now: IT’S NOT FUNNY. IT’S SO NOT FUNNY, SO CUT IT OUT. I might laugh it off in an effort to stop you from continuing, but I seriously want to smack you.

2.) They’ll respond with: “Oh…” Long pause. Looks around. “Really? That’s weird.”

Or

3.) The best case scenario: They respect my friendship enough to make an effort not to whistle in front of me. The problem with this is it often leads to them telling others to stop whistling in front of me (even when I tell them not to tell anybody else), and then, magically–those people will start whistling even more when I’m around. Which is usually followed by a laugh and a: “Oh, Kim! I totally forgot! Sorry.”

Most people–and by most, I mean my family–will tell me I just have to get over it. This is quite possibly the WORST thing you can say to me. Get over it? Like it’s some guy I dated for a week or some job I didn’t get. Get over it? If I could–don’t you think I would? If I could just wiggle my nose and blink it away, I would. And yes, that was totally a Bewitched reference.

I wish I had an answer. Even more so, I wish I had a solution. Someone suggested a psychologist to me. Sure, talking about your feelings is great and all but my fear is that a psychologist will sit me in a room and surround me with all the noises that I hate, and then try to force me to “get used to it,” or tell me to accept it, or something that I know is never, EVER going to happen. The one bright spot in all this is that after almost thirty-two years, I discovered that I wasn’t alone in my weirdness. In fact, my weirdness has a name! Misophonia. Every time I say it, that 2 Live Crew song pops in my head… you know the one… “Me So Horny.” I’m a child, I know, but either way–my weirdness has a name and I couldn’t be more thrilled! I guess I should thank Ms. Perky, herself, Kelly Ripa, for bringing Misophonia to light. After all this time, I didn’t think there was anyone in the world that shared in my not-so peculiar peculiarity. But apparently, there’s a ton of people just like me. And there’s a whole lot of comfort in that. It won’t cure the way my skin crawls that moment I see someone suck in their cheekbones and push their lips out in an O-shape as I anticipate that dreadful sound that’s about to pop out from their mouths, but it certainly nice to know I’m not alone. And that’s a beautiful thing.

March 21, 2017 0 comments
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Is Misophonia Neurological?

by Sensory Diversity March 21, 2017
written by Sensory Diversity

Is misophonia neurologicalMany people have wondered, is misophonia neurological? Classifications of disorders are usually based upon their underlying causes. Thus, if a disorder is caused by a neurological problem, we would say it is a “neurological” disorder.

However, in modern times it has become increasingly difficult to categorize disorders in this way because disorders overlap, and causality is often unknown. This, of course, adds to the confusion.

Neuroscientist Joseph E. LeDoux has been studying the implications of auditory over-responsivity in the part of the brain called the amygdala. The amygdala plays an important role in the body’s fight/flight/freeze processes. It is because of the nature of the amygdala and the limbic system that misophonia is most-likely neurological in origin.

The amygdala is also involved with memory. In terms of misophonia, regardless of whether or not one is born with the disorder individuals make memories in which the body’s fight/flight response is associated with particular sounds. In addition, some of us may be born with a higher arousal system, or may simply be more sensitive to auditory stimuli. Therefore, some of us may be more vulnerable to forming these memories. The perception of memory offers reasonable theories as to why cognitive therapies such as CBT have shown little progress for misophonia, and have been said to make the disorder worse. Dr. LeDoux is working on whether or not memory reconsolidation therapy can have an impact on persons with misophonia. This research is particularly interesting because it is widely innovative in regard to approaches for misophonia.

Edelstein, Brang, Rouw, and Ramachandran (2013) found some similarities between Synesthesia and Misophonia. Edelstein et al. proposed that misophonia “displays similarities” to synesthesia. Edelstein et al. used both self-report (qualitative interviews) and physiologic measures (Skin Conductance Response, or SCR) to characterize aversive reactivity in Misophonia:

“The underlying neurological cause of this condition may be similar to that of synesthesia in terms of enhanced connectivity between relevant brain regions. In short, a pathological distortion of connections between the auditory cortex and limbic structures could cause a form of sound-emotion synesthesia.” (Edelstein et al., 2013).

The authors note that limitations of the study include small sample size, a lack of screening for psychiatric or psychological problems (no measures of mental health disorders were included), and that SCR measures autonomic arousal, but does not describe the nature of the emotion associated with that autonomic arousal.

As you may have noted, the synesthesia research is applicable to Misophonia as it directly addresses the aberrant brain connectivity that the Jastreboff’s originally conceived of.

While synesthesia research does not directly translate into treatment, it can certainly further our understanding of the disorder and therefore inform treatment. There are a few more synesthesia research studies underway and it will be interesting to find out results.

March 21, 2017 0 comments
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How Do I Get a Misophonia Diagnosis?

by Sensory Diversity March 20, 2017
written by Sensory Diversity

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Because misophonia is not currently in the DSM-5 (the standard classification of mental disorders used by mental health professionals in the U.S), finding a misophonia diagnosis is nearly, if not literally, impossible. Because of insurance codes, American medicine relies on diagnostic codes to classify disorders. However, this is changing. More and more conditions are being judged on a handful of symptoms instead of a cookie-cutter diagnosis. Unfortunately, this system will not happen over night.

 

How do you obtain a misophonia diagnosis?

The short answer for obtaining a misophonia diagnosis is that technically, you cannot. However, many doctors are compassionate and understanding. Dr. Linda Girgis, MD, discusses the particular challenge of misophonia diagnosis.

Rare diseases are difficult to diagnose just by their virtue of being rare. But, more importantly, science does not understand all of them so well either. Some patients can go years until they are diagnosed and others simply never are. And when they are diagnosed, sometimes no treatments exist. Additionally, third-party insurance companies can stand as a barrier to getting to a diagnosis and the treatment that is needed.

Misophonia diagnosis has many barriers. Luckily, researchers are avidly working to ensure that these problems will not exist forever. For now, though, many wonder what they can do. There is no cut and dry answer. Finding compassionate doctors can be a great help toward coping with the disorder. A growing number of professionals are willing to help you find the answers that you seek.

 

The Misophonia Provider Network

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The Misophonia Provider network
is a project developed by the IMRN. This network provides a map of professionals that have at least a basic understanding of misophonia. In the future, the Misophonia Provider network will provide courses to educate professionals. For now, the provider network features US providers only, but will add additional countries as they grow. Clicking entries on the interactive map will take you to provider information and biographies. Additionally, you can browse for providers based on their type.

 

Choose Therapists/Doctors you are comfortable with

If you are not comfortable with your doctor or therapist, please consider finding another. While some may have trouble with this because of insurance many therapists are understanding of this predicament and will do their best to find solutions for you. If you are not comfortable with your doctor or it is “not a good fit” then both parties may be wasting their time and your money. If your therapist or counsellor is not compassionate and willing to understand (or learn about) your disorder, then you should consider finding one that will.

 

Consider asking your therapist/doctor to help you achieve work or school accommodations

Accommodations for your disorder could include a change or workspace (somewhere quieter), exams in a private location (for students), headphones, and whatever else you may feel comfortable with. You can print this sample letter and take it to your doctor as an example of an accommodation request.

 

March 20, 2017 0 comments
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Singing Misophonia Away

by Sensory Diversity March 8, 2017
written by Sensory Diversity

Ever since I was a little girl, I loved singing. I would sing in the shower, sing in public, and sing at church. I joined a choir when I was still in elementary and remained a part of that choir up until I graduated from 8th grade. I sang in a choir in high school up until I graduated. Now that I’m in college, I am part of a youth choir that sings at different churches.

Singing has always been a part of my life. When I first started experiencing misophonia, I wondered how this would affect my singing. It didn’t. Not at first. I was okay to sing in groups and do a solo every so often with one ear plug in.

As I got older, triggers got worse, and words got lost because all I could hear was the trigger. It scared me. I didn’t think I’d be able to continue singing because the noises around me angered me so much. I almost quit singing. I had to wear headphones while I sang so I wouldn’t get triggered. I didn’t know if I was being too loud or too soft. I had to look at people’s lips to know if I was singing on beat, something I never used to have trouble doing until I started wearing headphones. The thing I loved best, I almost quit because misophonia just made it so much harder.

Fortunately, I couldn’t just stop singing. It would hurt too much. I sang when people bullied me and it made me want to disappear. I sang when I was happy, sad, or angry about something. I sang when I was in love.

I sing because it takes away the pain. I sing certain songs just lift my spirits. Other songs speak to me when I’m in a horrible mood, and then that mood just gradually goes away after I sing them. Sometimes, the person singing the song triggers me, which is frustrating. If that happens, I find a karaoke version of the song and sing it.

Singing a particular song after I get triggered helps me calm down. It’s called Gasoline, by Halsey. For those who don’t like to hear or read bad words, there’s at least two mentions of the “F” word in that song. But the reason I sing (and listen to) the song is for these two phrases: “Are you insane like me? Been in pain like me?” Another one of my favorite phrases in the song is “Do you tear yourself apart to entertain like me?” I can relate, because it feels like I try so hard to “entertain” people by being friendly and holding back my triggers (“Been in pain like me?”). They wouldn’t understand how much pain I’m in because normal, everyday sounds don’t anger people to the point that it can be called disabling.

Misophonia makes me feel insane. But after listening to and singing this particular song a few times, it just makes me feel better. It’s like I’m talking to the “normal” people about misophonia, only I’m doing so inside my head.

When I sing, misophonia is just gone. I’m in my own little world, singing to my heart’s content. Singing misophonia away.

March 8, 2017 0 comments
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When it comes to compassion, be a Josie

by Sensory Diversity February 8, 2017
written by Sensory Diversity

Today I had the opportunity to chat with an amazing person online. While scrolling through some Facebook posts I came across a teacher, “Josie” reaching out for some answers. One of her students, Jimmy appeared to be suffering from Misophonia. She witnessed his reactions of rage to repetitive noises in the classroom. The matter was discussed with the occupational therapist, who brushed her concerns aside blaming his outbursts on behavioral issues. Josie did not accept this explanation, she knew there was something more to his misery and she wanted to find out more about Misophonia and how she could help provide Jimmy with some relief.

I read and re-read her post and thread of comments that followed in absolute admiration. This was not her child, but she recognized that there was some other issue, and was proactive in finding out more information. Throughout the day I thought more and more about everything that was posted. Josie showed so much compassion, spending her Saturday trying to learn more about Misophonia so she could help this young man.
I see so many students struggling through their classes, desperate for some kind of relief. They are either afraid to ask for help, or even worse afraid of the outcome. When you suffer from Misophonia, no one can tell, so it must not be real? It must be something they are making up. WRONG! The struggle is real, and it is absolute torment.

If Jimmy is lashing out in the classroom I can only imagine the intensity of the rage inside this young man. Maybe he doesn’t know how to explain what he is feeling. You cannot blame him for that, he is a child. Even as an adult I was not able to explain how I was feeling and the explanations do not make sense. Most of us have grown up thinking that we are monsters. We have this anger and rage “for no reason.” Makes sense, right? I mean why would someone get so enraged because your friend is crunching on a carrot? With Misophonia, our brain interprets sounds differently, sending a signal that results in a “fight or flight” response. We cannot ignore the sounds. In fact, our ears seem to turn into a microscope, zooming into the triggering sound, tuning out everything else. Often that sound will continue to echo in our heads long after it has stopped.

Without knowing about Misophonia, Josie tried to teach Jimmy to remove himself from certain situations. One day a stack of Jenga blocks fell (one of his known triggers) collapsed and he immediately left the room. Josie understood. She did not reprimand him, she did not shun him. In fact, she was so proud of Jimmy. It is the little things that count and mean the most.

The key to living with Misophonia is to recognize and know your trigger sounds, making it easier to be prepared. If Jimmy sees some other students playing Jenga, he can go play at the opposite end of the room. When music time comes, and the other students will be singing and humming, Jimmy can be excused from the activity and take a book to the library. Now that Josie knows Jimmy suffers from Misophonia, she will be able to be more understanding to Jimmy’s needs. I have no doubt in my mind that she will continue to advocate for him.
I have never met Josie, I do not know anything about her. But I do know that she is my hero. When I approached her to ask if I could write this article about her story, she was honored. Josie thought she was doing what any other teacher would do, try to “assist a suffering child.” I think we all know that is not the case.

I am a “Jimmy.” Josie, there are no words to describe your compassion and determination for going above and beyond. On behalf of all of the other Jimmy’s in the world… thank you from the bottom of our hearts. You are truly an inspiration.

In a world full of people who do not know, who do not understand or who dismiss our pain and suffering… be a Josie.

February 8, 2017 0 comments
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Sukhbinder Kumar’s Misophonia Study

by Sensory Diversity February 5, 2017
written by Sensory Diversity

Breakthrough Misophonia Study by Dr. Sukhbinder Kumar provides strong evidence that Misophonia is a ‘real disorder’. 

 

 Jennifer Jo Brout, PsyD and Michael Mannino, PhD candidate

Dr. Sukhbinder Kumar, and his team from the Institute of Neuroscience at Newcastle University and the Wellcome Centre for NeuroImaging at University College London (UCL) published a groundbreaking Misophonia study, which recently appeared in Current Biology.

What makes this study “ground-breaking?”

In an interview with Dr. Kumar, he explains the study and what it might mean for people with Misophonia. Dr. Kumar states that his team is specifically using Magnetic Resonance Imaging (MRI). Kumar’s team found identifiable differences in the brains of misophonic individuals. The study reveals numerous important findings.

First, there is a notable difference in the connectivity in the frontal lobe between the cerebral hemispheres in people with Misophonia. The difference appears to be due to higher myelination in the ventromedial pre-frontal cortex (vmPFC). The vmPFC sits almost right above the eye-socket, the bottom middle towards the front of the brain. It is involved in processing and regulation of emotions like fear and empathy, and decision making.

“The higher myelination in this area of the brain in Misophonia subjects suggests abnormal connectivity”

The myelin sheath cells surround the connecting axons of neurons, allowing for, and increasing electrical conductivity between brain cells. Without this, cells could not communicate properly.

Also, the ventromedial prefrontal cortex is central to understanding Misophonia because it is part of a complicated network of connections between numerous other areas of the brain. It receives sensory information, processes that information, and influences the functioning of many other brain areas including those involved in memory, olfaction and perhaps of great importance, the amygdala (where fight/flight is mediated and where salience, or importance, is assigned to incoming sensory stimuli).

Dr. Lorenzo Díaz-Mataix (LeDoux Lab, NYU) comments: “In the study we are conducting, we explore individual different responses in rodents induced by acoustic stimuli, [which they associate with threat]. The auditory threat then triggers neural activity in the amygdala; behavioral responses (freezing), autonomic activity (increases in heart rate, blood pressure), and the release of stress hormones. These neural, behavioral, autonomic, and endocrine responses vary across individuals, with some rats consistently responding strongly and others weakly to the same stimulus. This work relates to the Kumar study since the insula connects directly with the amygdala. We believe that our experiments, under controlled laboratory conditions will complement and add to our understanding of brain circuits that underlie symptoms related to threat processing in psychiatric conditions, including Misophonia.”

The study also revealed that a major area involved in the brain’s ability to pick out what it thinks are “salient”, or important, stimuli (the anterior insular cortex, or AIC) showed greater activation for Misophonia subjects responding to trigger sounds.  The AIC  is involved in processing emotions and integrating sensory stimuli (such as sounds) from both the outside world and from within the body.

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Here, “salient” means picking out or paying attention to something that stands out from its neighbors, like off-color in the case of vision, or in this case, an off-sound. Importantly, this area also showed abnormal “functional” connectivity to other brain regions highly involved in processing emotions, including the amygdala, the vmPFC, and the posteromedial cortex (PMC), also involved in emotional regulation.

Dr. Kumar hypothesizes that the difficulty in processing sensory information in these brain networks leads to a “mismatch between how a person perceives their physical state and what their physical state really is”. This refers to an often overlooked sense “interoception”, which allows us to accurately perceive our body states. As an example, Dr. Kumar explained that “a person may feel as though they have a dry mouth, yet objectively, their mouth is not dry”. Dr. Kumar is very interested in this finding and is continuing research on how this relates to Misophonia.

The take home message here is that due to this aberrant connectivity, those with Misophonia misinterpret the common misophonic trigger sounds in a way that causes their bodies to respond as though they are under threat.  The amygdala is the part of all this that takes all this “mis” information, and then tells the body,  ‘let’s do something about this‘.

Dr. Kumar hopes that this study will help lead to treatment. Treatment possibilities include learning ways to self-regulate (or bring down the nervous system arousal). We also spoke about the potential of memory re-consolidation therapy. Memory re-consolidation therapy would involve changing the physiological response to the trigger sound. This was developed in the Joseph LeDoux lab at NYU and has been successfully trialed in rodents, and is currently being trialed successfully in human beings for Post Traumatic Stress Disorder and phobias.

Dr. Joseph LeDoux comments: This seems like an important and well-conducted study by a research team from a leading functional imaging center published in a top-tier journal implicating the insula cortex in auditory responsivity in Misophonia. As the study shows, the insula is well situated to play a role in processing sounds as threats given that it receives auditory inputs and is also connected with the amygdala and medial cortical areas.  I was surprised that the anterior insula was found to be acoustically responsive in this study since most the posterior insula is usually found to be the sensory (including auditory) responsive region. Regardless, this seems to be an important advance in linking symptoms in Misophonia to the brain. 

Dr. Kumar adds that this study validates misophonia is it’s own disorder. It cannot be classified within any psychiatric or specific neurological disorder. When asked if he thought misophonia should be classified as neurological or psychiatric, Dr. Kumar explained that the lines between psychiatric and neurological are blurred. “Many psychiatric disorders are neurologically driven”, and this differentiation may be irrelevant.”

For more information on Dr. Kumar and related studies http://ttp://misophonia-research.com/misophonia-advisory-board/

For more information on misophonia https://sensorydiversity.com/what-is-misophonia/

February 5, 2017 0 comments
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Research

Misophonia and Brain Connectivity

by Sensory Diversity February 4, 2017
written by Sensory Diversity

The human brain is a complex system, consisting of around 80 billion neurons and around 1000-10000 connections between each of those neurons. Enormous complexity, so much, in fact, that the brain has trouble even fathoming its very own complexity! There are even more glial cells in the brain that aid and support the neurons, and neurotransmitters, which allow the neurons to communicate. Historically, certain parts of the brain were thought to produce certain functions. This mostly originated from a field called Phrenology, where a phrenologist would identify different aspects of your personality based on the different bumps on your skull, which of course corresponded to those parts of your brain underneath. Brain research has come a long way. Today, we have moved away from a modular paradigm, in which generally single brain areas have unique functions, to a network paradigm, in which cognitive abilities (and even consciousness itself) like attention, perception, language, memory all emerge from, the complex integration of brain areas that are connected and interact with each other in very dynamic and complex ways. Likewise, problems with cognition, certain dysfunctions, or pathological conditions, are thus problems with connectivity, that is, network problems. Thus, misophonia is a network problem, a connectivity problem. Like the brain itself, the subject is complex, so let us briefly unpack these concepts: what is a complex system, what is a brain network, how do they work, and what goes wrong?

First, a complex system is a system of many interacting elements or components that are coupled in nonlinear ways which exhibit certain properties like self-organization, emergence, and pattern formation. What does this mean? Some examples: social networks composed of humans interacting, economic markets composed of people trading, weather patterns like hurricanes composed of water and air molecules, even ant colonies, a swarm of birds, or ecological systems composed of various organisms – and of course, the human brain composed of brain cells. Each of these has many, many elements which interact with each other. The interactions are nonlinear. This means, that for example, a small input into the system (from the outside) may produce a very large output! Or, like old cliché: the whole is much more than the sum of the parts; when you add up all the elements, or contributions from the elements, you do not get what you would expect. These systems are dynamic, which means that they change over time, sometimes in very surprising ways: think of for example, an economic crash, or a sudden creation of a hurricane. This is very related to the butterfly effect, where a butterfly flaps its wings in Texas, which ultimately leads to the formation of a hurricane in the Caribbean. This may be just a metaphor, but it is useful in understand something called Chaos theory, where small, tiny changes in a systems input, can lead to large unexpected changes down the road. This happens in the human brain! Also, the concept of self-organization means that there is no top-down organizational plan or structure, that comes from a designer. A good illustration is to consider an orchestra; in this case, there is a conductor, a leader, following a specific written piece of music. The brain, or a swarm of birds, is not like that: there is no conductor, somehow, all of the pieces working together organize themselves! Global patterns form, or emerge from the interactions of local components, that know nothing about what is going on from a bird’s eye view.

Starlings, for example, group together in formations that can be a mile long, and can send huge waves from one side to the other warning of danger. Ants can work together to form a bridge to cross a gap. No one ant knows about the concept of a bridge – likewise, no one neuron can experience the color red. The study of complex systems is fascinating and is relatively new field of research, and once we understand how the brain works in this manner, we can begin pinpoint the causes of disorders like autism, or misophonia.
One of the main tools to understand the brain as a complex system, is network science. Networks are composed of nodes (single brain areas), and edges, or links, that connect them. Networks can have 2 or more nodes. One well-studies brain network, called the default mode network, is active, actually, when you are not! That is, when are you are not involved in any specific task, or just daydreaming, or thinking about yourself or others, or contemplating the future, this network becomes active, and vice versa, this network suppresses itself when you then become active or involved in a task. Much research suggests that this networks does not function correctly in pathological conditions like autism or schizophrenia. Brain areas can be connected in three ways: structurally, functionally, or causally. Structural connectivity is the physical, or anatomical connections between brain areas. Certain brain areas may not be (directly) structurally connected, but yet still be functionally connected. This means that these brain areas will be active at the same time (for some event), even though they may be very, very indirectly connected. Lastly, causal connectivity refers to the information flow in the brain: one brain area may cause another brain area to become more or less active.

Where there exist problems in any of these kinds of connectivity, pathological conditions emerge. For example, in autism, studies have shown fewer long-distance connections between brain areas, compared with children without autism. Moreover, certain brain areas involved in social brain networks become active in sync, when they shouldn’t be, or should be syncing up when they do not. Research is now ongoing into the functional connectivity problems involved in misophonia. One methodology, called Dynamical Causal Modeling, is being used by Dr. Sukhbinder Kumar and his team in London, to identify which areas of the brain involved in auditory processing and emotion have a causal effect on other areas, demonstrating possible hyper (or hypo) connectivity problems. Once we understand the connectivity issues in misophonia, we can start to address how to correct them.

Last, as a neuroscientist trying to understand the brain, and a sufferer of misophonia, I am hopeful that in the future we will have a cure for this and so many other mental diseases.

February 4, 2017 0 comments
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Sensory Diversity is the recognition that every individual perceives, filters, and responds to the world in a unique way. While neurodiversity celebrates the different ways we think, sensory diversity focuses on the gateway to those thoughts: our senses.

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