Misophonia and Its Effects: Neuropsychological Implications

Source: Hay Dmitriy/Crello

The term misophonia may not be well-known to the masses; however, it is understood by those who have it. Misophonia is a strong emotional and/or physiological response to specific sounds. The responses may seem excessive to those who do not experience the condition; people who have misophonia can have varying reactions, from aggravation to anger, provoking a fight-or-flight response.

According to Cartreine (2019), misophonia is a real disorder experienced early in adolescence, and there is limited research to determine the cause; however, there are emerging studies exploring the severity and prevalence of misophonic symptoms. A 2019 study examined distinctive sounds which resulted in social isolation and avoidance. Forty-four patients, including 21 with misophonia, were evaluated by watching videos of misophonic (i.e., loud sounds), aversive (i.e., violence), and neutral (i.e., meditation) prompts. Electrocardiogram analysis and neuroimaging scanning were used to evaluate possible physiological changes.

Findings revealed that misophonic reactions provoked strong emotional responses and increased heart rate (Schroder et al., 2019). The neuroimaging data showed heightened brain activity, primarily within the right insula, right anterior cingulate cortex, and the right superior temporal cortex of patients observing neutral cues (Schroder et al., 2019). These findings showed that audiovisual stimuli elicited anger and increased the physiological responses in individuals with misophonia.

Neuropsychological implications of misophonia

There is limited research to determine the genetic factors of misophonia. However, the study identified altered brain activity, implicating neuropsychological conditions that are linked to the disorder. As a result, the study implied that specific brain regions are affected by misophonic symptoms.

Daniel Levinson, a forensic neuropsychologist and research faculty member at California Southern University, discussed the specific brain regions involved and the relationship between neuropsychology and misophonia. “The anterior insular cortex is located just beneath the superior temporal gyrus, which is where the primary auditory projection area lies,” he reported. The anterior insular cortex (AIC) is responsible for emotional responses, including anger, fear, and aversion. In addition, the AIC acts as a sensory signal, receiving sensory data from external stimuli.

The AIC works with the primary auditory cortex, the first step in receiving information before sending it throughout the body. The primary auditory cortex is responsible for sound processing and sends those signals to the parietal and frontal lobes of the brain. The AIC and the primary auditory cortex work with the amygdala, a neural construct that also incites strong emotional responses to threatening stimuli, such as fear. Levinson purported that the amygdala is also associated with anger and violence. He emphasized, “if there is heightened activity in the AIC resulting from certain auditory stimuli, this could trigger activity in the amygdala” (D. Levinson, personal communication, January 2, 2021).

Not only does misophonia trigger strong emotional responses, but it can also affect long-term memory. Based on empirical literature, neuroimaging scans showed that AIC accounted for increased activity throughout other brain regions, particularly long-term memory (Brout et al., 2018). “Where areas for storage of long-term memory are also located in the temporal gyrus, an increase in the AIC could also trigger memories, including traumatic events such as those related to PTSD,” stated Levinson.

The effects of misophonia

Misophonia can cause conflict in familial, professional, and social relationships. Not understanding specific triggers and predicting responses can lead to avoidance and social isolation. Additionally, the long-term effects of misophonia can lead to constant irritation and anger, which may also cause verbal aggressiveness toward those who project the noises. Therefore, people with misophonia might feel like they cannot connect with others or keep close relationships because of the distress and challenges it causes. Also, misophonic symptoms can cause communication issues due to feeling misunderstood or portrayed as bizarre or unstable behavior. However, some resources can assist individuals with the condition.

In 2013, the Misophonia Association, a non-profit organization, was established to support people and their families who suffer from misophonia. The condition can be treated through a multidisciplinary approach. For example, individuals who believe they may suffer from misophonia should consult their doctor to complete a comprehensive medical evaluation and rule out potential medical or physical conditions. Also, they can be referred to audiologists for prescriptive sound therapy. Finally, people can seek therapeutic practices to understand their condition and minimize triggers that worsen their responses.