Moving Away From Reductionist Thinking in Misophonia

When conceptualizing misophonia, it helps to shift your thinking away from that which is reductionist. Reductionist thinking may be necessary for scientists to break down that which they seek to analyze, but it leaves the rest of us confused about the nature of misophonia. Two particularly misleading reductionist thought processes are the categorical and the binary. With categorical thinking we ignore important nuances, and view concepts and situations broadly. Human beings naturally like to categorize because it is cognitively efficient, allowing us to more easily remember massive amount of information. However, that doesn’t make it right for all situations or ideas. Similarly, binary thinking also reduces complex ideas, conditions, and problems to only two sides, leading us to believe that we must pick one. Binary thinking gives us a yes/no or good/bad scenario.

Categorical thinking still dominates mental health diagnostic manuals well into the 21st century and gives us false ideas about human functioning. Mental health disorders do not fit neatly into categories. In fact, many mental health disorders are also neurological disorders, developmental disorders, or related to medical disorders. The categories are false. We know that misophonia crosses the boundaries of disciplines. However, the diagnostic manuals we use don’t allow for this. Therefore, we often end up with multiple diagnoses for one individual. How can we rethink misophonia without rigid categories?

Anderman, et al., (2023) address this in their research using a symptom network model to explain why misophonia co-occurs with other disorders. Symptom network modeling assumes that disorders arise from an interaction of traits that occur in the general population and across different diagnoses. In symptom network modeling, transdiagnostic symptoms will appear as an inter-connected hub with some symptoms/traits closely connected to misophonia and others distant. Therefore, more severe misophonia will have a wider reach in the network. The data suggest that sensory over-responsivity (and pain associated with sensory stimuli) is a central trait in misophonia and may explain the negative impact seen on mental health. This way of thinking about disorders frees us from the rigidity of classification and allows us to understand misophonia with the complexity it deserves. Hopefully we will see more of this kind of work. However, this alone won’t solve the problem.

We have also learned to think in a false binary in terms of human functioning, and as a result in terms of misophonia as well. Perhaps the best and most misleading form of binary thinking relates to the way the mind and body have been historically bifurcated in human development, medicine, and psychology. Likely we all agree now that the mind and body are inherently intertwined. Yet, this binary from the past has led us to false assumptions and ultimately to more binary thinking.

Is misophonia neurological or behavioral? Is misophonia learned or genetic?

These are each highly complex questions that don’t fall neatly into categories and do not fit into a yes/no binary. Let’s review these concepts and unpack how we got here in the first place, so that we can update the way we think about misophonia.

First, let's do away with neurological versus behavior. All behavior is subsumed by neurological functioning. Without a brain, we would have no behavior. The original behaviorists (in the 1920’s) did not presume that human beings were without brains. Instead, they focused on the idea that behaviors are learned through interaction with the environment and may be changed via learning. This makes sense, considering that the advent of neuroscience was still approximately 50 years to come. Essentially behaviorism focuses on observable behavior.

Let’s delve into this a bit in terms of the binary "nature versus nurture." We all know that genes play a tremendous role in human nature and health and that attributing neurodevelopmental and neuropsychiatric conditions solely on constructs such as "bad parenting" was a contemptible mistake! While our understanding of nature versus nurture has advanced greatly, the concept of epigenetics (the study of how the environment influences gene expression) is still counterintuitive to most of us. Many of us were taught that “nature” and “nurture” were mutually exclusive. That is, human nature is attributed to either nature or nurture, but not both. For centuries, people placed human development, health and disease processes primarily into one category or the other. For example, a disease or condition was either genetic (nature) or acquired (nurture). However, the field of epigenetics has revealed that it is not simply which genes we have that determine our health, personality, and so on, but how those genes interact with the environment also matters. Is misophonia genetic or environmental? It is both.

When thinking about misophonia, remember to stay away from false categories and binary thinking that will serve to agitate you when trying to understand the disorder. Misophonia will never make sense in the binary. Unfortunately, you will still see these categories and binaries in scientific writing and in popular press, because language and thinking are intertwined and take a long time to shift. In this case, however, semantics matter. One way to change your viewpoint is to try to think in the "both/and." Both/and thinking helps us to realize that numerous things can be true at the same time: Misophonia is both genetic and environmental. Misophonia is both in the mind and the body. Misophonia is both neurological and behavioral.