Proposed Diagnostic Criteria for Misophonia: A Multisensory Conditioned Aversive Reflex Disorder

Misophonia is an underinvestigated condition often typified as an extreme sensitivity to specific, low volume sounds and images that elicit an intense physiological and emotional response (Jastreboff and Jastreboff, 2002, 2014; Edelstein et al., 2013; Schröder et al., 2013; Wu et al., 2014; Cavanna and Seri, 2015; Dozier, 2015a, 2017). While misophonia has been described as a distinct psychiatric disorder that should be delineated as such (Schröder et al., 2013), Taylor (2017) proposed that extensive research is needed before such a conclusion is warranted. Symptomatology of misophonia intersects to some extent with that of several other recognized psychiatric disorders including but not limited to: specific phobia, obsessive compulsive disorder (OCD), sensory processing disorder (SPD), and posttraumatic stress disorder (PTSD). However, misophonia symptoms are not sufficiently captured by any diagnosis in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; American Psychiatric Association, 2013; Bernstein et al., 2013). For a description of diagnostic differentials, the reader is referred to (Schröder et al., 2013). We support Taylor’s (2017) call for research to accurately characterize misophonia as a disorder or features of another syndrome, but we also propose there is a pressing need to include the findings of recent research in diagnostic criteria for misophonia, regardless of whether misophonia is a distinct psychiatric, neurological, medical, or behavioral disorder, or a component of another disorder. Although the prevalence of misophonia has yet to be formally determined, research suggests that it is not a rare condition. In a study that included a nonclinical sample of 483 undergraduate students, nearly 20% experienced clinically significant misophonia symptoms (Wu et al., 2014). In another study Schröder et al. (2017) reported that in a recent 5-year period, the center had over 500 misophonia patient referrals, further highlighting the prevalence of misophonia and the need to establish an accurate description of this condition. Collectively, the 3 authors have treated over 600 patients in the past 4 years. Presently, there are several relevant Facebook groups, of which one, the Misophonia Support Group, has over 15,000 members.