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Misophonia: Phenomenology, comorbidity and demographics in a large sample
Status:: #Bare-bones-review-🦴
Metadata
- Item Type: #journalArticle
- Authors: Inge Jager, Pelle de Koning, Tim Bost, Damiaan Denys, Nienke Vulink
- Date: 2020-4-15
- Date Added: 2020-04-23
- URL: https://dx.plos.org/10.1371/journal.pone.0231390
- DOI: 10.1371/journal.pone.0231390
- Cite key: undefined
- Topics: refrences to mark up, ../Misophonia MOC
- Tags: , #Misophonia, #added-to-Misophonia-data-base,
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Abstract
Objective Analyze a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition.
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Article Review table
| Background/Purpose | Background- Purpose- • examine the psychiatric, somatic, and psychological nature of misophonia by studying its phenomenology in a large sample |
| Participants/samples | • 575 outpatients meeting the authors criteria for misophonia. |
| Measures | • Misophonia Screening list (MSL) • Amsterdam Misophonia Scale(A-MISO-S) • AMISOS Revised • Hamilton Depression Rating Scale(HDRS) • Hamilton Anxiety Scale(HAS) • Symptom Checklist 90 Revised (SCL-90-R) • and more |
| Procedures | • administered scales to subjects. analyzed scale results and demographic variables |
| Results | • 26% comorbidity with OCD traits, 10% comorbidity with mood disorders, 5% comorbidity with ADHD, and 3% comorbidity with autism. • heavy traits of perfectionism and neuroticism • Quality of life significantly impaired by misophonia severity |
| Discussion/Limits | Conclusion- • The authors conclude that misophonia is a distinct psychiatric disorder. • The findings indicate that systematic psychiatric evaluation is necessary due to high risk of misdiagnosis. • The data support that misophonia is not primarily audiological in nature. • The authors conclude that oral or nasal sounds are required triggers for diagnosis. • The findings indicate hyperfocus is a core symptom. • The authors propose revised Amsterdam UMC 2020 diagnostic criteria. • The findings indicate symptom severity is associated with reduced quality of life. |
| Limitations:: | • Single-site study; possible selection bias. • Use of AMC 2013 criteria; possible confirmation bias. • Some questionnaires not validated in Dutch or lacked norm group. • A-MISO-S not psychometrically validated; AMISOS-R under validation. |
| Future Directions:: | • Use revised Amsterdam UMC 2020 criteria in future studies. • Conduct international multi-center studies. • Multidisciplinary approach (psychiatry, audiology, psychology). • More treatment studies (e.g., RCT of CBT). • Further validation of misophonia questionnaires. |
| Relevance:: | • a good source for information on the phenomenology comorbidity, and demographics of a large misophonic sample. |
Notes
key terms and concepts
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Misophonia – A condition characterized by an impulsive aversive physical reaction (irritation, anger, or disgust) to specific repetitive stimuli, primarily human-produced sounds.
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AMC 2013 diagnostic criteria – Initial proposed psychiatric diagnostic criteria for misophonia developed at Amsterdam UMC.
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AMISOS-R – Revised Amsterdam Misophonia Scale; measure of misophonia severity.
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A-MISO-S – Amsterdam Misophonia Scale; clinician-rated severity measure.
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CPQ (Clinical Perfectionism Questionnaire) – Self-report measure assessing clinical perfectionism.
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FMPS – Frost Multidimensional Perfectionism Scale; measure of perfectionism traits.
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DPSS-R – Disgust Propensity and Sensitivity Scale-Revised.
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DS-R – Disgust Scale-Revised.
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AQ (Autism Spectrum Quotient) – Self-report measure of autism traits.
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MANSA – Manchester Short Assessment of Quality of Life.
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OCPD – Obsessive-compulsive personality disorder.
my questions
my comments
misc. notes
Jager 2020 findings of phenomenology and comorbidities in Misophonia
Annotations
(8/20/2022, 3:24:44 PM)
Objective Analyze a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition.
The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%).
subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. Two percent reported tinnitus and 1% hyperacusis
Comorbidity found in sample
In a random subgroup of 109 subjects we performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities.
This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used.
TLDR limitations
This study with 575 subjects is the largest misophonia sample ever described
Fact check this claim. if it is true then we need to make sure we know this.
In 2013 our research group at the Amsterdam University Medical Centers (Amsterdam UMC, location AMC) proposed the first diagnostic criteria for misophonia as a psychiatric disorder[2] (Table 1). Thereafter, research on misophonia has increased vastly. The Amsterdam viewpoint is misophonia is definitely a psychiatric disorder, though there’s no agreement among different research teams.
All other samples (of the papers included in our 2018 search) merely used questionnaires to diagnose misophonia. Without a systematic clinical interview, which is missing in almost three quarters of all described subjects, misophonia symptoms could possibly be better explained by another disorder or results could be influenced by self-report biases (references in S1 Table and S1 Fig).
Limitation of previous samples and rationale for current study
Therefore, we assessed a new sample of subjects with misophonia symptoms who were referred to the AMC by their general practitioner, which is both quantitatively and qualitatively superior to previous research
method and rational
The first aim of this study was to determine whether referred subjects with misophonia-like symptoms actually suffered from misophonia using a psychiatric interview conducted by three experienced psychiatrists. The second aim was to
goals of this study
determine phenomenology, comorbidity, and demographics of the misophonia sample to address three major issues: 1) whether misophonia should be approached from an audiological or psychiatric/psychological perspective; 2) whether specific psychological profiles, which have been associated with misophonia, such as disgust sensitivity[10], autism-like traits[11,12] and perfectionism[2] are still valid; and 3) whether misophonia is a distinct psychiatric disorder for which diagnostic criteria should be determined.
goals of this study
575 subjects met criteria for misophonia.
The 204 subjects excluded from this sample were: subjects with primary autism spectrum conditions (ASC), primary attention-deficit (hyperactivity) disorder (AD(H)D), a primary diagnosis on Axis II (varying from schizotypal personality disorder to obsessive compulsive personality disorder) and subjects without a DSM-IV diagnosis. Hearing impairments or audiologic disorders were no exclusion criterion.
Exclusion criteria
Misophonia Screening List (see S1 Appendix), Misophonia Sound List (MSL; see S2 Appendix),
look into these
Comorbidity
Subjects exhibited especially high morality and clinical perfectionism
Misophonia triggers
Fig 1.
Nature of the response
see Table 3
General somatic
Severity
Subjects had mild symptoms on the HAS and HDRS and a high score on the SCL-90-R. Quality of life varied from a low satisfaction on the MANSA, to some impairment in day-to-day life on the SDS, particularly with family relations[40], to a slightly lower perceived quality of life on the WHOQoL-BREF[41]
Impact of Misophonia
Subjects all described to have made adjustments to their day-to-day life, such as avoiding public transport. Many subjects lost work or relationships because of misophonia. Rarely, subjects were desperate for help or expressed suicidal ideations in the clinical interviews.
interesting consequences of Misophonia
This is the largest qualitative and quantitative description of a sample of misophonia subjects so far (N = 575)
Fact check this
Our study demonstrates that clinical examination from a medical-psychiatric perspective is invaluable for diagnosing misophonia, as one out of four referred subjects does not suffer from misophonia.
Implications of the study
Risk of misdiagnosis is high, because misophonia-like symptoms could be explained by comorbid conditions such as OCPD traits, mood disorders, AD(H)D, and ASC
high risk of mis-diagnosis
Prevalence of hearing loss found in our population is even less than expected based on the prevalence of disabling hearing loss in normal population for the Netherlands (PTA > 40 dB HL in better ear around 5% for adult population[45]).
Hearing loss in sample lower then in general population
Severity of misophonia symptoms is negatively correlated with quality of life. Family relations especially suffer, but the influence on working life remains limited with only 5% on sick leave.
Impact of Miso
Development and severity of misophonia symptoms in this large sample are consistent with findings in the 2013 AMC sample[2]. In our sample, however, a larger percentage is female. Specifically, age of onset, course, severity of symptoms, and a positive family history[49, 6, 7]
consistent findings and implications.
supports misophonia as a distinct disorder[50].
consistent findings and implications.
Findings from psychiatric, medical, and psychological assessments substantiate this conclusion
Our findings result in a revision of the 2013 criteria, which are illustrated in the next paragraph and marked in Table 5. We emphasize that to be diagnosed with misophonia, all criteria should be met. As in all psychiatric disorders a subclinical group probably exists, in most cases lacking criterion E-R.
revised dx criteria
In a mass experiment which was performed among the general population, adding a corresponding image to a disgusting sound had no effect[53]. This interaction effect is probably typical for misophonia subjects.
Interaction effect
Subjects often stated the emotional response to be far more intense towards loved ones inducing misophonia triggers
Context also influenced the emotional response; when
misophonia trigger sounds were made by toddlers, mentally disabled adults, or elderly with dementia, an emotional response seldom occurred.
First, the Amsterdam UMC is the only center in the Netherlands with a specific treatment for misophonia, which could lead to a selection bias. Furthermore, since no other criteria were available, AMC 2013 diagnostic criteria were used for selection of subjects, possibly leading to confirmation bias. However, we believe we limited confirmation bias, because we examined all patients who were referred with misophonia-like symptoms; using questionnaires with a broad scope, and we investigated alternative symptoms, e.g., anxiety, in our psychiatric evaluations. Finally, types or versions of questionnaires administered changed over time in this sample. Some of the questionnaires administered are not yet validated in Dutch translation or lack a norm group, but were the best available. Also, the A-MISO-S is not psychometrically validated and the AMISOS-R is in the process of validation.
Limitations
conclusion, this analysis of a large sample confirms that misophonia is a distinct psychiatric disorder characterized by an intense emotional reaction of irritation, anger, and often disgust elicited by specific auditory, visual or sensory triggers predominantly induced by another person, resulting in preoccupation and avoidance.
We suggest future studies to use the revised Amsterdam UMC proposed criteria and to conduct international multi-center studies. A multi-disciplinary approach, especially including psychiatry, audiology, and psychology, would be preferable. International confirmation of the Amsterdam UMC revised criteria is needed before next steps in research can be taken. Future research should also include more treatment studies (e.g., a RCT of CBT or a new intervention) and validation of misophonia questionnaires.