Gum chewing, nose sniffing, pen clicking… Repetitive leg shaking, hair twirling, the sight of someone eating. A disturbing odor. For the vast majority of people, these particular sounds and visuals are nothing more than background ambient stimuli. For a small, discrete population these stimuli trigger severe and immediate emotional and behavioral responses. Rage and anger swell up immediately; hatred and blame instantly fill the mind. And within seconds, the body prepares for flight.
Misophonia is a unique set of symptoms, most likely attributable to neurological causes unrelated to hearing-system dysfunction. It can be described as an immediate and extreme emotional response of anger accompanied by an automatic physiological flight response and a fundamental discomfort to identifiable auditory, visual, and olfactory stimuli.
Age of Onset
The physiological response to a trigger is flight /fight. Here is a very basic play by play of what happens in the body:
1) When our senses perceive a danger or threat, sensory nerve cells pass the perception of the threat to the hypothalamus area in the brain.
2) Some hypothalamic cells release coricotropin-releasing hormone into the pituitary gland, while other cells simultaneously transmit a
nerve signal down the spinal cord and activate the sympathetic motor system.
3) The pituitary in turn incites cells to release a chemical messenger into the bloodstream.
4) Both the chemical messenger and nerve impulse travel to the same destination, the adrenal gland.
5) The adrenal glands sit atop the kidneys.
6) They receive nerve and chemical signals which activate the release of epinephrine (adrenaline) and norepinephrine (noradrenaline) into
7) These "stress hormones" cause several changes in the body, including an increase in heart rate and blood pressure. Cortisol is released into
the blood stream resulting in an increase in blood pressure, increase in bloodsugar levels, and suppression of the immune system.
8) In the lungs, epinephrine binds to receptors on smooth muscle cells wrapped around the bronchioles, causing the muscles to relax and
allowing more oxygen into the blood.
9) An increase in heart rate pushes more blood throughout the entire body to deliver oxygen, fuel, and strength to organs and muscles.
10) The brain is directed to focus only on the big picture in order to determine where threat is coming from. Thus, there is trouble focusing on
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The estimated range of age-of-onset tends to be between the ages of 8 and 13, or late childhood through mid-adolescence. Having a discrete age of onset range signifies that there is a developmental component to the disorder. Given the prevalence of the age of onset prior to puberty, the disorder could be considered a developmental childhood disorder.
Critically, it is the emotional response of anger without overt acts of aggression that distinguishes this syndrome from fear-based anxiety disorders. Although the prevalent emotional reaction is anger, other elicited emotions are upset, sadness, disgust, fear, anxiety, and an overwhelming need to cry. Along with emotional responses are cognitive (thought) reactions to triggers. Cognition refers to information processing, utilizing mental processes of attention, memory, problem solving, making judgments, and decision making. A sufferer may feel (think) intense hatred toward the origin of the trigger (the source). A cognitive judgment that might arise would be “That person is a slob. People who chew gum are like cows chewing cud.” Consistently across testimonies, as story tellers recount their experiences, it is their thoughts about the people creating the triggers, and not the triggers themselves — that illicit negative value judgments. More often than not, the sufferer believes that the person making the noise is purposely and consciously causing discomfort.
Anger vs. Fear
In the Workplace
You have a gum chewer sitting next to you and you can not get any work done. Can you move my desk? Can the company ask the gum chewer to stop?
The only place to eat is a small room, and everyone chomps on salads. Can you eat at my desk, although its currently not allowed?
In the American Disabilities Act, an impairment is defined as Any mental or psychological disorder, such as an intellectual disability (formerly termed "mental retardation"), organic brain syndrome, emotional or mental illness, and specific learning disabilities. Although misophonia is not in the DSM-V (the American Psychiatric Association Manual of Disorders) or ADA list of disorders, you still have rights and negotiation power.
For parents who want to provide an optimal learning environment for their child with misophonia, interaction with the school is critical. Children who had struggles in the school environment school may qualify for support services for reasons including attention deficit disorder, emotional disorders, cognitive disorders and developmental delay. Your child may be eligible for an Individualized Education Program (IEP). An Individualized Education Program is the cornerstone of a quality education for each child with a disability. The team that writes a child’s Individualized Education Program includes the parent(s), regular education teacher(s), special education teacher(s), other individuals from the school and district, and the student when appropriate. A meeting to write the IEP must be held within 30 calendar days of deciding that the child is eligible for special education and related services. Type your paragraph here.
Trigger expansion is a key component of this disorder. It expands in sensory modality, from sound to sight to smell, creating a multitude of daily onslaughts that are virtually impossible to avoid. For almost all sufferers, the number and type of triggers increase through time. This is due to the nature of sensory processing: there is great overlap in the sensory cortices of the brain. The signals from a trigger from one sensory modality (such as a chewing sound) get neurologically associated with signals from another trigger (such as the sight of a person chewing) in a non-conscious, non-learned process. Sufferers across the board engage in hypervigilant attention to sources, situations, and environments where triggers might occur. Hypervigilance can begin as a cognitive process in which an individual concerned about particular threats closely monitors environmental conditions. This acute attention can alter the sensitivity of the brain to trigger stimuli. And through these changes in sensitivity, the brain is primed to take in, modify, and expand triggers.