Sensory Processing Differences
Some people have exceptional wiring in their brains and bodies. This can present as extreme sensitivity and refined processing of incoming stimuli resulting in aptitudes, gifts and talents, or it can cause pain, distress, and misunderstandings. Others may be outside the norm in their need for increased intensity in order to feel sensory input. The field of occupational therapy coined terms such as ‘sensory sensitivity’ and ‘sensory defensiveness’ to describe these variations. Making intentional choices in one’s sensory diet can result in living a more balanced, emotionally regulated and interpersonally satisfying life.
A large majority of people I see experience sensory processing differences. In my practice I always screen for the presence of auditory, visual processing, and learning differences that may add a layer of complexity to one’s life. We explore client understanding of themselves and how they meet the world with their neurophysiological individuality. Together we hold the strengths and any challenges as co-occurring, and direct life choices, strategies and goals in pursuit of joy, fulfillment and reaching one’s desired potential while offering scaffolding and interventions as relevant. A primary focus of the work is shifting to a non-pathologizing mindset that respects the good intentions and neurodiversity of individuals, couples, family members, and work/school settings.
Misophonia/Misokinesia
Misophonia is a sensory processing variant with intense social emotional and functional implications. Currently considered by many a clinical disorder of sensory intolerance, it bridges sensory strengths and heightened perception with emotional and physical suffering. In misophonia, certain sensory inputs trigger immediate, intense emotional or physiological responses that are generally perceived to be unreasonable given the circumstances. Misophonics describe the stimulus, or its producer as, “driving them crazy.” Their reactions can range from anger and annoyance to panic, the need to flee, and at times, provoke verbal or albeit rare, physically aggressive reactions toward others or oneself. The disorder is sometimes called Selective Sound Sensitivity Syndrome (4S) but appears to impact any sensory system, such as vision, touch, smell, taste, movement (Misokinesia) or energy perception as well.
Triggers of Misophonia
Individuals with misophonia often report they are triggered by oral sounds, and soft sounds such as the noise someone makes when they eat, chew, or even breathe. Other adverse sounds include repetitive sounds such as keyboard or finger tapping or mechanical sounds such as windshield wipers or leaf blowers. Sometimes motion is the cause – fidgeting, picking, jostling, or wiggling body parts. Still others simultaneously have sensitivity to loud or high-pitched sounds as well, which is not misophonia per se, but often co-occurs.
Underlying Mechanism of Misophonia
Researchers believe that the brains, bodies, and emotional systems of those with misophonia are wired differently. How sensitive the mechanical systems may be, and how the brain filters sensory input, and matches it to memories, expectations, values, and attributions of intent, seem to play roles. The variability of its presentation can seem perplexing, as circumstances, stress level, sense of safety and autonomy, seem to influence its experience. Exposure to ‘trigger’ stimuli tends to breed greater reactivity. Recent research notes involvement of mirror neurons and a sense of one’s body feeling out of one’s control.
Severity and Impact of Misophonia
The disorder appears to range from mild to severe. Individuals report a range of physiologic and emotional responses, with accompanying thoughts. A mild reaction might result in feeling
anxious, or uncomfortable, accompanied by an urge to flee, or a feeling of disgust. If more severe, the sound in question might cause intense irritation, anger, rage, fear, panic, nausea, with significant emotional distress before, during, and after a misophonic event.
The disorder can significantly negatively impact one’s family, social and work/school life, and self-esteem. Those with the misophonia have been known to develop anticipatory anxiety when going into situations where triggers may be present. One might avoid restaurants or eat separately from one’s spouse, family, or roommates. Left untreated Misophonia can generalize to other sensory systems, worsen, and drive sufferers to greater isolation, family discord, and depression. Some instances of self-injury and suicide due to misophonia have been reported.
Interventions for Misophonia
While there has yet to be ‘a cure’ for misophonia, much of the suffering can be ameliorated with multidimensional interventions. I have developed a model of intervention based on the most current research that involves psychoeducation, cognitive, emotional, attentional, interpersonal and self-regulation skills training, mindfulness and relaxation practices, environmental interventions, and interpersonal agency centered around one’s ethics and values.
Having grown up in, and currently having, a misophonic family, I am personally familiar with the complexities and intensities misophonia creates. One of few, perhaps the only clinician in the Boston area, with the clinical training and experience of working with many clients and their families, as well as teaching clinicians about misophonia, I have the capacity to discern and integrate the complexity of co-existing overlapping neurodiversities, such as AD/HD, Anxiety, Depression, Obsessive Compulsive Personality Disorder, as well as the assets of this neurophysiopsychosocial variant, such as many being gifted or talented, high achieving, empathic, socially attuned, justice and ethically-minded, perfectionistic and goal-oriented.
Get Experienced Evaluation
Misophonia is not a hearing disorder, but one should pursue a hearing evaluation to rule out auditory anomalies that can be playing a role if misophonia is suspected.
Though misophonia is not an anxiety disorder, it does share characteristics with, and often feels, like intense anxiety or panic. However, treating misophonia with classic exposure and response prevention techniques, commonly used to treat phobias and anxieties, is contraindicated—and can make misophonia worse. It is important to seek coaching, counseling, psychotherapy or consultation with someone who understands, and has experience with misophonia specifically.
In clinical practice I blend elements of ACT, CBT, DBT, Polyvagal theory, social thinking, mindfulness, and trauma theory, assertiveness, attention training and affect regulation into treatment that is individualized to each client’s presentation and needs.
Services I offer for Misophonia/Misokinesia include psychological screening, individual counseling, coaching, or consultation. I also offer family consultation and education, and health provider in-services and training. I am piloting a support group in the near future.
Contact this office to get started.