This is a guide for Doctors/Therapists/Audiologists/OT's who are seeing individuals with Misophonia. Individuals with Misophonia may also download this and bring to their doctors!

1. INTERNATIONAL MISOPHONIA RESEARCH NETWORK
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Jennifer Jo Brout, Psy.D.
International Misophonia Research Network
Misophonia Guide for Doctors
and Clinicians

2. JENNIFER JO BROUT, PSY.D.
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What is Misophonia?
Individuals with Misophonia experience
heightened autonomic nervous system arousal
accompanied by negative emotional reactivity
in response to specific, pattern-based sounds.
The intensity of both neurophysiological and
emotional responding varies from mild to
severe across individuals, as well as differing
environments. Misophonia was termed by
Jastreboff and Jastreboff (2001) as they
differentiated it from hyperacusis (a disorder
in which individuals perceive sounds as louder
than they are. Sometimes individuals with
Misophonia also have hyperacusis, but not
always. The Jastreboffs (2001) proposed that
Misophonia was primarily an auditory-based
disorder which also involves brain areas that
process sympathetic nervous system arousal
and emotional valence.Currently, there is
some disagreement within the literature as
to how the disorder should be classified.
However, there seems to be a consensus that
a multi-disciplinary approach to research and
treatment is most appropriate.
Misophonia Research
Research specific to Misophonia is in its
infancy. Most studies involve case reports, or
are limited by small samples without control
groups. In addition, these studies rely on self-
report measures that are not yet validated.
However, studies using physiological measures
(e.g. skin conductance, heart rate) consistently
demonstrate sympathetic nervous system
arousal in response to auditory (and sometimes
visual) stimuli, verifying subjective reporting
(Edelstein, Brang, Rouw, & Ramachandran,
2013; Kumar et al., 2017).
Brain imaging and neural network modeling
reveal a notable difference in connectivity in the
frontal lobe between the cerebral hemispheres
in people with Misophonia. The difference
appears to be due to higher myelination in the
ventromedial prefrontal cortex (vmPFC), which
is involved in the processing and regulation of
emotions like fear and empathy as well as in
decision making (Kumar et al., 2017).
Studies addressing the specific mechanisms
underlying Misophonia are not conclusive.
However, processes related to both the
central and peripheral nervous systems such
as pre-attentive processing of stimuli and
salience detection, as well as the integration of
perceptual salience with atypical awareness of
internal body states emerge as important (Brout
et al., 2018).
Finally, age of onset is unknown, and preliminary
studies suggest that both children and adults
have Misophonia. Misophonia may overlap with
other developmental, medical and psychiatric
disorders, and may also present without co-
occurring diagnoses. Common co-occurring
disorders are hyperacusis (Jastreboff &
Jastreboff, 2001), Autism Spectrum Disorder
(Brout et al., 2018; Danesh & Kaf, 2012),
Sensory Processing Disorder (Brout et al.,
2018; Cavanna & Seri, 2015), and Obsessive-
Compulsive Disorder (Webber, Johnson, &
Storch, 2014). Anxiety appears to mediate
Misophonia symptoms, and may also co-occur
as a disorder (Brout et al., 2018).
2018 Literature Review
Please read the entire Literature Review here:
https://www.frontiersin.org/articles/10.3389/
fnins.2018.00036/full
See references at end.
International Misophonia Re-
search Network (IMRN)
Dr. Jennifer Jo Brout established The
International Misophonia Research Network
(IMRN) in order to facilitate cross-disciplinary
Misophonia research. Disappointed by her
own experiences with the state of the field

3. INTERNATIONAL MISOPHONIA RESEARCH NETWORK
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when seeking help for her own child in 1999, Dr.
Brout began efforts to establish better research
practice, improved diagnosis, and innovative
clinical practice related to individuals with
difficulties processing sensory information (with
a particular focus on auditory over-responsivity).
Dr. Brout established the Sensation and Emotion
Network (SENetwork) in 2007 and founded the
Sensory Processing and Emotion Regulation
Program at Duke University in 2008 (with funds
from her family foundation). The Sensory
Processing and Emotion Regulation Program was
renamed the Misophonia and Emotion Regulation
program in 2015.
The International Misophonia Research Network
advisory board features professionals from many
disciplines, and the advisory board can be found
here: www.Misophonia-research.com/advisory-
board
Misophonia Treatment
While there is no official treatment for Misophonia,
a multidisciplinary approach can be used to help
patients cope with Misophonia. Coping skills are
an important part of managing Misophonia.
Coping skills are beneficial for Misophonia
patients, because they help patients to:
• Reduce the intensity and duration of reactivity
when triggered
• Ease the anxiety and emotional distress related
to Misophonia
• Help sufferers to understand the disorder
• Improve academic, occupational, or social
functioning
• Reduce family tensions related to Misophonia
• Allow sufferers and their families to advocate for
themselves while at work and in school
Coping skills are Psychoeducational
(understanding Misophonia, the nervous system,
and the brain), Physiological (how to calm the
body and return to homeostasis), Cognitive
and Emotional (altering thoughts and emotions
surrounding Misophonia), and Behavioral
(developing new behavioral patterns of
responding).
Misophonia Provider Network
Providers interested in helping Misophonia
patients in their areas can be listed on the
Misophonia Provider Network. A short class is
offered to providers for listing on the network.
The Misophonia Provider Network was formed
along with the International Misophonia Research
Network (IMRN) in order to connect individuals
to a cross-disciplinary network of researchers
and professionals. Our provider network does
not allow providers to simply list with us. Rather,
we try to ensure that the providers associated
with our Network understand Misophonia from an
interdisciplinary perspective and have a working
knowledge of the scope of Misophonia research
and clinical practice standards.
Dr. Jennifer Jo Brout formed the IMRN in order
to facilitate cross-disciplinary research in
Misophonia and conditions related to auditory
over-responsivity. The IMRN connects sufferers
and researchers to accurate and current
information related to the disorder. The IMRN
supports science that informs treatment and
better practice standards for Misophonia. The
IMRN does not accept donations and instead
facilitates research through crowd sourcing and
other funding strategies. You can find the provider
network at www.Misophoniaproviders.com .

4. JENNIFER JO BROUT, PSY.D.
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References and Selected Papers
Brout, J.J., Edelstein, M., Erfanian, M., Mannino, M., Miller, L.J., Rouw, R. Rosenthal, M.Z. (2018)
Investigating Misophonia: A review of the empirical literature, clinical implications, and a research
agenda. Frontiers of Neuroscience, 12(36). doi:10.3389/fnins.2018.00036
Cavanna, A. E., & Seri, S. (2015). Misophonia: current perspectives. Neuropsychiatric Disease and
Treatment, 11, 2117–2123. doi:10.2147/NDT.S81438.
Danesh, A. A., & Kaf, W. A. (2012). DPOAEs and contralateral acoustic stimulation and their link to
sound hypersensitivity in children with autism. International Journal of Audiology, 51, 345-352. doi:10.
3109/14992027.2011.626202
Edelstein, M., Brang, D., Rouw, R., & Ramachandran, V. S. (2013). Misophonia: physiological
investigations and case descriptions. Frontiers of Human Neuroscience, 11(296). doi:10.3389/
fnhum.2013.00296.
Gavin, W. J., Dotseth, A., Roush, K. K., Smith, C. A., Spain, H. D., & Davies, P. L. (2011).
Electroencephalography in children with and without sensory processing disorders during
auditory perception. American Journal of Occupational Therapy, 65(4), 370-377. doi:10.5014/
ajot.2011.002055.
Jastreboff, M. M., & Jastreboff, P. J. (2001). Components of decreased sound tolerance: hyperacusis,
Misophonia, phonophobia. ITHS News Letter, 2, 5–7.
Jastreboff, M. M., & Jastreboff, P. J. (2002). Decreased sound tolerance and tinnitus retraining
therapy (TRT). Aust. NZ J. Audiol., 24, 74–84. doi:10.1375/audi.24.2.74.31105.
Jastreboff, P. J., & Jastreboff, M. M. (2014). “Treatments for decreased sound tolerance (hyperacusis
and Misophonia),” in Seminars in Hearing, 35(2). New York, NY: Thieme Medical Publishers.
Kumar, S., Hancock, O. T., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., Griffiths,
T.D. (2017). The brain basis for Misophonia. Current Biology, 27(4), 527-533. doi:10.1016/j.
cub.2016.12.048
Meltzer, J., & Herzfeld, M. (2014). “Tinnitus, hyperacusis, and Misophonia toolbox,” in Seminars in
Hearing, 35. New York, NY: Thieme Medical Publishers.
Rouw, R., & Erfanian, M. (2017). A large-scale study of Misophonia. Journal of Clinical Psychology,
74(3), 453-479. doi:10.1002/jclp.22500. [Epub ahead of print].
Schröder, A., van Diepen, R., Mazaheri, A., Petropoulos-Petalas, D., de Amesti, V. Vulink, N., &
Denys, D. (2014). Diminished n1 auditory evoked potentials to oddball stimuli in Misophonia patients.
Frontiers in Behavorial Neuroscience, 8(123). doi:10.3389/fnbeh.2014.00123.
Webber, T. A., Johnson, P. L., & Storch, E. A. (2014). Pediatric Misophonia with comorbid obsessive–
compulsive spectrum disorders. General Hospital Psychiatry, 36(2), 231 e1. doi:10.1016/j.
genhosppsych.2013.10.018.

5. INTERNATIONAL MISOPHONIA RESEARCH NETWORK
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Further Reading
Baguley, D. M., & McFerran, D. J. (2011). “Hyperacusis and disorders of loudness perception,” in
Textbook of Tinnitus. A. R. Møller, B. Langguth, D. DeRidder, & T. Kleinjung (Eds.) New York, NY:
Springer.
Davies, P. L., & Gavin, W. J. (2007). Validating the diagnosis of sensory processing disorders using
EEG technology. American Journal of Occupational Therapy, 61, 176–189. doi:10.5014/ajot.61.2.176.
LeDoux, J. (2015). Anxious: Using the Brain to Understand and Treat Fear and Anxiety. New York,
NY: Penguin.
Neal, M., & Cavanna, A. E. (2013). Selective sound sensitivity syndrome (Misophonia) in a patient
with Tourette syndrome. Journal of Neuropsychiatry and Clinical Neurosciences, 25(1), E01–E01.
doi:10.1176/appi.neuropsych.11100235.
Perry, W., Minassian, A., Lopez, B., Maron, L., & Lincoln, A. (2007). Sensorimotor gating deficits in
adults with autism. Biological Psychiatry, 61(4), 482–486. doi:10.1016/j.biopsych.2005.09.025.
Rosenthal, M. Z., Neacsiu, A. D., & Geiger, P. J. (2016). Emotional reactivity to personally-relevant
and standardized sounds in borderline personality disorder. Cognitive Therapy and Research, 40(3),
314–327. doi:10.1007/s10608015-9736-y.

6. JENNIFER JO BROUT, PSY.D.
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Misophonia Links and Resources
http://www.Misophonia-research.com/
International Misophonia Research Network.
http://www.Misophoniainternational.com/
Misophonia International.
http://www.psychologytoday.com/blog/noises
Blog by Dr. Brout on Misophonia research and coping.
https://www.amazon.com/Exploring-Misophonia-Shaylynn-Hayes/dp/1544279280
Exploring Misophonia (2017) by Shaylynn Hayes, edited by Dr. Brout. An anthology on Misophonia,
incorporating interviews with sufferers and professionals.
https://www.allergictosound.com
Allergic to Sound, a Misophonia advocacy and community site based in the UK.
http://dukescience.org/content/Misophonia
Misophonia and Emotional Regulation Program at Duke University co-founded by Dr. Brout.
Other Resources
https://self-reg.ca
The MEHRIT Center, an educational organization, established by Dr. Stuart Shanker to work towards
a vision of calm, alert children, youths, and adults flourishing in physically and emotionally nurturing
environments.
https://www.spdstar.org
SPD Star Institute, for comprehensive information on Sensory Processing Disorders
http://differentbrains.com
Different Brains, a not-for-profit organization dedicated to promoting the understanding and
acceptance of the basic variations in the human brain known as neurodiversity
http://a2aalliance.org
The Adversity 2 Advocacy Alliance, a nonprofit organization dedicated to promoting and fostering the
power of turning personal challenges into service to others with similar challenges.