Is Misophonia a Form of OCD?
Misophonia a condition characterized by the experience of extreme discomfort associated with a range of sounds (“triggers”). The most common sound triggers typically emanate from the facial region (mouth or nose) of other individuals and commonly include chewing, crunching, slurping, or sniffling. Often it is a few individuals that sufferers find the most triggering, usually close family or friends.
A common question regarding misophonia is whether it is a form of obsessive-compulsive disorder (OCD). The foundation for this question can be attributed to the overlapping patterns between the two conditions such as the “obsessive” hyperawareness of the sounds and the ongoing attempts to avoid the trigger. This is a very important question because we have a very effective treatments for OCD, and if misophonia is a form of OCD then the treatment for OCD—exposure and response prevention (ERP), should work for misophonia.
The problem is, ERP does not seem to work for misophonia--at least in its classic application. There is no evidence suggesting that merely exposing one to sound reduces sensitivity to the sound. However, the fact that the therapy does not work is not necessarily a proof that misophonia is not a form of OCD. In order to develop some possible direction with the question it will serve useful to understand what OCD and misophonia are, and what their differences may look like. Understanding these differences can serve as the foundation for treating misophonia. Thus, the aim of the article is to understand what are some core aspects of OCD and misophonia and how their respective treatment are similar and/or dissimilar.
To begin to understand the difference between OCD and misophonia, let us use the following vignette to help us.
Ann, also called by her friends as Anxiety Ann, is known for her propensity for worrying about the many things that can go wrong in every situation. She has, however, one fear that towers above all others: contracting lyme disease. One days she returns from a hike and find that she has tick on her foot. Since ticks are a source of lyme disease she hurriedly gets tested for lyme disease and she learns that she in fact tests positive. She is stunned: her fear has come true!
In this story there are two “time zones”: before and after getting lyme. The time zones in relation to the fear are associated with difference emotions. Before: The anticipation and apprehension of getting something unwanted, which yields anxiety. When there is a possibility of getting lyme in the future, the natural emotion is anxiety. When the lyme showed up, it was already the reality, the emotion is different. It could still be anxiety about what might come next—but there is also something else more dominant: anger and frustration. “I can’t believe I have lyme after all that!”
Anxiety occurs prior to something unwanted happening and anger occurs when the unwanted thing is already there. There is one thing in common between the two reactions: they are both emerging in relation to something unwanted (in this case lyme disease).
Whenever a person has something in their mind that they envision that could happen and they don’t want it to happen, the natural response is to feel anxiety. I see spider, I don’t want to get bitten by it, I feel anxiety about the possibility of getting bitten. Anxiety emerges when there is something in the future I don’t want.
OCD emerges when there is something in the future that can happen that I really don’t want. If Jane had OCD, she would think of every type of way that she could possibly get lyme and work hard to make sure it doesn’t happen. Lots of handwashing, avoidance of walking near woods—you get the idea. This is to make sure that something bad doesn’t happen in the future.
Misophonia is the time equivalent of when Jane already got lyme. Its already here, there is no changing that reality. Right now there is nothing she can do about that fact. It’s a cold hard fact. Misophonia involves the reality of living in a world where people make triggering sounds on a regular basis. The unwanted reality is already here. It is the product of finding oneself living in a world where people are making certain sounds that one finds unacceptable. Both OCD and misophonia have in common this: they are both working very hard to get rid of something. In OCD it’s the future possibility of getting hurt, and in misophonia it’s the current reality of triggers. They are also similar in they are working towards the impossible-we cannot totally uproot a future possibility from existence, and we cannot change reality as it is right now.
And they both have this in common: they both feel some sense that they could do something about getting what they want. An underlying belief (or hope) among OCD individuals is that if they protect themselves enough, they will be completely safe. In misophonia, there is often a a sense that “if people will just change their habits, if the source of the sounds will just go away, there will be peace.” With OCD the possibility of harm always remains, and thus the threat and need to compulse; with misophonia, people will likely always continue to engage to make the triggering sounds. People will breath and eat.
If the therapy for OCD is to learn to how to live with the vulnerability of a future unwanted possibility (which thus also involves learning to live with anxiety) then misophonia is about learning how to let go of efforts to change the current reality, even though it might feel like we can do something about it. Because misophonia therapy is distinct from exposure therapy in this qualitative way, I believe, traditional exposure therapy has not been a promising form of therapy. To this end, I developed a therapy specifically for misophonia called experiential acceptance and stimulus engagement (EASE) which addresses these crucial nuances. In a paper recently published in the Journal for Obsessive Compulsive and Related Disorders, I, along with my co-authors, explain in detail the theoretical model and therapy approach for misophonia.
In summary, misophonia and OCD share some similarities but their differences make a large difference in regards to their respective treatments. OCD involves learning how to accept a future possibility along with anxiety that comes with the vulnerability. Misophonia, on the other hands, is about learning how to accept the reality that certain sound triggers will likely never go away.
