Proposed Diagnostic Criteria for Misophonia

In 2013 by Arjun Schröder and associates at the University of Amsterdam proposed diagnostic criteria for misophonia which only considered auditory triggers. Recent research supports revising those criteria to include other sensory modalities (sight, vibration, smell, etc.) along with the nature of the misophonic response. The directors of the Misophonia Institute (Michelle Lopez, Chris Pearson, and Thomas Dozier) proposed revised diagnostic criteria for misophonia. The criteria include the preceding information in a format suitable for professionals.

By Thomas Dozier, Michelle Lopez, and Christopher Pearson, Directors of the Misophonia Institute

Drawing from the existing literature and clinical experience, and derived from Misophonia: Diagnostic Criteria for a New Psychiatric Disorder by Schröder et al. (2013), we propose the following diagnostic criteria:

  • The presence or anticipation of a specific stimulus such as a sound, sight, or other stimulus (e.g. eating sounds, breathing sounds, machine sounds, hand movement, vibration), provokes an impulsive, aversive physical and emotional response which typically begins with irritation or disgust that quickly becomes anger.
      • Although auditory and visual stimuli are the most common, the stimulus can be any sensory modality.
      • The stimulus is a conditioned stimulus, which excludes responses in which the stimulus is unconditioned, eliciting an unconditioned physiological response (i.e. sensory over-responsiveness or sensory processing disorder).
      • Where a single occurrence or a small number of stimulus instances cause the default response.
      • Where a minimal intensity instance of the stimulus will elicit the default response (e.g. low volume baby crying or quiet breathing). If a high intensity instance of the stimulus is necessary to elicit the response, then it does not support the diagnosis of misophonia, especially if the stimulus is uncomfortably loud or startling.
  • The stimulus elicits an immediate physical reflex response (skeletal or internal muscle action, sexual response, warmth, pain, or other physical sensation). Note the physical response cannot always be identified, but the presence of an immediate physical response may be used to more clearly identify the condition as misophonia.
  • A moderate duration of the stimulus (e.g. 15 seconds) elicits general physiological arousal (e.g. sweating, increased heart rate, muscle tension).
  • Dysregulation of thoughts and emotions with rare but potentially aggressive outbursts. Aggressive outbursts may be frequent in children.
  • The negative emotional experience is later recognized as excessive, unreasonable, or disproportionate to the circumstances or the provoking stressor.
  • The individual tends to avoid the misophonic situation, or if he/she does not avoid it, endures the misophonic stimulus situation with discomfort or distress.
  • The individual’s emotional and physical experience, avoidance, and efforts to avoid cause significant distress or significant interference in the person’s life. For example, it is difficult for the person to perform tasks at work, attend classes, participate in routine activities, or interact with specific individuals.
  • The individual’s response is not better explained by another disorder, such as obsessive-compulsive disorder (e.g. disgust in someone with an obsession about contamination) or post-traumatic stress disorder (e.g. avoidance of stimuli associated with a trauma related to threatened death, serious injury or threat to the physical integrity of self or others).