Romke Rouw of the University of Amsterdam and Mercede Erfanian of Maastricht University, both located in The Netherlands, have published a research paper on misophonia.

The paper is titled, “A large-scale study of misophonia” and was published in the Journal of Clinical Psychology as an epub in May 2017 and then as a journal article in March 2018.

The research study focuses mostly on misophonia but it does contain some data about ASMR.

What is misophonia?  The article states, “…a condition in which individuals react negatively to specific patterns of sound and/or to sounds that occur in specific situations or settings…”

The concept of misophonia is common in discussions about ASMR because some people will respond to the sounds of whispering, mouth sounds, and chewing with deep relaxation, brain tingles, and enjoyment (ASMR) but others will respond to those same sounds with annoyance, anger, or anxiety (misophonia).

The authors of the study used an online survey to gather data from 301 individuals (83% female) who experience misophonia.  The females in the study reported slightly more severe symptoms of misophonia than the males, which could explain the higher female response rate.

The following are some of the self-reported data from the individuals about their misophonia.

Top 3 feelings/emotions:

• Extreme Annoyance/Irritation (94%)
• Anger/Rage (90%)
• Stress/Anxiety (89%)

Top 3 types of physical discomfort:

• Clenched/tightened/tense muscles (90%)
• Increased temp, blood pressure, or heart rate (60%)
• Pressure in chest, arms, head, or whole body (41%)

Top 5 effects on life:

• Tried not to be around people if they make trigger sounds (89%)
• Can’t pay attention at a movie or in class when people are making trigger sounds (87%)
• Realize they are hyper-focused on noises that should be in the background and are unable to ignore them (74%)
• Triggers are worse when tired (61%)
• Can be triggered by sounds from television or video (59%)

Effect of alcohol:

• Lessened (36%)
• Aggravated (2%)
• No change (20%)
• [No alcohol use (43%)]
• Note: marijuana/cannabis was also reported to lessen misophonia

Effect of caffeine:

• Lessened (3%)
• Aggravated (18%)
• No change (61%)
• [No caffeine use (19%)]

Effect of nicotine:

• Lessened (6%)
• Aggravated (1%)
• No change (19%)
• [No nicotine use (74%)]

Earliest memories of misophonia:

• Ages 2-4 years (15%)
• Ages 5-12 years (45%)
• Ages 13-17 years (30%)
• Ages 18 or older (9%)
• Don’t know/Other (1%)
• Note: symptoms demonstrated decreasing severity with increasing age

Top reported “Other conditions or diagnoses”:

• None (50%)
• Anxiety disorders (13%)
• Depressive disorders (13%)
• Tinnitus (12%)
• PTSD (12%)
• ADD/ADHD (12%)
• Note: only PTSD showed statistical correlation to misophonia severity

The study also had a question about ASMR.

“Do you ever experience pleasurable tingling sensation in the head, scalp, back, or peripheral regions of the body in response to visual, auditory, tactile, olfactory, or cognitive stimuli? (e.g., experiencing tingling strong desirable sensation when someone is whispering in your ear or rubbing fingers on a rough surface).”

• Yes (49%)
• No (51%)
• Note: No significant difference was found between these two groups for their misophonia symptoms.

Basically, this question shows that about half of the individuals who experience misophonia may also experience ASMR.  This is similar to the findings in a 2017 research paper about ASMR which showed that 43% of individuals who experience ASMR also may experience misophonia.  Additonally, a 2018 research paper about ASMR showed that 36%  of individuals who experience ASMR also have symptoms of misophonia (compared to only 22% of controls having symptoms of misophonia).

Furthermore, many of the replies to the other questions in this misophonia study by Romke Rouw have parallels to ASMR.

Examples of parallels between misophonia and ASMR:

• Hypersensitivity to specific sounds
• Triggering sound can be in real life or in a video
• General response to specific sounds (discomfort vs comfort)
• Consistent psychological response (annoyance vs relaxation)
• Consistent physical response (tense muscles vs brain tingles)
• Earliest memories usually in childhood

The other data in this study may also have parallels to ASMR but not enough data about ASMR has been published to check this yet.

It would be interesting for some researchers to use the exact wording of some of the questions from this misophonia survey and administer it to a large group of individuals who experience ASMR.

Click HERE to read the abstract and view the link to the full article.

Additional interesting thoughts about ASMR and misophonia thanks to a recent conversation with Dr Cara Altimus from the Milken Institute:

• According to this 2014 study, 20% of individuals reported experiencing misophonia.  Although it is currently unknown, 20% may be a rough estimate for the percent of individuals who can experience ASMR.  The blog post by 23andme.com about misophonia and an associated gene also reported a 20% prevalence of misophonia.  Another study done by Dean McKay using Amazon’s mechanical turk also seemed to show a 20% prevalence of misophonia in a random population sampling.  And this 2018 research paper about ASMRreported that about 22% of their control group showed symptoms of misophonia.
• According to this 2013 study, misophonics have a strong negative response to typing sounds but not rainfall sounds.  This is curious because both result in similar tapping noises.  In contrast, ASMR individuals have a strong positive response to typing sounds but rainfall sounds are not common ASMR triggers.  Again, curious because both are similar tapping noises.  The key difference to typing sounds and rain sounds is the involvement of a human making the sounds – so misophonia and ASMR seem to be socially-mediated conditions.
• According to this 2017 study, misophonia is associated with increased activation in the anterior insular cortex, abnormal functional connectivity, increased myelination in vmPFC brain region, and increased heart rate and galvanic skin response.  Overall these results highlight an increased emotional and sympathetic response possibly due to changes in brain wiring.  If ASMR and misophonia are commonly co-occuring conditions, then this may suggest similar changes in brain wiring, although with differently affected regions, neurotransmitters, or symptoms.
• Misophonia, ASMR, synesthesia, and sometimes autism tend to all get thrown into the same discussions because occurrences of these conditions may overlap in some individuals.  This does not mean that any are manifestations of the other, yet rather, that they all may arise due to atypical wiring that occured early in development and manifested in childhood.  It may be likely that these conditions overlap within individuals the same way that an earthquake may cause plumbing and/or electrical changes in the same house, but that doesn’t mean the plumbing changes caused the electrical changes.
• Excellent 2018 review paper on misophonia.
• Reddit discussion about having misophonia but still enjoying ASMR triggers.

Additional thoughts after attending the Milken Institute Research Retreat on Misophonia held in Chicago on July 24-25, 2018:

• Although sounds are the primary trigger for misophonia, visual triggers like the nervous shaking of legs or tactile triggers like a tight shirt collar or an itchy clothing tag can also trigger the same feelings as misophonia.  This makes misophonia more like the multi-sensory aspect of ASMR.  Interestingly, audio triggers may be the largest group of triggers for ASMR.
• A 2017 fMRI study by Dr Kumar showed that misophonia was associated with hyperconnectivity of brain regions.  A 2016 fMRI study on ASMR showed that some regions had increased connectivity and some regions had decreased connectivity.  Overall, ASMR and misophonia may involved altered connectivity due to altered myelination.
• A browsing of online discussion threads about the effect of medications on misophonia showed that 13 out of 14 individuals reported SSRI medications helpful for reducing misophonia.  Anecdotal reports of the effect of medications on ASMR usually state that SSRI medications reduce ASMR.
• Misophonia triggers usually involve another person, e.g., chewing, mouth sounds, breathing, finger tapping, throat clearing, slurping, foot shuffling, keyboard tapping, pen clicking, lip smacking, and coughing.  Although non-human sounds like pets eating, air conditioner sounds, planes flying overhead, and the hum of refrigerators have also been reported to stimulate misophonia.  This trend is similar to ASMR because most sounds that stimulate ASMR are created by other humans, although some non-human sounds can also less often stimulate ASMR.
• Preliminary data was presented at the retreat that showed the squishy sounds of someone chewing stimulated misophonia but the squishy sounds of mud did not as much.  When people were tricked to think that the mud sounds were mouth sounds and vice versa, participants had less misophonia to the mouth sounds and more misophonia to the mud sounds.  Like ASMR, this supports that misophonia may be socially-mediated.
• Family members may be stronger triggers of misophonia than non-family members.  This seems to be different from ASMR.  Strangers in ASMR videos can provide stronger ASMR triggers for many individuals than real life triggers.
• Overall, I wondered if chronic stimulation of NorEpi signaling could be driving misophonia.  This could explain the increased anger and annoyance, heightened sensitivity to sounds and sometimes other stimuli, the muscle clenching, and increased skin conductance.  The chronic NE could be pushing down serotonin levels to cause OCD symptoms which were often associated.  The use of SSRIs would raise serotonin and push down NE levels to explain the reported reduction of misophonia symptoms I read about in some forums.

Sept 2019 article about Misophonia and ASMR in Discover Magazine: read now

March 2020 article about Misophonia: read now

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• Tips: How to be an ASMR researcher.
• Insight: Interviews with ASMR researchers.
• Browse: ASMR research and publications.

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