Schröder et al. (2017) raise three points related to our recent work on misophonia (Kumar et al., 2017).
Firstly they consider the diagnosis of misophonia in our patients. There are no diagnostic criteria for misophonia in ICD 10 or DSM-5 and our criteria are based on our experience of striking similar emotional responses to certain sounds in the subjects we have assessed clinically and more than 150 subjects who were assessed as having misophonia based on our questionnaire (Kumar et al., 2014). Schröder and colleagues feel that the diagnosis of misophonia should be based on criteria that they have developed, based on a series of case reports and a descriptive account of the features in 42 subjects. That study (Schröder et al., 2013) is described by the authors themselves as “anecdotal and observational.”
In terms of the criteria themselves, a second point, we have an open mind and do not feel that anger is necessarily a sine qua non for the condition. Our subjects were selected on the basis of having stable typical responses to trigger sounds over years which are commonly anger (in 86% of 157 subjects who did our questionnaire) but which can take the form of extreme anxiety. Further work on this might take the form of multivariate analysis to seek clustering of symptoms to support the existence of a clear syndrome. But we have now been contacted by more than 300 misophonia sufferers who describe both types of emotion and we do not feel as certain about the diagnostic status of anger as Schröder and colleagues. Moreover, in a recently published large scale study (Rouw and Erfanian, 2017) involving more than 300 misophonic participants, the primary reported emotional response was irritation/annoyance and not anger. Subjects also reported a range of other emotions including disgust, anxiety, impulsiveness (See Table 3 in Rouw and Erfanian, 2017).
The authors pointed out that our brain correlates could be of “general annoyance” and not of anger in misophonia. We strongly disagree. In our study, subjects gave not one but two ratings (i) misophonic distress and (ii) general annoyance. The behavioral data clearly shows dissociation between the two: while the trigger sounds caused misophonic distress, unpleasant sounds triggered general annoyance but not the misophonic distress. Higher brain responses and a stronger connectivity pattern in response to trigger sounds but not to unpleasant sounds therefore reflect misophonic distress and not general annoyance.
The third point raised concerns the possible sensitisation of subjects to trigger sounds by exposure during two visits to our lab. We do not understand how re-exposure to sounds that have been producing a typical misophonic reaction for years might have any bearing on the reaction produced.
The critical advance in our study is to show structural and functional brain changes in the subjects studied using random-effects analyses that allow robust inference about the population from which they were drawn, and which show changes in a plausible brain network for frontal control of emotional responses in insula. The work provides further evidence for a biological syndrome and we hope that it stimulates further work to robustly define the syndrome behaviourally after the important initial steps taken by Schröder and colleagues.
Statements
Author contributions
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.
Funding
The authors would like to thank Wellcome Trust for financial supporting this project (Wellcome Trust grant number: WT091681MA).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
1
KumarS.HancockO.CopeT.SedleyW.WinstonJ.GriffithsT. D. (2014). Misophonia: a disorder of emotion processing of sounds. J. Neurol. Neurosurg. Psychiatry85:e3. 10.1136/jnnp-2014-308883.38
2
KumarS.Tansley-HancockO.SedleyW.WinstonJ. S.CallaghanM. F.AllenM.et al. (2017). The brain basis for misophonia. Curr. Biol.27, 527–533. 10.1016/j.cub.2016.12.048
3
SchröderA.van WingenG.VulinkN.Denys (2017). Commentary: The Brain Basis for Misophonia. Front. Behav. Neurosci.11:111. 10.3389/fnbeh.2017.00111
4
SchröderA.VulinkN.DenysD. (2013). Misophonia: diagnostic criteria for a new psychiatric disorder. PLoS ONE8:e54706. 10.1371/journal.pone.0054706
5
RouwR.ErfanianM. (2017). A large-scale study of misophonia. J. Clin. Psychol. [Epub ahead of print]. 10.1002/jclp.22500
Summary
Keywords
misophonia, mental disorders, neuroimaging, auditory disorders, insula
Citation
Kumar S and Griffiths TD (2017) Response: Commentary: The Brain Basis for Misophonia. Front. Behav. Neurosci. 11:127. doi: 10.3389/fnbeh.2017.00127
Received
09 June 2017
Accepted
15 June 2017
Published
29 June 2017
Volume
11 - 2017
Edited by
Pietro Pietrini, IMT School for Advanced Studies Lucca, Italy
Reviewed by
Tomaso Vecchi, University of Pavia, Italy; Claudio Gentili, University of Padua, Italy
Updates
Copyright
© 2017 Kumar and Griffiths.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sukhbinder Kumar sukhbinder.kumar@newcastle.ac.uk
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.