Introduction
Misophonia is widely viewed as a scientific and clinical puzzle, with no known cause and no reliable treatments. This is how I viewed it until I discovered the work of Tom Dozier, who appears to have solved the puzzle of misophonia—and developed a set of effective treatments for it—while being relatively overlooked by both patients and researchers.
Dozier’s key insight is that the misophonic response involves a physical reflex. This reflex is acquired via simple Pavlovian conditioning, and is what gives misophonia its distinct quality of physical intrusiveness. I argue that this insight effectively solves the puzzle of misophonia, and that much of the apparent complexity surrounding the condition is actually incidental.
Dozier’s model
In my understanding of Dozier’s model, we start off with a non-misophonic response to the stimulus. How we relate and respond to a stimulus is influenced by everything about us: our personality, physiology, history, and emotional state; as well as context and social dynamics. I’ll refer to this catch-all idea as the whole person or the whole self.
If our response consistently involves a physical action—common examples include hunching the shoulders, clenching the jaws, and tightening the chest—then this action may become a reflex. This is Pavlovian conditioning, where the autonomic nervous system recognises a consistent pattern and eventually starts executing the response automatically.
(Interestingly, as Dozier points out, in the classic example of Pavlovian conditioning the bell may not have to remind the dogs of meat in order to produce the salivation reaction. The ANS may simply be picking up on the pattern, bell → salivation.)
This involuntary and unwanted physical reflex is felt in the body and adds to the existing irritation or anxiety felt in relation to the stimulus.
As a secondary effect, the physical reaction may also be intensified, creating a vicious circle where the reflex becomes stronger, making subsequent occurrences even more unpleasant, and so on. (This reinforcement idea rhymes with Scott Alexander’s idea of a trapped prior.)
Surrounding complexity
Acquisition
A good theory of misophonia should be able to explain why some things become triggers and some don’t. The range of triggers—and, importantly, similar things that aren’t triggers—is remarkably diverse and rich in detail: some people are triggered by speech in a foreign language; to others this has no emotional significance whatsoever. Someone might be triggered by leg-swinging. Someone else might be triggered by a word, but only when it’s pronounced a certain way, and only by a particular person.
Considering this, it is hard to imagine a good theory of misophonia that doesn’t embrace the full range of possible human experiences and dispositions – the whole person – in its answer to the above question. For any model attempting to narrow down the mechanism—to a specific sensory modality, brain anomaly, personality trait, social dynamic, or other factor—there is bound to be someone somewhere with a trigger/non-trigger pair that refutes the model.
The reflex model handles this problem beautifully. By seeing that the core of the misophonic response is a conditioned reflex, we can answer the question very simply: if something causes a physical reflex then it’s a misophonia trigger; if it doesn’t then it isn’t. The question then becomes why reflexes develop—Pavlovian conditioning—and then why we have consistent physical reactions to certain experiences in the first place, to which the answer is the whole person.
The burden of explaining trigger acquisition, then, can be offloaded from the “figuring out misophonia” project and onto neuroscience and psychology generally; where we already have a wealth of research, theory, and intuition to draw from.
Triggering
So far I’ve looked at what happens before we’re triggered, up to the point of the physical reflex response. I’ve argued that much of the apparent complexity surrounding this aspect can be offloaded, with the misophonia-specific part now occupying a much smaller area of the picture.
What happens after we’re triggered can also appear complex, and I argue that a similar process applies here. The feeling of a physical intrusion alongside an already irritating or anxiety-provoking stimulus is bound to amplify the original feelings. It is bound to add an extra sense of violation, of transgression of a boundary. So what is left to explain?
Part of me is drawn to the conclusion that the whole idea of misophonia as a distinct condition dissolves under examination. It may be that “misophonia” becomes nothing more than a useful label for when normal emotional responses and Pavlovian conditioning coincide in a particular way: not nothing, but not the scientific and clinical puzzle it’s currently viewed as.