Etiology, composition, development and maintenance of misophonia: A conditioned aversive reflex disorder

Misophonia is a recently identified condition in which an individual has an acute reaction of hatred or disgust to a specific commonly occurring sound. We propose that misophonia is a form of conditioned behavior that develops as a physical reflex through Pavlovian conditioning. Although misophonia is generally considered to be a one-step reaction, in which the sound elicits rage or disgust, as well as typical autonomic responses associated with these emotions, we propose that misophonia is a two-step reaction, in which the sound elicits an aversive conditioned physical reflex, and the aversive conditioned physical reflex elicits hatred or disgust. We also propose that the emotional response to trigger stimuli creates a Pavlovian conditioning paradigm that maintains or strengthens the misophonic physical reflex. Finally, we propose that new misophonic trigger stimuli are developed through the pairing of a neutral stimulus with a misophonic trigger stimulus. We suggest that a better name for misophonia is Conditioned Aversive Reflex Disorder (CARD) since it focuses attention on the reflexive nature of this condition and incorporates multiple stimuli modalities. A counterconditioning treatment for misophonia is presented with brief case descriptions which demonstrate the conditioned reflex nature of this disorder.