Rough ideas -- trying to triangulate on the core of misophonia
Misophonia is still poorly understood. It resists being boxed in by a simple explanation. It is full of apparent contradictions: for example, the misophonic response feels visceral and immediate, and yet it is highly sensitive to context and social dynamics.
The aim of this page is to gather together some of the recurring themes, and metaphors I’ve used repeatedly, when thinking about misophonia from various angles. The idea is that these might provide useful vocabulary and interesting avenues to explore.
Metaphors are not to be taken scientifically. It would be easy to slip into pseudoscience with technical-sounding metaphors and analogies, and I want to avoid this. Their only purpose is to help us talk about phenomena that don’t have well-established names yet.
Metaphor: “Grounded” and “ungrounded” sensations
Metaphor from electricity, with ungrounded being “abnormal”, something to pay attention to, unresolved, something that can quickly build up a large static charge ready to pop off. Grounded = normal, normal flow, resolved, healthy energy.
A jaw that sits comfortably, providing a background sense of functional bite and all the implications for balance, smooth movement, and general biomechanical health, is a grounded feeling. See left molar sense.
A jaw that can’t find a good resting spot – like your author’s, where the most comfortable position for the TMJ would put the teeth in an edge-to-edge or underbite – creates tension, discomfort, and deprives the brain of molar sense.
Being touched by a feather seems to create a paradoxically strong sensation and may also be a helpful image for the idea of an ungrounded charge.
Metaphor: triggers are like words
In some ways, trigger stimuli become like words.
The trigger’s “meaning” is the ensuing sensations and negative response.
Similarities:
Words can be written or spoken; misophonia is also multimodal
Amplification/asymmetry – large response from small stimulus
Abstraction: misophonia seems to be at a high level of cognition, not low level like a hypersensitivity of nerves in the ear
Context sensitivity and necessity of interpretation: a misophonic trigger has to be interpreted as what it is, that is, the same audio waveform may not be a trigger if it’s not perceived as coming from a human
Theme: Power, powerlessness, being seen as a child/someone who needs protection
Themes of power and powerlessness come up often.
Being seen as someone who is powerless, helpless, or incompetent feels very similar to a misophonia trigger for me and certainly feels like it primes me for worse reactions.
There is a more complete version of this section that is too personal to publish, but I would be happy to share in a research context.
Speculation/analogy: phantom limb
Invoking unresolvedness similarly to the grounding analogy.
Amputees can have an itch that resolves when they scratch a model arm.
Wanted to get this in here, also, as it is an example of the weirdness and mystery of the mind. It spans the physical and the psychological: how can a phenomenon arising from such a blunt physical mutilation – the physical itch felt on an arm that’s not actually there – be affected by the kind of high-level cognition required to make the “scratching a fake arm” trick work?
Another element of this, which I’m not sure about now, was to do with my sense of how my skull is shaped vs. how it is shaped. At some very general level, I think I have an idea of how my skull should be shaped – informed by years of trouble with how it is shaped, by my knowledge of craniofacial dystrophy, intellectual knowledge of how it should be, and estimates of how it would have to be shaped for my jaw to feel comfortable – and I almost sense this shape as a phantom limb. This is itself a metaphor and may not really be analagous to the phantom limb effect.
Speculation: misophonia triggers are often objectively unhealthy
Clicks and pops from the mouth can indicate jaw joint dysfunction. This relates to the whole misocfd category, cfd being craniofacial dystrophy. In my own triggers there is an overlap between them and objective CFD that seems too great to be coincidental, but it could just be that those triggers relate most strongly to me own anatomy, which is quite severely affected by CFD.
Some triggers are less clear, like leg swinging or foreign accents, so this seems unlikely to be the ultimate explanation.
Intent, obliviousness
Another interesting element is that the other person’s disposition toward the trigger seems to matter. Triggers are worse if the other person seems to get some kind of satisfaction from, or be oblivious to, the sound they’re making or the action that produces it.
Bias, subjectivity, interpretation of emotions, ascription
I subscribe to the construction view of emotions. Emotions are concepts and similarly to how we might put together some visual stimuli and context and conclude that we’re looking at a chair, we might put together some internal sensations and context and conclude that we are angry.
A lot of my speculation about what makes misophonia triggers enraging could be the kind of after-the-fact, narrative rationalisation that can seem very convincing without much real evidence supporting it. Memory is fallible. The brain likes stories that make sense.
Stages, sequence, overall model
I suggest thinking of a misophonic reaction in two stages. The first is the “core” of misophonia, and it’s the fact that the stimulus somehow was felt inside the body.
Factors leading up to this might include:
hypermirroring
misophonics’ heightened interoceptive sensibility
confusion in the system that differentiates between internal and external stimuli
(See The brain basis for misophonia and The motor basis for misophonia.)
In this model, there isn’t any emotion yet – just the raw sensation that we have been penetrated by something. I doubt this as I’m writing it – it’s hard to separate the raw sensation from the emotions that seem obviously to follow from it – but it’s one way to think about it. It is my working model.
The emotion comes after.
The raw penetration sensation directly produces negative affect and increased arousal. Affect and arousal are some of the core ingredients of emotion but they are not emotion.
The creation of emotion involves high-level cognition (sloppy use of terminology here, may be technically inaccurate). The same combination of affect and arousal – which exist within the body – might produce anxiety in one context and anger in another. “Produce” is even probably the wrong word – we actually create instances of emotion concepts from the underlying stimuli. The brain is active in the creation of emotion.
I think the rationalisations also come afterward, possibly after emotion.
So we have:
raw sensation of penetration -> negative affect, increased arousal -> construction of an emotion (anger or panic) -> rationalisation, narrative
A concrete example:
Family member’s chewing sounds seem to penetrate body
Negative affect and increased arousal produced
Anger instantiated as the most appropriate emotion concept based on the base feeling (penetration) plus context, history, interpersonal dynamics, sufferer’s personality
The emotion is chosen by the brain unconsciously as a kind of estimate to answer the question why did I feel a burst of negative affect and increased arousal just now, and what kind of response would be appropriate (and therefore how best to prepare to make that response)?
The answer could have just as easily been Anxiety: there is no consistent biological fingerprint that determines which of the two – which in their extremes manifest as “fight” or “flight” will be felt; the brain chooses with context etc.
rationalisation applied in the form of “that was rude”, bad table manners, maybe consciously or subconsciously invoking past history with that person.
The rationalisation is made to answer the question why did I get a sudden burst of [anger | anxiety] just now?
I believe the pathology that produces misophonia may only go up to the second step above, that is the production of negative affect and increased arousal in response to a sensation of having been “touched”.
Descriptions of misophonia commonly contain descriptions of anger, anxiety, and mention the importance of interpersonal dynamics. These are all true, but they may not be fundamental. A more accurate description of misophonia might read something like this:
Misophonia is a condition in which external stimuli can be felt inside the body.
Anger and anxiety are obvious results of this, but they are not fundamental to it.
Interpersonal dynamics do affect step 1 though
The above description is incomplete. It neglects to mention the importance of context and interpersonal dynamics in whether the stimulus is felt inside the body in the first place.
It might seem like this brings us back to a more complex model where complex cognition is involved from the start. And I suppose it does.
But I think it’s still important to separate out the process of a misophonic trigger into those steps, and the model is still valid; we just need to explain more about how step 1 happens. We may have a situation where:
Complex cognition, social dynamics, and context are all important to create the preconditions for the “core trigger” – the penetration sensation.
The penetration sensation occurs, and it’s just that – the feeling of being touched on the inside.
Complex cognition, social dynamics, and context are all involved in what happens afterward – the construction of emotions and narratives about what just happened.
It’s important not to try and create a simple overarching narrative that lumps the two instances of “complex cognition etc” into a single explanatory model for the whole sequence of the trigger.
It’s also important to recognise that the emotions and narratives may be kind of arbitrary, and therefore might be misleading when trying to figure out what’s actually going on. If we feel a sudden increase in negative affect and arousal, the brain will try to construct an appropriate emotion and our more autobiographical/narrative self will try to figure out why we’re feeling that emotion. The reuslting story may be just that, a story, no matter how convincing and concrete it feels.
The brain will probably also have a bias for simple stories that are easily understood by the part of the brain that deals with keeping track of social dynamics. Bear this in mind.
All that said, we still need to explain why some stimuli – or the same stimuli in different contexts – are triggers and some aren’t.
In summary, the best approach may be to only look at step 1 and what happens before it.
Stages: Before step 1
Default mode network, body budget, social contexts
One thing I’ve noticed in myself is that I’m much more prone to triggers when I’m with family than when I’m with strangers or acquaintances.
I know this is separate to the well-recognised observation that family members are more likely to be triggers because I have triggers that come from myself. Those triggers – such as from the shape of my mouth – are worse in the presence of family, and are even sensitive to the conversation topic. More personal, and more inward-focused, topics = more sensitivity.
It’s as though I have a “focus” of inner sense, and the more this is pointed inward – along with another variable which is something like how integrated the person is into my bodily regulation – determines how sensitive I am to triggers.
If I’m with strangers, my focus is directed more externally, and the people I’m around aren’t as integrated into my bodily regulation as family or close friends. In these situations I simply don’t feel the rage that I sometimes feel from the shape of my own mouth.
This rage comes when I’m on my own, in certain states, and when I’m with family.
It may have something to do with the default mode network. Need to look into this more; DMN was mentioned in the Brain Basis paper and I think is associated with inner sense.
Conversation topic also has a large impact on whether I get the self-triggered rage in the presence of family. “Do you want to …” can create unbearable rage, whereas “What do you think of [some political thing]” can take my attention away from my mouth and actually avoid the trigger.
Hypermirroring
I think hypermirroring, as described in the motor basis for misophonia, is a good candidate for a direct cause of step one.
HM itself depends on social context, as mirroring is stronger with people we have stronger bonds with.
Anticipation
Anticipating a trigger causes heightened stress, which may further increase sensitivity.
General
My sense is that there are multiple factors required to get to step 1, which I’ll refer to as “being touched”.
One may very well be misophonics’ inherent heightened interoceptive sensibility.
We may also have some kind of problem with distinguishing between internal and external stimuli.
Hypermirroring may be another, and/or it may depend on some of the above.
CFD, tongue tie, strait jacket
A metaphor I keep coming back to to describe my own experience with self-triggered misophonia/misokinesia is that of being in a strait jacket.
Tongue tie is known to cause all kinds of bodily restrictions.
The teeth and jaws are known to be important in posture and balance.
They are near the vestibular system, which is also important for balance and fluid movement.
They are also near the ears, which, while the connection may be indirect, seems to point to the possibility that dysfunction there could interplay with sensitivity to audial triggers.
There is a bone in the middle of the head called the sphenoid, which as been described as a mirror of the pelvis.
It’s hard to get a sense of this unless it goes wrong, but the teeth, jaws, and neck alignment are essential for overall biomechanical stability, agility, and comfort.
See Releasing the Psoas for just a taste of this.
How this plays into misophonia is unclear but there is a definite interaction.
Other ties
I also have lip and buccal ties, and certain lip movements (in others) are also triggers.
Restrictions stacked like Russian dolls
When I found out about jaw expansion I basically booked a flight immediately, and got the first stages of treatment on credit cards.
This ultimately contributed to a financial collapse which saw me move into a caravan.
I had some bad days and the height of anger seemed to rise when I was aware of being restricted at multiple levels of abstraction.
At the lowest level, my tongue – I think the tongue is really central to all this – doesn’t fit inside my mouth. It’s also tethered (“tied”) to the floor of my mouth, which may be a large part of why my skull didn’t grow big enough to accommodate it in the first place.
So I have this background sense of being trapped.
Then, the immobility of my tongue and the misalignment of my skull causes me to feel more generally trapped inside my body – unable to move fluidly. It creates a kind of clumsiness where my movements are janky and robotic and I’m prone to brush things off surfaces and making the fine movements to e.g. put a toothbrush back in its glass requires a frustrating amount of concentration and gross motor effort. It electrifies the nerves going all along and through my body, makes me hyper aware of the constant tension in my pelvis that probably comes from an inability to get my teeth to sit together properly.
Then, moving around like this janky robot, I’m stuck inside a caravan, which is a small and awkward space to move around in even if you have the normal amount of agility and fluid movement.
Then, the caravan is on a piece of land that I don’t own and therefore don’t have control over.
Then, in life generally, I have no money, so I’m mostly powerless to change any of these aspects.
Around this time I also had another health issue, thoracic outlet syndrome, which makes even walking around troublesome.
This multi-level feeling of constrictedness and powerlessness really made for some exquisite crescendos of all-consuming rage. At the center of it all, and really most directly distressing, was my tongue not being able to move around as freely as it should. Human bodies are fascinating.
Control
Some sufferers describe a sense of the stimulus feeling like it’s temporarily controlling them, that they’re not in control of the relevant part of the body.
Violation
Misophonia often comes with a sense of violation. I think this is understandable given that it feels like the stimulus touched us inside our body, and it doesn’t really need explanation beyond that.
Frustration of goal-directed behaviour, mirroring, restriction
I read in a paper or article the suggestion that misophonic rage could have something to do with being unable to achieve a goal (goal in the sense of any state of affairs, not like a life goal).
This rings true to me.
I wonder if part of my tongue-related misophonia comes from tongue restriction.
Some tongue-related sounds are related to movement of the tongue.
Maybe these sounds somehow remind me of my tongue’s restrictedness?
Looking at this from a mirroring perspective, maybe these sounds cause patterns of motor neuron firing corresponding to me making that sound myself, but my tongue is restricted, so this runs into unresolvedness and frustration of goal-directed behaviour. Unresolved because I can’t achieve the feeling I expect to be able to achieve – I expect to feel (from mirroring) what it would feel like (at some level of cognition, not necessarily fully experiencing it tactilely) if I made that sound. But my model of my tongue – the model my brain uses to try to execute that simulation – includes the fact that my tongue is restricted, so I’m unable to run the simulation (a goal) and the discrepancy between expectation and reality creates a sense of tactile unresolvedness.
Tentatively, this could be generalised to the leg swinging trigger – which I can’t talk about in much detail because I don’t have it. But the idea would be that seeing leg swinging creates a similar tension and frustration based on the sufferer’s bodily restrictedness.
Hypothesis
Bring some of these themes and observations together:
I think a component of misophonia might be:
mirroring an action that relates to a restricted body part.
For example, I have audial triggers that are mouth sounds that specifically involve the tongue, and I have a restricted tongue – both in terms of the space it occupies and, mor importantly I think, in terms of being tied to the floor of my mouth.
I have visual triggers for some lip movements, and I have restricted lips (tongue tie etc are referred to as “tethered oral tissues”).
One of my triggers is a specific pronunciation of a word that suggests restriction of the mouth in general – a mandible that’s trapped behind a downswung maxilla (CFD).
I had all or most of these triggers before I knew about CFD or TOTs.
Mechanism
There could be a long term and a short-term component to the mechanism. Long-term, a restriction might create a kind of background anxiety around that part of the body. The brain is keeping track of how mobile the body is – it needs an accurate model of the body in order to control it effectively. It also – I assume – has some expectations and/or goals for the body. It wants – by some mechanism; I know the brain is flexible and can adapt to a large range of body configurations – a certain range of motion and flexibility.
It wants to achieve certain postures – the tongue and jaws want to sit – obviously I’m using “want” as a shorthand here – in harmony. The teeth, TMJ, tongue, and lips need to work together in order for the face to be both relaxed and working well. Nasal breathing, teeth lightly touching, lips sealed, lip competency, etc.
Difficulty in achieving this – such as by CFD or TOTs – will create chronic tension via whatever means you use to compensate – forward head posture, not having a proper lip seal, etc.
This will be tracked in the brain and will create a general sense of unease and charged/unresolvedness around these structures.
This may prime them to be extra sensitive, somehow.
The brain may somehow perceive these structures as body parts that it doesn’t have full control over.
Conversely, maintaining correct rest posture easily will contribute to a sense of ease and control around these areas. Use of these structures – all the fine control involved in eating, speaking, etc – will also reinforce a sense of “everything is working well” in the brain’s model of these structures. The brain will learn by repeated experience that the mouth works in harmony, has a good range of motion and flexibility.
In general, a sense that the body is working well will create positive affect and reduced arousal. A kind of reassurance loop of sensing what the parts are doing now (proprioception, tactile sense) and using experience to simulate and predict function (range of motion, flexibility, ability to control as precisely as needed). Groundedness.
In the short term, (hyper) mirroring of affected areas may temporarily exacerbate feelings of not being in control, tension, and ungroundedness in the affected area. The brain may get into a rapidly escalating loop of sensing the discomfort, attempting to control – or simulate control – of the body part, and being unable to achieve the reassuring sense of connectedness and control because of the restriction.
There are various ways this could interact with the process of the misophonic response.
It could be one of the necessary components to create the “touch feeling” – the core sensation of being touched on the inside.
It could also carry on beyond that and into the emotion generating phase, while not being necessary for the generation of negative emotion (touch feeling is sufficient), but possibly escalating it.