Misophonia is associated with altered brain activity in the auditory cortex and salience network

Abstract

Misophonia is characterized by intense rage and disgust provoked by hearing specific human sounds resulting in social isolation due to avoidance. We exposed patients with symptom provoking audiovisual stimuli to investigate brain activity of emotional responses. 21 patients with misophonia and 23 matched healthy controls were recruited at the psychiatry department of the Amsterdam UMC. Participants were presented with three different conditions, misophonia related cues (video clips with e.g. lip smacking and loud breathing), aversive cues (violent or disgusting clips from movies), and neutral cues (video clips of e.g. someone meditating) during fMRI. Electrocardiography was recorded to determine physiological changes and self-report measures were used to assess emotional changes. Misophonic cues elicited anger, disgust and sadness in patients compared to controls. Emotional changes were associated with increases in heart rate. The neuroimaging data revealed increased activation of the right insula, right anterior cingulate cortex and right superior temporal cortex during viewing of the misophonic video clips compared to neutral clips. Our results demonstrate that audiovisual stimuli trigger anger and physiological arousal in patients with misophonia, associated with activation of the auditory cortex and salience network.

Figure 1

(A) Visual analogue scale (VAS) ratings (range from 0–100) were used to score how much anger, anxiety, happiness, sadness, and disgust each clip evoked for the participants personally. Misophonic clips provoked more anger (p < 0.001), disgust (p < 0.001) and sadness (p < 0.001) in patients compared to controls. (B) Change in anger sub scores on the POMS-SF. Graphs show the two mean anger sub scores filled out before and after the paradigm. Misophonic patients had higher anger scores before and after. The difference in anger change between the two groups was significant (p < 0.048). (C) Heart rate was recorded as the interval between two heartbeats, the inter-beat-interval (IBI). Smaller IBI means faster heart rate, reflecting increased physiological arousal. Patients showed larger differences between the mean IBIs for the misophonic and neutral condition (p < 0.001) and between the aversive condition and neutral condition (p = 0.007), i.e. more physiological arousal during the misophonic and aversive condition. No differences were found for controls.

Figure 2

Statistical maps showing increased activation in patients during the misophonic condition in three regions of interest: (A) right insula (pSVC = 0.030), (B) right ACC (pSVC = 0.046), and (C) right superior temporal cortex (pSVC = 0.035).