Let’s Not Confuse Misophonia and Sensory Processing Disorder – Part 1

Ask Tom Dozier
January 15, 2016
Let’s Not Confuse Misophonia and Sensory Processing Disorder – Part 2
August 4, 2016

Let’s Not Confuse Misophonia and Sensory Processing Disorder – Part 1

Misophonia vs. Sensory Processing Disorder (SPD)

Misophonia and SPD are different

Misophonia and SPD are different

Recently there have been some people who want to redefine misophonia as a form of sensory processing disorder (SPD) or sensory over-responsiveness. I think there are good reasons to not combine misophonia and SPD, and especially not to consider misophonia as a form of SPD. This is confusing to some individuals who have both SPD and misophonia. The disorders are not mutually exclusive. I think it is well-meaning individuals who have both disorders that are promoting they be combined. From their experience, the two disorders combine to create a horrible sensory problem, but the disorders should not be combined because they are distinctively different.

Research on SPD has been underway for at least two decades. It has gained increased attention because children with autism often have sensory issues, and there are generally considered SPD. SPD was considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM), release 5, which occurred in 2013. But it was not included in the DSM-5, likely because there is still a strong debate over whether SPD is a real disorder. For instance, see the Scientific American article, Is Sensory Processing Disorder for Real?

SPD includes three broad categories. These are sensory modulation disorder, sensory-based motor disorders and sensory discrimination disorders. Sensory based motor disorders and sensory discrimination disorders do not have symptom similarities to misophonia, so I will not discuss them further.

Sensory modulation disorder appears as a problem with the intensity, duration, or frequency of the stimuli. It includes three categories:
– sensory under-responsivity – not at all like misophonia
– sensory craving/seeking – not like misophonia. People with misophonia avoid trigger stimuli.
– sensory over-responsivity – appears to have similarities with misophonia

Sensory over-responsivity (which I will call SPD from here on for simplicity) shows up as fearful, stubborn (or other negative behaviors), and self-absorbed behavior, in response to strong/loud stimuli. It may also include distress, anxiety, anger, and other strong emotions when exposed to stimuli, especially when the stimulus is prolonged. For example, an SPD child may have a fear response when hearing a toilet flush, but if he is forced to stay close, and there are repeated flushes, his emotions and behavior will escalate. Sometimes the emotions and extreme behavior happen instantly. It is common for children with SPD to have meltdowns. Emotional distress, meltdowns, and negative behaviors are common with misophonia, but with misophonia anger and disgust are the most common emotions. Misophonia occasionally includes a fear response, but never includes self-absorbed behavior. Misophonia also includes anxiety, and children (and even adults) with misophonia often have meltdowns.

One big difference with misophonia and SPD is the age of onset. SPD is generally present at very young ages. It shows as an infant who is upset by a loud toy, or a toddler who is afraid of a vacuum cleaner. One of my grandkids could not tolerate the sound of the toy grill on the playhouse, so I muffled the speaker. Misophonia can develop at any age. About half of those with misophonia had onset by age 10. But misophonia does begin in later years for some. A recent study I conducted shows about 5% of individuals had onset of misophonia as adults, and for some, it did not begin until they were in their 50s.

With both misophonia and SPD, a person has a strong emotional response to auditory, visual, or tactile stimuli, but SPD triggers and misophonic triggers are very, very different. I will discuss this in my next post.

20 Comments

  1. snes says:

    I have melt downs with both. They can feel similar to the person experiencing it.

    • Tom Dozier says:

      I really appreciate your comment. Because the reaction are similar or the same, it is easy to assume SPD and misophonia are the same. You can develop a misophonia reflex to an SPD stimulus, so the conditions can seem to overlap.

  2. Kt says:

    Why do we have to be diagnosed with a disorder (a social construct) in order to get help for what ails us?

    Much of the time a diagnosis actually gives the patient the ailment, especially in the cases where there isn’t an objective test. (Like a flu test or x ray) I have loads of symptoms but no diagnosis and honestly I’m glad. I’m still getting excellent treatment, and I’m not burdened with some pesky health issue that has no real solution.

  3. S. says:

    I have to say, I totally agree with the idea, just based on the data presented. I also have an 8 yr old son who has Misophonia, but it literally showed up over the course of the last year.

    Just because someone has Misophonia, does *not* mean they are autistic, and it does *not* mean they have Sensory Processing Disorder. If this were so, I would have had some clues to this when he was a young child or baby. However, my son was perfectly able to hear normal sounds from scraping dishes and utensils for the first 7.5 years of his life, then, all of a sudden, he wasn’t. It just happened, almost overnight.

    I often wonder if Misophonia is due to a vitamin D3 deficiency, coupled with heavy metal toxicity in the body. Since vitamin D3 is responsible for building the scaffolding for our neurons, it would make sense that Misophonia would occur in late childhood, when everything in the body is starting to work more cohesively, and also, as people age, when everything in the body is starting to fall apart.

    As for heavy metals toxicity, we are just now learning that baby foods, even the organic ones, contain *toxic* levels of lead and arsenic.. then there are also the heavy metals in vaccines that are waaaay over the FDA’s minimums for ADULTS, let alone new born babies. (I’m not an anti-vaxer, but I do have my new baby on an alternative vaccine schedule, “Dr. Paul’s Vaccine Schedule” if you want to search it, which makes it so he only gets a metal-containing or formaldehyde-containing vaccine once per month so that his body has time to process it. And we hold off on Hep B and MMR until he is in elementary school.)

    • Austin says:

      “Self-absorbed ” behavior? I think what you’re trying to say is that autistic people (who grow up to be adults, btw) can respond to sensory overload with a meltdown or a shutdown. Both of these are involuntary and similar to a migraine or seizure in terms of brain activity. Shutdowns are less recognized, but can involve being unable or nearly unable to move or speak. That might be what you mean by “self-absorbed” behavior, the person appearing withdrawn or unresponsive. Pain is not selfish.

      • Marian says:

        Thank you for saying that. I felt like the term self absorbed was far fetched due to the lack of control people suffering from spd experience.

  4. Ecclissi says:

    P.S. sensory under-responsivity *is* like over-responsivity. Both are sensory disregulation and an inability to modulate it yourself even when you realize it is happening.. Just like you might have trouble with triggering images no matter how well you mentally prepare yourself for one..

  5. Ecclissi says:

    Okay.. In My (not so) Humble Opinion:

    There *is* some overlap between these disorders. Your image shows SPD and Autism as having overlap, but Misophonia as completely separate of both. I don’t think that is accurate either, though.
    People with a phobia aren’t Autistic, but the reaction to a phobia trigger is the same as what I experience a lot of the time… Sorry for getting wordy, it’s hard for me to find the right words sometimes. I don’t think in words. I think with my senses. That doesn’t make me less intelligent than someone who is more.. regular(?) but it does mean I tend to end up with walls of texts as I try to narrow what I feel down..
    Sorry in advance:

    For me my sensory issues have traits of several “phobias”. Including Misophobia and Trypophobia, OCD and other things basically related to the sensory system going haywire.
    The same things that are triggers for people with these phobias trigger mine, probably in a very similar way.

    Meanwhile I have also given birth three times without needing any pain medications. It’s not about “being tough” I just have a very high pain tolerance and it can take me a bit to realize something is in fact hurting. By that time though it goes from 0 to 20 as by the time that I feel something, I am at the stage where I can’t really fish through it. That is what they mean with sensory under reactivity.

    The problem is that my sensory issues and ability to respond to social cues correctly gets considerably worse when I get too stimulated or if I am tired.. this gets to the point that I *really* can’t function anymore at all, and I can even go non verbal when this happens. It’s like language disappears. Like having a word on the tip of your tongue but you can’t find it, but having that with *all* words.. it’s a blank mental state that is really distressing, and that is the best I can describe that..
    Mostly, it involves *all* of my senses.
    I also have social issues.
    I’m Autistic, and it *is* similar to what you have, but involving far more areas.

    We can avoid triggering images or specific sounds etc. if we know we have these phobias, and be fine the rest of the time. When it involves all of your senses it becomes impossible to avoid being triggered..

    I am pretty sure I am not the only one who is a generally high functioning Autistic person who recognizes the same triggers for these phobias and have the same reactions as you might have to these images, sounds, etc. What you say is absolutely recognizable for me.

    The difference is in what systems are effected. How many of them.
    To imagine this as your diagram, maybe instead imagine three rings within one another, the where the larger ring represents an impact on a person’s functioning..

    Autism might be the biggest ring as it involves both all of the sensory systems *and* social ones as well..

    SPD might be a middle ring that doesn’t effect social functioning, but *does* effect reactions to several different sensory stimuli. Multiple senses are involved.

    Specific phobias might be the smallest circle in the middle of the other two .. it might effect a single sense in a very specific way..

    As someone with Autism, I can tell you that for me, the social issues and other sensory issues feel very much like the reaction I have to Misophobia and Trypophobia. Very much, what you describe. Just in far more areas.
    Maybe looking at it from that perspective you can see what it might be like to have that reaction in multiple senses, and in social settings as well, and get a pretty good image of why people with Autism struggle so much, and stim etc. when we can’t avoid triggers and things get too much. What would you do in our stead?

    Having one phobia can be annoying and very seriously distressing, but you can probably function okay with it most of the time. If nothing else you can avoid triggers. I can’t because the triggers are everywhere at all times.

    Feel free to disagree with me on any of this, but this is my experience and how I see it. I get what you said, but I think these do share some overlap.

  6. Olivia says:

    You need to be more specific about what you mean by “self absorbed behavior.” It really seems like you’re throwing people with SPD under the bus by insinuating that those with misophonia are not selfish, and those with SPD are. SPD I believe is more associated with autism spectrum disorder, and autistic people have historically been pathologized as self absorbed/selflish because we tend to hyper-fixate on our special interests and talk about them a lot, and struggle to outwardly express empathy (NOT the same as having no empathy period.) Language is powerful, and I’m just asking you to think critically about how the language you use contributes to the demonization of autistic people.

    • Tom Dozier says:

      I agree with you. I think I got that term from a page on SPD. It doesn’t sound like words that I would typically use. I agree I need to change it. Thank you for pointing this out.

  7. Andrea says:

    I don’t think the APA is denying SPD is “real”, it’s just not considering it a psychiatric disorder. Insurances widely cover OT services for SPD. It’s most certainly not a made up disorder.

    • Tom Dozier says:

      I agree. I think the problem is the broad definition of SPD including sensory modulation disorder, sensory-based motor disorders, and sensory discrimination disorders. Most of the time when we talk about SPD, we are referring to cases of sensory over-responsivity. One study reported that if a person has sensory over-responsivity, they are more likely to develop misophonia.

  8. Lucy says:

    I think this explanation makes good sense. I have always wondered if the two could be mutually exclusive. I would diagnose myself with sensory over responsivity. I tend to have strong reactions to short term and especially prolonged stimuli but not the same emotion as a misophonia attack. I don’t feel as though the two are related, however perhaps there is something to the fact that I may have them both. If you could develop misophonia maybe you could be more at risk for doing so if you have SPD. Maybe the personality type at risk is highly neurotic.

    • Tom Dozier says:

      Yes. There is a reseach study that reported people with SPD are more likely to develop misophonia that those who do not have SPD.

  9. Wendy says:

    And maybe they are connected and not connected

  10. Wendy says:

    Get off your high horse Gloria.

  11. Wendy says:

    I feel misophona and spd are connected. And it’s not a mental condition it is a neurological one. Although will cause phychological
    Behaviours. It’s a sensitivity to sounds.

  12. Gloria says:

    Are you really that dense? The SPD Foundation itself says otherwise.

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