Triangulating the root cause of misophonia

One thing I’ve been doing since I read the mirroring paper is trying to figure out the root cause of misophonia, and in doing so I’ve noticed some recurring themes—ideas I keep arriving at from slightly different angles, and which therefore seem worthy of explicitly recording. In this way I hope to make some progress towards triangulating the root cause, or the essential nature, of misophonia within the space of the various dimensions I’ve been thinking about (psychological, psychosocial, physical, neurological).

A major throughline in my thinking is that jaw dysfunction—possibly via airway constriction, forward head posture, and resulting chronic tension; possibly via tongue tie and fascia; possibly by a more subtle mechanism related to self-image and an abstract feeling of constrainedness—or a combination of all of the above—might play a central role in the etiology of the disease.

A fact I keep thinking about recently is that tongue tie release patients often describe TENSION RELEASE, STORED ENERGY RELEASE, and e.g. “finally being able to relax”. One patient noticed that their feet spontaneously adjusted to a symmetrical posture immediately following the TTR procedure. There are several videos of patients having the TTR procedure at https://www.youtube.com/@TheBreatheInstitute/videos (warning: surgery footage).

The explanation for the posture adjustment is that the tongue is connected to the big toe, ultimately, via fascia. If the tongue has restricted mobility due to tongue tie (ankyloglossia), this has knock on effects throughout the body.

Patients describe similar feelings—anxiety relief, stored energy release, etc—after maxillo-mandibular advancement (MMA) surgery, which gives the tongue more physical space and prevents it from blocking the airway.

Combining these observations with the fact that misophonia has been connected to orofacial mirroring, and that sufferers describe sensations like ITCHING TEETH, something is GRIPPING MY HEAD, suggests that it may not be a coincidence that we have both an epidemic of jaw- and airway dysfunction due to modern diets, and people suffering from misophonia that is largely focused on the mouth, both from the perspective of how it feels for the sufferer to be triggered, and the fact that oral dysfunction could be a factor in the creation of common trigger sounds from others (e.g. glottal clicking, snorting, snoring, and general excessive loudness of e.g. chewing, which points to physical dysfunction).

Subjectively, misophonia can feel similar to the intense FRUSTRATION one might experience from being physically restrained, which tongue tie, chronic tension, and posture issues do cause in some sense.

This leaves the question of how we get from a trigger sound or image to a misophonic response.

The orofacial mirroring paper suggests that HYPERMIRRORING may be involved, the idea being that misophonics have a higher tendency to mirror, creating the sensation of LACK OF CONTROL and VIOLATION of personal space and/or bodily integrity. The mirroring is experienced too strongly and the brain gets confused about whether the sensation is coming from inside or outside, resulting in an unpleasant sensation of BEING TOUCHED and, again, a lack of control.

The brain basis paper found that misophonics have higher INTEROCEPTIVE SENSIBILITY, which is the ability to sense the viscera and what’s going on inside the body. This makes sense.

If misophonia requires, for example, heightened interoceptive sensibility or some other neurological factor, then the question is where does objective physical dysfunction fit in?

I believe that one of the reasons misophonia is so hard to pin down might be that it has MULTIPLE CAUSAL FACTORS, i.e. maybe misophonics are those individuals who have both heightened interoceptive sensibility AND chronic tension—or some other combination of factors. This would make it hard to make any one hypothesis make sense if focused on just a single factor.

Then there are the PSYCHOSOCIAL elements. For one, there’s the more subjective, interpersonal angle: the subjective feeling of being triggered often comes along with feelings of having being transgressed against, or of the triggerer being rude or inconsiderate in their production of trigger sounds.

The other psychosocial element is the fact that a misophonic trigger often requires CONTEXTUAL and social factors: we often won’t be triggered by the same pattern of sound if we don’t perceive it as coming from a relevant SOURCE (a close friend or family member, for example, or just “a person”). This feeds into the idea that MIRRORING plays a significant role: mirroring requires that we perceive another person, and mirroring is stronger between more closely related individuals, so it’s a good fit to explain this aspect of the disorder.