In January, the Duke Center for Misophonia and Emotion Regulation hosted a webinar, led by Zach Rosenthal, a professor and a clinical psychologist who would love to see misophonia released from medical purgatory. Rosenthal founded the center, part of the Duke University School of Medicine, in 2018; in addition to misophonia, he and his team also study misokinesia, a condition that was first named in a 2013 study by the Dutch psychiatrist Arjan Schröder. Misokinesia is an aversion to movements in the absence of sound. Very rarely, it can present in isolation, but, like misophonia itself, it’s usually a problem within a problem: if the sound of sipping bothers you, the sight of it likely does, too.
The webinar’s attendees were a mix of researchers, patients, and the parents of children who are grappling with misophonia. As the session began, a message popped up onscreen, directed from one attendee to another: “Lisa M. please stop chewing or turn off camera, thanks.” Everyone was already on mute. Still, to engage in a trigger-associated movement was a bold choice. Chewing gum on a misophonia Zoom is like bringing a knife to a balloon flight.
Rosenthal structures misophonic symptoms according to the acronym BASIC: behavioral (escape and avoidance), attentional (vigilance and distractibility), somatic (physical hyperarousal), interpersonal (inhibition, indirect aggression), and cognitive, which can be “sliced into internalizing cognitions versus externalizing cognitions,” he told me. “Either it’s my fault—I’m bad, I’m broken, I’m terrible. Shame, shame, shame. Or it’s your fault—you’re bad, you’re terrible. Anger, anger, anger.” When we spoke after the webinar, he was quick to point out that there is no “E” in BASIC. Thrown by the simplicity of this pronouncement, I took a moment to scan the word. His story checked out. But I wondered why he was so adamant about keeping “E,” as in “emotion,” off his list of symptoms when a feature of misophonia is an emotional response.
“Because emotion is not simply one thing,” he explained to me. “It occurs across all the letters. It includes behavior. When we get angry, we have strong underlying biological responses, full stop. You can’t divorce emotion from biology.”
I had not planned on divorcing anything from anything, but Rosenthal is accustomed to the world’s tendency to pigeonhole misophonia, to paint the condition as a manufactured malady and those who live with it as hysterics.
“This is a phenomenon that does not fit into any one clinical discipline, but people want to stick baby in a corner,” he added.
During the webinar, Rosenthal noted an accomplishment of the previous year: the establishment of a World Misophonia Awareness Day, on July 9th, in memory of Michelle Del Valle, a teen-ager from Orlando who died by suicide in 2023, after struggling with misophonia. In addition to the center’s evergreen goal of raising awareness, Rosenthal is hoping that 2026 will be the year that misophonia is finally recognized with a code by the International Statistical Classification of Diseases and Related Health Problems, or I.C.D. Developed by the World Health Organization, the I.C.D. is a global concern, separate from the Diagnostic and Statistical Manual of Mental Disorders, or DSM, a U.S. publication that classifies psychiatric conditions. The DSM is more widely known in the States, and sometimes deployed as a barb (i.e., “So-and-So should have their own entry in the DSM”). Misophonia might appear in the DSM eventually, but, for now, the focus of the misophonia community is the I.C.D., which is used by pediatricians and primary-care doctors. Rosenthal submitted the proposal arguing for its inclusion.
Misophonia is often diagnosed alongside anxiety, A.D.H.D., and O.C.D., which do have official diagnoses. But, Rosenthal said, “If misophonia is the only diagnosis people meet criteria for, it will enable them to receive treatment with it as the sole diagnosis. If it’s in the I.C.D., it becomes an option in the medical industry’s drop-down menus. It becomes a real thing.”
Lucia Lara, an occupational therapist in Seattle who focusses on pediatric sensory-processing disorders—she recently treated an eighth grader who had to contend with a class science experiment involving bouncing Ping-Pong balls—echoes Rosenthal’s beliefs: the code won’t alter what she does, she stressed, but, when it comes to health insurance, “those codes are important to facilitating the reimbursement process.”
