Meaning transfer and conditioned anger to orofacial sounds: A referential learning model of misophonia

When confronted with orofacial sounds such as chewing or breathing, persons with misophonia react with intense anger and disgust, accompanied by perceived meanings of intrusion, violation of personal boundaries, offence, or diminished autonomy. To build a laboratory model of how such responses can be acquired, a first study (N = 92) tested an anger provocation emotional imagery scenario, hypothesized to evoke misophonic meanings in student population. Using a differential conditioning procedure, a second study with non-misophonic participants (N = 64) tested whether these misophonic responses could be experimentally conditioned to an orofacial sound. In the acquisition phase, one sound (eating/sniffling) (CS+) was paired 3 times with the provocative scenario (US), whereas a control sound (sniffling/eating) (CS-) with a control relaxation scenario. Both sounds were presented without imagery in a subsequent test and extinction phase. To test whether conditioned responses would generalise, orofacial sounds similar to the CSs were presented before acquisition and after the test phase. Participants rated experienced emotions and meanings after each trial, while heart rate, respiration, and corrugator muscle activity were recorded during stimulus presentation. Test phase results showed that relative to the CS- sound, the CS + sound was associated with higher self-reported anger, violation, offence, and with a higher heart rate. These conditioned responses failed to extinguish, and did not generalise to sounds that were similar to the CSs. These findings demonstrate that misophonic responses can be conditioned to orofacial sounds, supporting the role of referential learning as a potentially etiological process underlying misophonia.