Un nuevo paradigma para la misofoníafactores etiológicos en el desarrollo de la misofonía y criterios diagnósticos

Resumen

Background: Misophonia is a complex neurophysiological and behavioral disorder of multifactorial origin, characterized by an intense physiological and emotional response produced by intolerance to auditory stimuli/movements of the same pattern, regardless of their physical properties. It significantly affects daily functioning and quality of life, but its causes are unknown. Moreover, there is a lack of valid instruments to assess the severity of misophonia, as well as a lack of effective treatment strategies to improve its symptomatology. Objectives: To propose a new paradigm for the understanding and representation of misophonia, taking into account emotional, physiological, morphological and social variables, based on six objectives: 1) to perform a theoretical review based on three hypotheses: misophonia was a new clinical area largely unknown, the number of evidence confirmed that it was a disorder of important severity and affected the quality of life of the sufferers and their relatives. 2) to investigate and validate the association between misophonia and craniomandibular disorders and 3) to study its relationship with anxiety and depression disorders, under the hypothesis that the greater the craniomandibular deviation, the greater the degree of misophonia and the greater the affectation in anxiety and depression disorders. 4) to study the relationship between misophonia and its Social Representation and 5) the self-perception and the perception of people suffering from this disorder. 6) to study whether the confinement derived from the COVID-19 pandemic had altered the psychophysical and emotional responses of people with misophonia, under the hypothesis that forced confinement had severely affected people suffering from misophonia, and those who lived with them. Methods: Systematic review was carried out with the PRISMA method from the beginning of misophonia to the present. Qualitative and quantitative measures of cranioencephalic morphology were then performed to determine the relationship between misophonia and craniomandibular systems and psychiatric scales for anxiety and depression. The social representation of misophonia, the patients’ self-concept and that of their relatives was studied using IRaMuTeQ and a list of misophonic triggers was compiled. Finally, the impact of confinement during the pandemic by COVID-19 was studied by analyzing clinical consultations, neurophysiological parameters of cardiac coherence against trigger stimuli, and LSB-50 scale for psychological and psychosomatic symptoms. Results: 1) there is a relationship between craniomandibular structure and misophonia; 2) there is a relationship between the degree of deviation of craniomandibular measurements and the degree of misophonia; 3) a positive relationship is found between the diagnosis of misophonia and the presence of anxiety; 4) depression also has a relationship with the most severe degree of misophonia, but not with the diagnosis in general; 5) the Social Representation of misophonia facilitates its recognition and 6) it is confirmed that stressful situations, such as confinement, cause a decrease in Heart Rate Variability and an increase in psychological disorders such as anxiety and depression in patients diagnosed with misophonia. Conclusions: This doctoral thesis presents a new paradigm in misophonia research, which lays the foundation for a novel method as a first diagnosis. In addition, this work exposes the importance of social recognition of misophonia so that patients, families, and medical personnel have a unified concept that allows the development in the fields of diagnosis and treatment of misophonia. Finally, it highlights the importance of understanding how extreme situations such as forced confinement affect people with misophonia.