Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain.

Misophonia is a recently identified disorder of decreased tolerance to specific (mostly human) sounds and/or associated stimuli [, ]. When anticipating or perceiving so-called “trigger” sounds or stimuli (e.g., eating or mouth sounds), individuals with misophonia experience immediate and strong physiological and emotional reactions, which are often difficult to control, along with behavioral reactions [, –]. Situations with potential triggers are commonly avoided, escaped, or encountered with anticipation anxiety [, ]. Misophonia typically develops during childhood or early adolescence [–], and is associated with reduced quality of life and considerable educational, social and relational impairment in youth [, ]. While consensus on the definition of misophonia was recently reached by an international interdisciplinary group of experts through a Delphi-method [], consensus regarding diagnostic criteria for misophonia is still lacking. As a disorder of decreased sound tolerance, misophonia might be understood in the context of audiology (by contrasting its features with audiological disorders such as hyperacusis and tinnitus; [–]); and/or psychiatry (by contrasting its features with psychiatric disorders; [, ]). The absence of unified diagnostic guidelines complicates the research into etiology, assessment tools and treatment of misophonia, essentially leading to a vicious cycle. As a first step in addressing this problem, several research groups have proposed diagnostic criteria for misophonia [, –]. The Amsterdam UMC misophonia research group was the first to propose diagnostic criteria for misophonia as a psychiatric disorder [], and published revised criteria in 2020 after a follow-up study of 575 adult patients with misophonia (full criteria in []). These Amsterdam UMC 2013/2020 criteria have been criticized for being too restrictive (e.g., children might not recognize that their feelings are excessive; [, ]), and for their assumption of psychiatric etiology and the absence of differentiation from hyperacusis, which according to Jastreboff and Jastreboff [] might lead to biased samples of patients with misophonia. While it is important to consider these and other criticisms in the ongoing field of misophonia research, the proposed Amsterdam UMC 2020 criteria largely reflect the consensus definition of misophonia [] and form an important starting point for harmonization and comparison of future international misophonia studies []. For instance, in the current absence of unified diagnostic guidelines, the Amsterdam UMC 2020 criteria might serve as a basis for development of questionnaires, which allows for a more straightforward and cross-cultural comparison between different misophonia studies.