Suicidal misophonia: a case report

Misophonia is still an unclassified disorder and means literally "strong dislike (hate) of sounds". In this paper, we present a case report of an adolescent female who had misophonia that was complicated with two non-fatal suicide attempts. She presented with anxiety features and started to follow up for three years. Assessment of the level of misophonia for a year using Amsterdam Misophonia Scale (A-MISO-S) showed an extreme degree soon after the second suicide attempt. Initially, psychotherapy was noticed to be ineffective due to her poor motivation. Escitalopram was added to the management plan and improvement was reported in the depressive symptoms and obsessional thoughts of misophonia but were intolerable eventually because of the weight gain. Therefore, it was switched into Fluoxetine and Bupropion but six weeks later she attempted her second suicide by Bupropion overdose. At that point, the psychiatrist, the patient and her parents agreed to continue therapy with non-psychopharmacological treatment. Gradually she became more engaged in psychotherapy sessions after noticing its effectiveness. It was concluded that significant improvement of misophonia was reported when she was treated by Selective Serotonin Reuptake Inhibitors (SSRI) namely Escitalopram or Fluoxetine, motivated in psychotherapy sessions, adapted good coping strategies, decreased her dysfunctional challenging behaviour, rejoined social interaction and activity in her life, was more insightful and aware about her illness and developed self-acceptance.