That led her to misophonia, which audiologists first described in 2001. Experts still aren’t sure what causes it or how best to treat suffering patients, but even the small body of existing research provided McErlean with more reference material than her dive into ASMR. To start, she tapped the Misophonia Questionnaire, a scale developed by doctors at the University of South Florida in 2014. It assesses a patient’s symptoms and their severity, as well as the specific responses sounds elicit. The higher the score, the more likely a person will need professional treatment, like cognitive behavioral therapy, to cope. In a small 2018 study, McErlean found that 36 percent of subjects with self-reported ASMR had misophonia. Some of the randomly selected control subjects turned out to experience ASMR as well, and 70.8 percent of them fit the diagnostic criteria for misophonia. For those, McErlean suspects, discomfort triggered by some of the genre’s most popular noises could keep them from seeking out sounds that induce pleasant shivers.