From Misophonia through Puberphonia: Window Towards Gender Dysphoria in Autism?

Abstract

Autism is characterized by distinct patterns of social communication, interests, and behaviors. Gender incongruence (GI) involves a mismatch between one's experienced and assigned gender, often accompanied by significant distress (i.e., gender dysphoria, GD). Recent studies revealed that autistic individuals (AT) report GD more frequently than the general population (Wattel et al., 2022) and are overrepresented in gender clinic settings. Autistic individuals also report hypersensitivity to certain sensory stimuli which can elicit distress. When this distress is triggered by certain auditory stimuli (e.g., one’s or others’ biological sounds such as chewing or swallowing) it is conceptualized as misophonia. While misophonia is not unique to autism and has not yet been conceptualized as a formal diagnosis, it appears to be highly prevalent in AT. We propose that a lesser studied phenomenon, puberphonia, could exemplify an attempt to reduce the distress elicited by misophonia in a certain category of individuals. Puberphonia is characterized by an unusually high-pitched voice, predominantly in teenage boys, and men, that can occur in the absence of identifiable physical al causes. The psychogenic aspects of puberphonia are very little understood and we hereby propose several exploratory directions. On the one hand, we speculate that this may be an individual’s attempt at diminishing a distressing reaction (misophonia) to their deepening voice, and that this may in turn be an indicator of unrecognized GD. Given that voice pitch has also been reported to be higher in autistic males compared to controls, we further propose that AT is likely prevalent among cases of psychogenic puberphonia. Finally, we wish to draw attention to the lack of epidemiological data regarding puberphonia and its potential link to GD, misophonia and AT.