The prevalence of misophonia in a representative population-based survey in Germany

PURPOSE

Misophonia is a new disorder, currently defined as significant emotional and physiological distress when exposed to certain sounds. Although there is a growing body of literature on the characteristics of the disorder, the prevalence in the general population is still relatively unknown. This study therefore aims at determining the prevalence and symptom severity of misophonia in a large and representative general population sample in Germany.

METHODS

To examine the prevalence of misophonic sounds, misophonic reactions and misophonia severity, a cross-sectional population representative survey in Germany has been conducted. Participants (N = 2.522) were questioned retrospectively about misophonic symptoms using the Amsterdam Misophonie Scale - Revised (AMISOS-R).

RESULTS

Overall 33.3% reported to be sensitive to at least one specific misophonic sound. Within the total sample, subthreshold symptoms were reported by 21.3%, mild symptoms were reported by 9.9%, moderate to severe symptoms were reported by 2.1%, and severe to extreme symptoms were reported in 0.1% of participants.

CONCLUSION

Based on the diverging presentations and prevalence rates of misophonic sounds, reactions and symptoms according to the severity, it seems worthwhile to conceptualize misophonia as a rather continuous spectrum disorder (subthreshold, mild, moderate to severe), still taking into account that an additional categorical diagnostic approach might be necessary to derive a diagnosis in clinical practice.

Beyond sound irritation: cross-cultural evidence on the robustness of the five aspects of misophonic experience measured by the S-Five in a Polish sample

Misophonia is commonly associated with negative emotional or physiological responses to specific sounds. However, the consensus definition emphasizes that misophonia entails much more than that. Even in cases of subclinical misophonia, where individuals do not meet the disorder criteria, the experience can still be burdensome, despite not currently causing significant distress or impairment. The S-Five is a psychometric tool for comprehensive assessment of five aspects of misophonic experience: internalizing, externalizing, impact, threat, and outburst, and includes S-Five-T section to evaluate feelings evoked by triggering sounds and their intensity. We examined whether the five-factor structure developed in the UK could be replicated in a Polish sample, including individuals with and without self-identified misophonia. The Polish version of the S-Five was translated and tested on 288 Polish-speaking individuals. Comprehensive psychometric evaluation, including factor structure, measurement invariance, test-retest reliability, internal consistency, and concurrent validity evaluations, was conducted on the translated scale. Exploratory factor analysis suggested similar structure to the original English study, while bootstrap exploratory graph analysis showed the factor structure to be reproducible in other samples. The scale was found to be bias free with respect to gender, internally consistent and stable in time, and evidence of validity was provided using MisoQuest and Misophonia Questionnaire. These results offer support for the cross-cultural stability of the five factors and provide preliminary evidence for the suitability of the Polish version for clinical and research purposes. The study also investigated five facets of misophonia, triggering sounds, emotional responses, and their associations with symptoms of psychopathology across various cultures. It underscores the central role of anger, distress, and panic, while also highlighting the mixed role of irritation and disgust in misophonia across different cultural contexts. Mouth sounds evoked the most pronounced reactions compared to other repetitive sounds, although there were discernible cultural differences in the nature and intensity of reactions to various trigger sounds. These findings hold significant implications for future research and underscore the importance of considering cultural nuances in both research and the clinical management of misophonia.

Preliminary validation of the Norwegian version of the Berlin Misophonia Questionnaire Revised (BMQ-R-NOR)

OBJECTIVE

To perform a psychometric evaluation of a Norwegian version of the Berlin Misophonia Questionnaire Revised (BMQ-R-NOR).

DESIGN

Participants completed online versions of the self-report questionnaire BMQ-R-NOR on two occasions and MQ-NOR on one occasion. Convergent validity was assessed through Spearman's correlation between BMQ-R-NOR and MQ-NOR. Internal consistency was evaluated with McDonald's omega and Cronbach's alpha. Test-retest reliability was evaluated using Cohen's weighted kappa and intraclass correlation.

STUDY SAMPLE

82 participants with self-reported misophonia took part in the study at T1, and 53 of these participated at T2. However, only 41 of them were included in the test-retest analyses due to 12 participants being in treatment between T1 and T2.

RESULTS

Subscales from the BMQ-R-NOR and MQ-NOR were significantly positively correlated, indicating evidence of convergent validity (rs = 0.22*-0.74**). The BMQ-R-NOR showed overall good internal consistency (omega = 0.72-0.93; alpha = 0.70-0.93) and satisfactory test-retest reliability (ICC = 0.35-0.92).

CONCLUSION

The psychometric properties of the BMQ-R-NOR are considered satisfactory. However, it is advised to exercise caution when using it until further comprehensive validation studies are conducted to ensure robustness and reliability in clinical practice.

The effect of misophonia on cognitive and social judgments

Misophonia, a heightened aversion to certain sounds, turns common cognitive and social exercises (e.g., paying attention during a lecture near a pen-clicking classmate, coexisting at the dinner table with a food-chomping relative) into challenging endeavors. How does exposure to triggering sounds impact cognitive and social judgments? We investigated this question in a sample of 65 participants (26 misophonia, 39 control) from the general population. In Phase 1, participants saw faces paired with auditory stimuli while completing a gender judgment task, then reported sound discomfort and identification. In Phase 2, participants saw these same faces with novel ones and reported face likeability and memory. For both oral and non-oral triggers, misophonic participants gave higher discomfort ratings than controls did-especially when identification was correct-and performed slower on the gender judgment. Misophonic participants rated lower likeability than controls did for faces they remembered with high discomfort sounds, and face memory was worse overall for faces originally paired with high discomfort sounds. Altogether, these results suggest that misophonic individuals show impairments on social and cognitive judgments if they must endure discomforting sounds. This experiment helps us better understand the day-to-day impact of misophonia and encourages usage of individualized triggers in future studies.

The mediating role of anxiety in the relationship between misophonia and quality of life: findings from the validated Turkish version of MisoQuest

Introduction

Misophonia is a disorder characterized by decreased tolerance to certain sounds or their associated stimuli, and many measurement tools have been developed for its diagnosis and evaluation. The aims of the current study were to develop the Turkish version of MisoQuest, a fully validated misophonia questionnaire, to evaluate the relationships between misophonia, anxiety, and quality of life, and to examine the mediating role of anxiety in the relationship between misophonia and quality of life.

Methods

The reliability of the Turkish version of MisoQuest was conducted using data from 548 participants (Mean age = 28.06 ± 9.36). Then, the relationships between misophonia, anxiety, and quality of life were evaluated in a separate sample of 117 participants (Mean age = 25.50 ± 6.31) using the State-Trait Anxiety Inventory (STAI) and the Short Form 36 (SF-36) questionnaire.

Results

The results showed that the Turkish version of MisoQuest has good psychometric properties. Close-to-moderate positive correlations were found between misophonia and anxiety, and weak negative correlations were found between misophonia and quality of life. Anxiety mediated the relationships between misophonia and quality of life.

Discussion

These results emphasize that misophonia may be an important problem affecting people's quality of life and reveal the mediating role of anxiety on this effect.

An Automated Online Measure for Misophonia: The Sussex Misophonia Scale for Adults

Misophonia is a sound sensitivity disorder characterized by a strong aversion to specific sounds (e.g., chewing). Here we present the Sussex Misophonia Scale for Adults (SMS-Adult), within an online open-access portal, with automated scoring and results that can be shared ethically with users and professionals. Receiver operator characteristics show our questionnaire to be "excellent" and "good-to-excellent" at classifying misophonia, both when dividing our n = 501 adult participants by recruitment stream (self-declared misophonics vs. general population), and again when dividing them with by a prior measure of misophonia (as misophonics vs. non-misophonics). Factor analyses identified a five-factor structure in our 39 Likert-type items, and these were Feelings/Isolation, Life consequences, Intersocial reactivity, Avoidance/Repulsion, and Pain. Our measure also elicits misophonia triggers, each rated for their commonness in misophonia. We offer our open-access online tool for wider use (www.misophonia-hub.org), embedded within a well-stocked library of resources for misophonics, researchers, and clinicians.

Did Kant suffer from misophonia?

Misophonia is a disorder of decreased tolerance to specific sounds, often produced by humans but not always, which can trigger intense emotional reactions (anger, disgust etc.). This relatively prevalent disorder can cause a reduction in the quality of life. The causes of misophonia are still unclear. In this article, we develop a hypothesis suggesting that misophonia can be caused by a failure in the organization of the perceived world. The perceived world is the result of both the structure of human thought and the many conditioning factors that punctuate human life, particularly social conditioning. It is made up of abstract symbols that map the world and help humans to orient himself in a potentially dangerous environment. In this context, the role of social rules acquired throughout life is considerable. Table manners, for example, are a set of deeply regulated and controlled behaviors (it's considered impolite to eat with the mouth open and to make noise while eating), which contribute to shape the way the perceived world is organized. So it's not surprising to find sounds from the mouth (chewing etc.) among the most common misophonic sound triggers. Politeness can be seen as an act of obedience to moral rules or courtesy, which is a prerequisite for peaceful social relations. Beyond this example, we also argue that any sound can become a misophonic trigger as long as it is not integrated into the perceived ordered and harmonious world, because it is considered an "anomaly," i.e., a disorder, an immorality or a vulgarity.

The unified protocol for transdiagnostic treatment of emotional disorders for misophonia: a pilot trial exploring acceptability and efficacy

Introduction

Misophonia is a recently defined disorder characterized by distressing responses to everyday sounds, such as chewing or sniffling. Individuals with misophonia experience significant functional impairment but have limited options for evidenced-based behavioral treatment. To address this gap in the literature, the current pilot trial explored the acceptability and efficacy of a transdiagnostic cognitive-behavioral approach to treating symptoms of misophonia.

Methods

This trial was conducted in two studies: In Study 1, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was delivered to eight patients in order to receive feedback to guide revisions to the treatment to suit this population. In Study 2, ten patients received the revised UP treatment to explore its acceptability and preliminary efficacy. This study used a single-case experimental design with multiple baselines, randomizing patients to either a 2-week baseline or 4-week baseline prior to the 16 weeks of treatment, followed by four weeks of follow-up.

Results

The findings from these studies suggested that patients found both the original and adapted versions of the UP to be acceptable and taught them skills for how to manage their misophonia symptoms. Importantly, the findings also suggested that the UP can help remediate symptoms of misophonia, particularly the emotional and behavioral responses.

Discussion

These findings provide preliminary evidence that this transdiagnostic treatment for emotional disorders can improve symptoms of misophonia in adults.

Psychometric Evaluation and Misophonic Experience in a Portuguese-Speaking Sample

Misophonia, a disorder characterised by an extreme sensitivity to certain sounds, is increasingly being studied in cross-cultural settings. The S-Five scale is a multidimensional psychometric tool initially developed to measure the severity of misophonia in English-speaking populations. The scale has been validated in several languages, and the present study aimed to validate the European Portuguese S-Five scale in a Portuguese-speaking sample. The scale was translated into Portuguese using a forward-backwards translation method. The psychometric properties of the S-Five scale were evaluated in a sample of 491 Portuguese-speaking adults. Confirmatory factor analysis supported a five-factor structure consistent with previous versions of the S-Five scale. The five factors were as follows: (1) internalising appraisals, (2) externalising appraisals, (3) perceived threat and avoidance behaviour, (4) outbursts, and (5) impact on functioning. The satisfactory psychometric properties of the S-Five scale further indicated its cross-cultural stability. As a psychometrically robust tool, the S-Five can measure misophonia in Portuguese-speaking populations, allowing future studies to explore and compare misophonia in this population.

Targeting beliefs and behaviours in misophonia: a case series from a UK specialist psychology service

BACKGROUND

Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known.

AIMS

This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service.

METHOD

A service evaluation of one-to-one therapy for patients with misophonia (n=19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures t-tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated.

RESULTS

Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change.

CONCLUSIONS

Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.

Misophonia, self-harm and suicidal ideation

Aim

Misophonia is a sound sensitivity disorder characterized by an unusually strong aversion to a specific class of sounds-often human bodily sounds (e.g., chewing). These sounds can cause intense negative emotions which can cause profound difficulties in everyday life. The condition is linked with higher rates of anxiety and depression, and here we ask whether it co-occurs with elevated self-harm and suicidal thinking.

Methods

We measured self-harm and misophonia in the general population by examining a birth cohort sample from the Avon Longitudinal Study of Parents and Children (ALSPAC). We screened them for misophonia as adults, then analyzed their earlier data on well-being, self-harm, and suicidal thinking.

Results

Adults with misophonia had significantly higher rates of self-harm and suicidal ideation, as well as poorer well-being in a number of different measures at ages 16-17 and 23-24 years. Female misophonics were particularly at risk, from as early as their teenage years, though males, too, show elevated self-harm at 24 years compared to nonmisophonic peers.

Conclusion

Our data provide evidence of elevated risks of self-harm associated with misophonia and suggest the need for greater recognition and treatment pathways.

Measuring misophonia in youth: A psychometric evaluation of child and parent measures

BACKGROUND

Misophonia is characterized by intense emotional reactions to specific sounds or visual stimuli and typically onsets during childhood. An obstacle for research and clinical practice is that no comprehensively evaluated measures for pediatric misophonia exist.

METHODS

In a sample of 102 youth meeting the proposed diagnostic criteria of misophonia, we evaluated the child and parent-proxy versions of the self-reported Misophonia Assessment Questionnaire (MAQ; assessing broad aspects of misophonia) and the child version of the Amsterdam Misophonia Scale (A-MISO-S; assessing misophonia severity). Confirmatory and exploratory factor analysis were used to examine factor structures of the measures. Further, child-parent agreement on the MAQ and associations between both measures and misophonia-related impairment, quality of life, and misophonia-related school interference were examined to evaluate aspects of convergent validity.

RESULTS

For both youth- and parent-ratings, four MAQ factors emerged: pessimism, distress, interference, and non-recognition. A-MISO-S showed a unidimensional structure, but the item 'effort to resist' did not load significantly onto the unidimensional factor. Good child-parent agreement on the MAQ scales were found and both MAQ and A-MISO-S were moderately to strongly associated with misophonia-related impairment, quality of life (inverse association), and misophonia-related school interference.

LIMITATIONS

MAQ and A-MISO-S assess sensitivity to auditory but not visual stimuli, the sample size was modest, and repeated assessments were not conducted.

CONCLUSIONS

The combination of MAQ and A-MISO-S shows promise as a multidimensional assessment approach for pediatric misophonia. Future evaluations should include known-groups validity, screening performance, and sensitivity to change in symptom severity.

Session-by-session change in misophonia: a descriptive case study using intensive CBT

There is preliminary evidence that CBT may be helpful for improving symptoms of misophonia, but the key mechanisms of change are not yet known for this disorder of decreased tolerance to everyday sounds. This detailed case study aimed to describe the delivery of intensive, formulation-driven CBT for an individual with misophonia and report on session-by-session outcomes using a multidimensional measurement tool (S-Five). The patient was offered twelve hours of treatment over five sessions, using transdiagnostic and misophonia-specific interventions. Reliable and clinically significant change was found from baseline to one-month follow up. Visual inspection of outcome graphs indicated that change occurred on the "outbursts" and "internalising appraisals" S-Five subscales following assessment, and on the "emotional threat" subscale after first treatment session. The other two subscales started and remained below a clinically significant level. The biggest symptom change appeared to have occurred after second session, which included interventions engaging with trigger sounds. The results demonstrated the individualised nature of misophonia, supporting the use of individually tailored treatment for misophonia and highlighting the importance of using a multidimensional measurement tool.

The New York Misophonia Scale (NYMS): A New Instrument to Identify Misophonia in the General Population

Misophonia is a condition in which certain sounds and behaviors elicit distress that ranges from mild annoyance to disgust or anger. The aim of this research was to develop and validate an instrument to screen for misophonia in the general population. Study 1 developed and explored the factor structure and item quality of the New York Misophonia Scale (NYMS), which originally included 42 triggers and 13 behavioral reactions. A sample of 441 American adults responded to the instrument via social media platforms. Of the original 42 triggers, 25 clustered into 4 factors: repetitive actions, mouth sounds, ambient object sounds, and ambient people sounds. The 13 behavioral reactions loaded on to 2 factors, aggressive and nonaggressive reactions. Study 2 evaluated the psychometric properties of the final version of the NYMS using a sample of 200 American adults. The results supported the validity of the factor structure and the reliability of the final version of the NYMS from Study 1. Finally, Study 3 explored the concurrent and convergent validity of the final version of the NYMS with the Misophonia Questionnaire (MQ) and the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF). A sample of 171 adult participants completed all of the scales. Good concurrent validity was found with the MQ and good convergent validity was found with the DERS-SF. Overall, the NYMS appears to be a useful and promising instrument for assessing misophonia triggers, severity of distress elicited, and behavioral reactions to the distress in the general population.

Misophonia in the UK: Prevalence and norms from the S-Five in a UK representative sample

What is the reality of the misophonic experience in the general population? This is a study on misophonia in a large sample, representative of the UK general population. The study utilises a multidimensional psychometric tool, the S-Five, to study the intensity of the triggering misophonic sounds in everyday activities, the emotions/feelings related to them, and the norms of the key components of the misophonic experience: internalising and externalising appraisals, perceived threat and avoidance behaviours, outbursts, and the impact on functioning. Based on the S-Five scores and a semi-structured interview delivered by clinicians who specialise in misophonia, the estimated prevalence of people for whom symptoms of misophonia cause a significant burden in their life in the UK was estimated to be 18%. The psychometric properties of the S-Five in the UK general population were also evaluated and differences across gender and age were explored. Our results show that the five-factor structure is reproduced, and that the S-Five is a reliable and valid scale for the measurement of the severity of the misophonic experience in the general UK population.

A nomological network for misophonia in two German samples using the S-Five model for misophonia

The Selective Sound Sensitivity Syndrome Scale (S-Five) is a contemporary and multidimensional self-report instrument measuring different aspects of misophonia. The five-factor scale consists of 25 items measuring the severity of the misophonic experience. The items capture misophonia in relation to internalising and externalising appraisals, perceived threat, aggressive behavior (outbursts), and adverse impact on individuals' lives. It is complemented by a trigger checklist (S-Five-T), measuring the emotional nature and intensity of reactions to sensory triggers. In this work, we administered the S-Five in two German samples with a majority of individuals with significant misophonia. The S-Five and the supplementary S-Five-T were both translated into German using a rigorous translation procedure (i.e., TRAPD) and were separately tested in large German community samples. Psychometric analyses included the evaluation of the factor structure, measurement invariance with respect to age and gender, reliability (internal consistency and stability over time), and an extensive examination of the construct validity in a proposed nomological network. The nomological network we explore in this work consists of several constructs including different misophonic manifestations, anger and aggression, disgust propensity, anxiety sensitivity, depression, obsessive-compulsive traits, and functional impairment in different life domains. Results indicate evidence in line with the nomological network as demonstrated by strong correlations between the S-Five dimensions and convergent measures. All S-Five dimensions strongly correlated with overall misophonic symptoms (r ≥ 0.53). Internalising appraisals were highly associated with insight into excessive or disproportionate reactions to sounds (r ≥ 0.59), externalising appraisals with anger and irritability (r ≥ 0.46), threat with trait anxiety and dysregulation facets (r ≥ 0.62), aggressive behavior (outbursts) with anger and behavioral dysregulation (r ≥ 0.70), and impact with distress and functional impairment (r ≥ 0.64). The results demonstrate that the S-Five has a robust five-factor structure and allows to draw reliable and valid conclusions about misophonic experiences in German samples. The proposed nomological network gives an initial insight into the nature of misophonia and provides a formalized fundament to develop and test further hypotheses about misophonia in a more sophisticated and symptom-oriented way.

Phenotyping misophonia: Psychiatric disorders and medical health correlates

Misophonia is characterized by decreased tolerance to specific sounds and associated stimuli that causes significant psychological distress and impairment in daily functioning (Swedo et al., 2022). Aversive stimuli (often called “triggers”) are commonly repetitive facial (e.g., nose whistling, sniffling, and throat clearing) or oral (e.g., eating, drinking, and mouth breathing) sounds produced by other humans. Few empirical studies examining the nature and features of misophonia have used clinician-rated structured diagnostic interviews, and none have examined the relationship between misophonia and psychiatric disorders in the Diagnostic and Statistical Manual-5th version (DSM-5; American Psychiatric Association, 2013). In addition, little is known about whether there are any medical health problems associated with misophonia. Accordingly, the purpose of the present study was to improve the phenotypic characterization of misophonia by investigating the psychiatric and medical health correlates of this newly defined disorder. Structured diagnostic interviews were used to assess rates of lifetime and current DSM-5 psychiatric disorders in a community sample of 207 adults. The three most commonly diagnosed current psychiatric disorders were: (1) social anxiety disorder, (2) generalized anxiety disorder, and (3) specific phobia. The three most common lifetime psychiatric disorders were major depressive disorder, social anxiety disorder, and generalized anxiety disorder. A series of multiple regression analyses indicated that, among psychiatric disorders that were correlated with misophonia, those that remained significant predictors of misophonia severity after controlling for age and sex were borderline personality disorder, obsessive compulsive disorder, and panic disorder. No medical health problems were significantly positively correlated with misophonia severity.

Auditory affective processing, musicality, and the development of misophonic reactions

Misophonia can be characterized both as a condition and as a negative affective experience. Misophonia is described as feeling irritation or disgust in response to hearing certain sounds, such as eating, drinking, gulping, and breathing. Although the earliest misophonic experiences are often described as occurring during childhood, relatively little is known about the developmental pathways that lead to individual variation in these experiences. This literature review discusses evidence of misophonic reactions during childhood and explores the possibility that early heightened sensitivities to both positive and negative sounds, such as to music, might indicate a vulnerability for misophonia and misophonic reactions. We will review when misophonia may develop, how it is distinguished from other auditory conditions (e.g., hyperacusis, phonophobia, or tinnitus), and how it relates to developmental disorders (e.g., autism spectrum disorder or Williams syndrome). Finally, we explore the possibility that children with heightened musicality could be more likely to experience misophonic reactions and develop misophonia.

Evidence of Cross-Cultural Consistency of the S-Five Model for Misophonia: Psychometric Conclusions Emerging From the Mandarin Version

Misophonia is a disorder generally characterised by a decreased tolerance to everyday sounds. Although research is increasing in misophonia, a cross-cultural validation of a psychometric tool for measuring misophonia has not been evaluated. This study investigated the validity of the S-Five multidimensional model of the misophonic experience in a sample of Chinese participants. The S-Five was translated in a forward-backward method to Mandarin to establish a satisfactory translation. The translation was also independently back translated to English, with no significant differences when compared to the original S-Five. Through exploratory factor analysis, using responses from 256 Chinese individuals, the five dimensions (internalising appraisals, externalising appraisals, perceived threat and avoidance behaviour, outbursts, and impact on functioning) were replicated, indicating the cross-cultural uniformity of the experience of misophonia as captured by the S-Five. That is, current results point to the stability of the manifestation of misophonia across cultures, seen here for the first time in the literature. By design, the S-Five items were developed to reflect sound sensitivities in a manner that is not specific or matching to individuals of a certain age, gender, ethnicity, nationality, socio-economic status, and educational level. Testimonial to this fact is not only the replication of the five factors, but also the replication of the evidence towards satisfactory psychometric properties (reliability and validity) of the scale. Based on the results of this study, the S-Five is a psychometrically robust tool to be used within the Chinese population.

Psychometric validation of a brief self-report measure of misophonia symptoms and functional impairment: The duke-vanderbilt misophonia screening questionnaire

Misophonia is a newly described disorder of sound tolerance characterized by strong negative emotional reactions to specific "trigger" sounds, resulting in significant distress, pathological avoidance, and impairment in daily life. Research on misophonia is still in its infancy, and most existing psychometric tools for assessing misophonia symptoms have not been extensively validated. The purpose of the current study was to introduce and psychometrically validate the duke-vanderbilt Misophonia Screening Questionnaire (DVMSQ), a novel self-report measure of misophonia symptoms that can be used to determine misophonia "caseness" in clinical and research settings. Employing large online samples of general population adults (n = 1403) and adults on the autism spectrum (n = 936), we rigorously evaluated the internal structure, reliability, validity, and measurement invariance of the DVMSQ. Results indicated that 17 of the 20 original DVMSQ items fit well to a bifactor structure with one "general misophonia" factor and four specific factors (anger/aggression, distress/avoidance, impairment, and global impact). DVMSQ total and subscale scores were highly reliable in both general population and autistic adult samples, and the measure was found to be approximately invariant across age, sex, education level, and autism status. DVMSQ total scores also correlated strongly with another measure of misophonia symptoms (Duke Misophonia Questionnaire-Symptom Scale), with correlations between these two measures being significantly stronger than correlations between the DVMSQ and scales measuring other types of sound intolerance (Inventory of Hyperacusis Symptoms [General Loudness subscale] and DSM-5 Severity Measure for Specific Phobia [modified for phonophobia]). Additionally, DVMSQ items were used to operationalize diagnostic criteria for misophonia derived from the Revised Amsterdam Criteria, which were further updated to reflect a recent consensus definition of misophonia (published after the development of the DVMSQ). Using the new DVMSQ algorithm, 7.3% of general population adults and 35.5% of autistic adults met criteria for clinically significant misophonia. Although additional work is needed to further investigate the psychometric properties of the DVMSQ and validate its theory-based screening algorithm using best-estimate clinical diagnoses, this novel measure represents a potentially useful tool to screen for misophonia and quantify symptom severity and impairment in both autistic adults and the general population.

Emotion Processes Predicting Outbursts and Functional Impact in Misophonia

Misophonia involves a decreased tolerance to certain sounds and is associated with a range of emotions and emotion processes. In addition to the distress caused by misophonia, some individuals report having aggressive outbursts and significant impact on doing things they would like to be able to do. This study aimed to examine whether misophonia-specific cognitive and emotional processes were associated with misophonic outbursts and impact, and whether these relationships could be explained in part by emotion processes not specific to misophonia. A sample of 703 individuals, 315 of whom identified with having misophonia, completed measures of misophonia, depression and anxiety symptoms, anxiety and disgust sensitivity, interoception and beliefs about emotions. Exploratory correlation and regression analyses were used to build mediation models, which were tested using multiple linear regression. Externalising appraisals (blaming others for causing one’s reaction to sounds) were positively associated with misophonic outbursts, and this relationship was partially explained by anxiety symptoms and disgust sensitivity. Sense of emotional threat in misophonia predicted functional impact of misophonia, and this was partially explained by depression symptoms and negative beliefs about emotions. Anxiety sensitivity and interoception were not significant independent predictors of misophonic outbursts or functional impact. These results provide support for the relevance of emotion processes in misophonia and highlight the importance of using multi-dimensional measures of misophonia to improve our understanding of the condition.

The Relationship Between Self-Reported Misophonia Symptoms and Auditory Aversive Generalization Leaning: A Preliminary Report

Misophonia is characterized by excessive aversive reactions to specific "trigger" sounds. Although this disorder is increasingly recognized in the literature, its etiological mechanisms and maintaining factors are currently unclear. Several etiological models propose a role of Pavlovian conditioning, an associative learning process heavily researched in similar fear and anxiety-related disorders. In addition, generalization of learned associations has been noted as a potential causal or contributory factor. Building upon this framework, we hypothesized that Misophonia symptoms arise as a consequence of overgeneralized associative learning, in which aversive responses to a noxious event also occur in response to similar events. Alternatively, heightened discrimination between conditioned threat and safety cues may be present in participants high in Misophonia symptoms, as predicted by associative learning models of Misophonia. This preliminary report (n = 34) examines auditory generalization learning using self-reported behavioral (i.e., valence and arousal ratings) and EEG alpha power reduction. Participants listened to three sine tones differing in pitch, with one pitch (i.e., CS+) paired with an aversive loud white noise blast, prompting aversive Pavlovian generalization learning. We assessed the extent to which overgeneralization versus heightened discrimination learning is associated with self-reported Misophonia symptoms, by comparing aversive responses to the CS+ and other tones similar in pitch. Behaviorally, all participants learned the contingencies between CS+ and noxious noise, with individuals endorsing elevated Misophonia showing heightened aversive sensitivity to all stimuli, regardless of conditioning and independent of hyperacusis status. Across participants, parieto-occipital EEG alpha-band power reduction was most pronounced in response to the CS+ tone, and this difference was greater in those with self-reported Misophonia symptoms. The current preliminary findings do not support the notion that overgeneralization is a feature of self-reported emotional experience in Misophonia, but that heightened sensitivity and discrimination learning may be present at the neural level.

The Berlin Misophonia Questionnaire Revised (BMQ-R): Development and validation of a symptom-oriented diagnostical instrument for the measurement of misophonia

Misophonia is a clinical syndrome which is characterized by intense emotional and physical reactions to idiosyncratic sounds. However, its psychometric measurement is still in the early stages. This study describes the optimization of a self-report instrument, the Berlin Misophonia Questionnaire (BMQ), and addresses its strengths in comparison to existing psychometric measures. This new measure integrates contemporary empirical findings and is based on the latest criteria of misophonia. A cross-sectional online study was conducted using data of 952 affected as well as non-affected individuals. The final BMQ-R consists of 77 items in 21 scales, which were selected using a probabilistic item selection algorithm (Ant Colony Optimization). The results of confirmatory factor analyses, the assessment of reliability, and an extensive construct validation procedure supported the reliability and validity of the developed scales. One outstanding strength of the BMQ-R is its comprehensive measurement of misophonic emotional and physical responses. The instrument further allows for distinguishing between behavioral, cognitive, and emotional dysregulation; the measurement of clinical insight and significance; as well as discerning reactive and anticipating avoidance strategies. Our work offers several improvements to the measurement of misophonia by providing a reliable and valid multidimensional diagnostical instrument. In line with the scientific consensus on defining misophonia, the BMQ-R allows to formally recognize individuals with misophonia and so to compare findings of future studies. Undoubtedly, this measure fills a research gap, which we hope will facilitate the investigation of causes and treatment of misophonia.

Poorer Well-Being in Children With Misophonia: Evidence From the Sussex Misophonia Scale for Adolescents

Objective

Misophonia is an unusually strong aversion to a specific class of sounds - most often human bodily sounds such as chewing, crunching, or breathing. A number of studies have emerged in the last 10 years examining misophonia in adults, but little is known about the impact of the condition in children. Here we set out to investigate the well-being profile of children with misophonia, while also presenting the first validated misophonia questionnaire for children.

Materials and Methods

We screened 142 children (10-14 years; Mean 11.72 SD 1.12; 65 female, 77 male) using our novel diagnostic [the Sussex Misophonia Scale for Adolescents (SMS-Adolescent)]. This allowed us to identify a group of children already manifesting misophonia at that age - the first population-sampled cohort of child misophonics examined to date. Children and their parents also completed measures of well-being (for convergent validation of our SMS-Adolescent) and creative self-construct (for discriminant validation).

Results

Data show that children with misophonia have significantly elevated levels of anxiety and obsessive compulsive traits. Additionally children with misophonia have significantly poorer life-satisfaction, and health-related quality of life. As predicted, they show no differences in creative self-construct.

Conclusion

Together our data suggest the first evidence in population sampling of poorer life outcomes for children with misophonia, and provide preliminary convergent and discriminant validation for our novel misophonia instrument. Our data suggest a need for greater recognition and therapeutic outlets for adolescents with misophonia.

MDMA for the treatment of misophonia, a proposal

Misophonia is a disorder characterized by negative physical and emotional reactions to certain trigger sounds, such as chewing food. Up to 50% of population samples endorse some symptoms of misophonia, with about 20% having symptoms that impair normal life functioning. Most misophonia patients exhibit intense negative emotions and autonomic arousal (the fight-flight-freeze response) in response to a trigger, similarly to how someone with post-traumatic stress disorder (PTSD) might respond to a trauma trigger. Curiously, misophonia trigger sounds are often most distressing when coming from a specific person, suggesting the disorder may be responsive to interpersonal relationship factors. Treatment of misophonia is currently limited to the use of hearing modifications (e.g., earplugs or headphones) and psychotherapy, but many patients continue to suffer despite these best efforts. Phase 3 clinical trials suggest that MDMA is efficacious at treating the symptoms of autonomic arousal, negative emotions, and interpersonal suffering found in PTSD. As such, we propose that MDMA may represent an ideal treatment for some suffering from severe misophonia. In this perspective article, we review the symptoms of misophonia, and outline how MDMA may be uniquely suited for treating it, perhaps using a protocol analogous to the MAPS Phase 3 studies for PTSD.