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Misophonia is a common condition that causes significant distress and impairment for patients and families. Despite the growing body of literature, most treatment descriptions do not incorporate objective assessment measures or detail techniques to involve family members in addressing misophonia. This case report provides a step-by-step family-based cognitive-behavioral approach to treat youth with misophonia, uses objective rating scales to monitor therapeutic improvement, and elicits feedback on the therapeutic skills used between therapy sessions. It also provides guidance on implementing inhibitory learning exposures for youth with misophonia.

IntroductionMisophonia is a recently defined disorder in which certain aversive repetitive sounds and associated stimuli elicit distressing and impairing affective, behavioral, and physiological responses. The responses in misophonia may be stronger when the sound is produced by close friends and family, suggesting that the context in which a triggering cue occurs may have an important role in misophonia. As such, the goal of this study was to test experimentally whether the context of the sound source influences affective and psychophysiological responses to triggering stimuli in misophonia.MethodsSixty one adults with misophonia and 45 controls listened to audio recordings (8 s) of human eating, animals eating, and human mouth smacking sounds (without eating). After a break, the same audio recordings were presented embedded within videos of human eating (congruent stimuli), animals eating (congruent stimuli), and, in the mouth smacking condition, with visually incongruent stimuli (hands playing in mud or in a bowl with a watery dough). Psychophysiological responses—skin conductance response (SCR) and heart rate (HR), and self-reported affective responses (valence, arousal, dominance) were gathered during the experiment in a laboratory.ResultsParticipants with misophonia assessed all the stimuli as more negative and arousing than the controls, and reported feeling less dominant with respect to the sounds. Animal and mouth smacking sounds were assessed by all the participants as less negative and arousing than human eating sounds, but only in the audio-video conditions. SCR data partially confirmed increased psychophysiological arousal in misophonia participants during an exposure to mouth sounds, but did not reflect the self-report changes in response to different contexts. Misophonia participants had deeper deceleration of HR than controls during human eating sound with congruent video stimuli, while there was no group difference during human mouth smacking with incongruent video stimuli.ConclusionResults suggest that the context of mouth sounds influences affective experiences in adults with misophonia, but also in participants without misophonia. Presentation of animal eating sounds with congruent visual stimuli, or human mouth smacking sounds with incongruent stimuli, decreased self-report reaction to common misophonic triggers.

This case report presents five patients suffering from recurrent chronic urological inflammatory diseases and adverse sound sensitivity. Unifying psychological feature of all presented patients is their intolerance of usual bodily sounds produced by partners and other people, called “misophonia”, which makes long-term relationships impossible. In our sample, despite psychiatric care, misophonic symptoms have not ceased completely. Patients continued to practice partner avoidance, with frequent changes of sexual partners or long-term abstinence. Consequently, frequently unprotected sexual contacts caused new sexually transmitted diseases, combined with recurrences of chronic prostatitis/ cystitis, while abstinence led to chronic nonbacterial (congestive) prostatitis. It looks like misophonia complicates the ability to maintain long-term sexual relationships that might influence urological status in sufferers. Better understanding of misophonia, its coping mechanisms and the hypothetical indirect contribution of misophonia-related behaviour to urological pathology could be possible only after future multidisciplinary investigations with larger statistically significant number of enrolled patients.

This project examines whether misophonia and autonomous sensory meridian response (ASMR) are due to the same underlying mechanism (i.e., enhanced sensory sensitivity); whether the two phenomenon may be explained by individual differences in musicality and sensitivity to sensory processing; and whether the two phenomenon are more likely to be experienced by autistic individuals compared to non-autistic individuals.

Misophonia involves a strong emotional response to certain sounds and can cause significant distress and functional impairment. The aim of this study was to present and psychometrically evaluate a new, multidimensional measure of misophonia, the S-Five. The study also aimed to present and test a supplementary tool, a checklist of triggers that measure the nature and intensity of reactions. The stages of development for the measure are described. Psychometric testing on the final version of the tool was conducted using a sample of 828 individuals who identified with having misophonia. Analyses included factor structure assessment, measurement invariance testing, reliability (test–retest and internal consistency), and (concurrent) convergent validity assessment. Five factors emerged in the S-Five as dimensions of the experience of misophonia: internalising appraisals, externalising appraisals, sense of emotional threat, outbursts, and impact. No measurement bias was identified with respect to gender and age. All reliability and validity indices were satisfactory. The S-Five is a multidimensional measurement scale with satisfactory psychometric properties and will be a valuable tool for improving understanding of misophonia in research and clinical settings.

Purpose: Misophonia is a condition in which individuals experience negative reactions, including anger and disgust, to specific sounds in their environment. Individuals with misophonia often report feelings of anxiety and a reduced quality of life. While there is no cure for misophonia, there are management protocols supported by case studies in the literature, including tinnitus retraining therapy (TRT) and Misophonia Management Protocol (MMP), along with coping strategies. The purpose of this case study is to contribute to the field of clinical research on patients with misophonia. Method: Case studies involving misophonia are limited, and further research in this area is needed to provide evidence-based treatment. This case details misophonia questionnaires and assessment, case formulation, and management of misophonia in an 11-year-old girl, using a variation of both the TRT and MMP, including ear-level sound generators and coping strategies. Conclusions: This case serves as a contribution to the evidence base for the use of sound therapy and coping strategies in the treatment and management of misophonia, as well as tools that are available in diagnosing misophonia. Clinical implications reveal sound therapy and coping strategies as a means to manage misophonia symptoms. Further research is needed for large-scale data to be available.

Stimulating the Vagus nerve helps maintain the autonomic tone, indicating stabilising any hyperactivity in the nervous system. The vagus nerve stimulation is applied in individuals with seizures, depression, sepsis, pain, obesity, cardiovascular disease, lung disease, diabetes, stroke, and traumatic brain injury. Auditory neuroscience has been widely applied in individuals with tinnitus and has been demonstrated as a successful neuromodulation technique. Individuals with peripheral lesions of the hair cells induce a maladaptive change in the plasticity resulting in hyperactivity in the auditory and non-auditory structures. In order to reduce this hyperactivity, neuromodulation techniques such as; transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, transcranial random noise stimulation, neurofeedback, epidural and subdural cortical and deep brain stimulation. The vagus nerve stimulation is also one form of neuromodulation technique considered to reduce the symptoms of tinnitus. It is believed that the ramus Auricularis Nervi vagi, an afferent sensory branch of the vagus nerve, innervates the afferent sensory branch of the vagus nerve, the ramus auricularis nervi vagi also innervate the outer ear canal and parts of the auricle. This auricular branch of the vagus nerve also called Arnold's nerve, which gives a projection to the nucleus of the solitary tract. The vagus nerve stimulation in individuals with tinnitus works to activate the auricular branch of the vagus nerve to reduce its symptoms. A similar principle of vagus nerve stimulation can be tried upon in individuals with misophonia. Literatures states that individuals with misophonia have hyperactivity in their non-classical auditory pathway that can be suppressed with the help of vagus nerve stimulation. The article discusses the possible effects of vagus nerve stimulation in individuals with misophonia.

Acceptance and commitment therapy (ACT) is a promising psychotherapy for supporting traditional behavioral methods for treating misophonia, but has not been previously tested. ACT teaches skills to develop acceptance, mindfulness, and defusion from difficult internal experiences while increasing connections with personal values and encouraging meaningful behavioral changes. We are proposing to test ACT+ traditional audiological behavioral intervention as an integrated, multi-disciplinary approach for the assessment and treatment of misophonia. Participants will be 40 adults with misophonia and will be randomly assigned to receive 12 sessions of ACT+behavioral intervention or receive 12 weeks of progressive relaxation training+psychoeducation (PRT; a commonly used active control condition) after undergoing a comprehensive psychological and audiological evaluation. This study will help determine if ACT+behavioral intervention is a feasible and acceptable treatment for misophonia, help clarify active psychological mechanisms of misophonia, and determine whether or not this combination of services can effectively help individuals diagnosed with misophonia.

Aim: Research show that misophonia accompanies many psychiatric disorders and should be considered a mental disorder. Although there are suggested diagnostic criteria, no clear ones have been defined yet. This study aims to investigate the relationship of misophonia with other mental disorders and to determine its possible category in diagnostic classification systems. Material and Methods: We included the patients who applied to the outpatient clinics of the XX University Faculty of Medicine, Department of Psychiatry for the first time and healthy volunteers without a history of psychiatric disorder. A sociodemographic data form, Misophonia Interview Scale, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Barratt Impulsivity Scale (BIS), and Yale-Brown Obsession Compulsion Rating Scale (YBOCS) were administered to the participants. Results: 60.1% of the participants (n=158) did not have misophonia, 21.3% (n=56) had disorder-level misophonia, and 18.6% (n=49) had symptom-level misophonia. Except for the YBOCS-total and obsession/compulsion scale scores of the group with misophonia, all other mean scale scores were significantly higher than those without misophonia (p

Although misophonia is not yet included in the primary diagnostic manuals used by psychologists or psychiatrists, proposed criteria suggest that this condition is characterized by a strong negative reaction to and avoidance of certain trigger sounds. Misophonic trigger sounds are largely human-made (e.g., chewing and slurping) and evoke responses such as disgust, irritation, and/or anger that are out of proportion to the situation and cause distress and/or impairment. Currently, there is no gold standard evidence-based treatment for misophonia. As the misophonia treatment literature grows, several important questions are arising: (1) should exposure to aversive sound triggers be included in treatment for misophonia and (2) how can clinicians best assess misophonia symptoms. This case offers one example of misophonia being successfully treated with a cognitive-behavioral approach to treatment (including exposures) in an adolescent girl. This case also offers an example of how clinicians may conduct a comprehensive assessment of misophonia symptoms. Theoretically and empirically derived recommendations for including exposure in misophonia treatment are presented. Information from this case may be helpful in informing future research, as there is a paucity of evidence-based assessment and treatment protocols for misophonia.

Background Misophonia is a condition marked by dysregulated emotions and behaviors in response to trigger sounds, often chewing, breathing, or coughing. Evidence suggests that misophonia develops in adolescence and the emotions and behaviors are a conditioned response to distress, resulting in social avoidance, stress, and family conflict. In addition, co-occurrence with other psychiatric illnesses such as anxiety, OCD, and Tourette syndrome is common. A transdiagnostic cognitive behavioral therapeutic (CBT) approach appears appropriate. There are currently no controlled studies of youth with misophonia. The current paper describes the approach to a pilot randomized, blinded family-based treatment study for youth ages 8-16 years. Preliminary results from a pilot open trial also are described. Methods A 2-phase dual site telehealth treatment study using a transdiagnostic CBT approach, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May et al., 2018), is proposed. Phase 1 consisted of a 4-case pilot of UP-C/A. Phase 2 includes a randomized trial comparing the UP-C/A to a standard relaxation and education protocol. Results Preliminary results from the pilot show modest improvements in evaluator-rated misophonia symptoms on the Clinical Global Impression Severity and Improvement scales. Limitations There is little research to inform evidence-based practice for youth with misophonia. Study limitations include lack of standardized misophonia assessment instruments and an absence of formal diagnostic criteria. Conclusions The current paper describes proposed methods for the first randomized controlled trial for youth with misophonia and their families along with results from a 4-case pilot.

Misophonia, a condition involving hypersensitivity, anger, and/or disgust in response to specific noises (e.g., chewing, tapping), is highly underresearched in children. Several case studies point towards the utility of cognitive behavioral therapy and related treatments (e.g., acceptance and commitment therapy [ACT]). ACT presents a particularly promising option, as it focuses on building psychological flexibility in response to difficult internal experiences, rather than trying to remove or change them (e.g., responding effectively to irritation provoked by chewing). The present case study describes “Kelly” (pseudonym), a 12-year-old girl with moderately severe misophonia symptoms, who received a 16-session course of ACT for misophonia. At post-treatment, Kelly reported a decline to the mild range of misophonia, as well as re-engagement in activities that were important to her and clinically significant reductions in depressive symptoms. These results suggest that ACT may be an appropriate treatment for children with misophonia; however, much more research is warranted.

Misophonia is an affective sensory processing disorder characterized by intense negative emotions in response to particular sounds; these responses are recognised by sufferers to feel unreasonably excessive [1,2]. Triggers tend to be idiosyncratic but are often human-made noises that originate in the mouth (lip-smacking, crunching, chewing, breathing). They can also include repetitive noises (e.g., clicking, tapping) and sometimes include sounds made by animals or inanimate objects (e.g., clocks, fans etc.). While most people perceive such triggers as moderately irritating or might even fail to notice them, the emotional reactions experienced by misophonics include anger, disgust, panic, and the feeling of being trapped [3, 4]. Co-occurring physical reactions – for example as measured by increased skin conductance [5] - have been likened to a ‘flight or fight’ response. Although little is known about its epidemiology, misophonia is thought to be relatively common. Wu et al. [6] found that 20% of a predominantly female undergraduate sample reported clinically significant misophonia. The condition also seems to present in other family members, with one study finding that 55% of their sample had misophonic family members [5] and another detailing a family in which 15 out of 34 members were affected by the condition across three generations [7]. Misophonia is often comorbid with other clinical disorders and symptoms such as generalised anxiety [6], and obsessive compulsive personality traits [3,8,9]. These profiling studies represent important first steps but what is lacking is a mechanistic understanding of how and why these features co-occur. Similarly, there is little understanding of how misophonia might arise out of individual differences in affective (i.e. emotional) processing or in sensory and attentional processing [36]. The few neuroscientific studies conducted to date suggest that both are likely to be important with a diminished EEG signature for early auditory change detection in misophonics [10] and differences in functional connectivity amongst regions of the brain involved in computing emotional salience [11]. Misophonia can be regarded as a heightened form of sensory sensitivity. As such it belongs, at least superficially, to a family of potentially related conditions that share this trait including hyperacusis, autism, migraine, synaesthesia (e.g. sounds evoking colours), amongst others [12]. All of these conditions are accompanied by heightened levels of discomfort to certain sensory stimuli. Whether there are any deeper similarities – in terms of underlying mechanisms – remains to be established. But the advantage of exploring this line of enquiry is that there are already substantial research efforts into all of these domains, with research into misophonia somewhat ‘behind the curve’. As such, we can leverage ideas and methods that have been applied in these other domains. The most obvious difference between misophonia and these other conditions is that misophonia is defined by atypical responsiveness to sounds in particular, whereas other conditions are defined by a broader sensitivity profile. Our testable hypothesis is that misophonic triggers (typically limited to a small set of auditory stimuli) may be the ‘tip-of-the-iceberg’ below which lies a pattern of less extreme (but nonetheless heightened) sensory sensitivities to a wider range of stimuli including to senses other than hearing. There is some preliminary evidence consistent with this in misophonia [6], and we will use additional scales that have been validated in conditions such as autism. Our proposal here is that broad sensory sensitivities may act as a type of ‘start-up kit’ from which misophonia later emerges. Hence, broad low-level sensory sensitivities may conspire with other traits (e.g., anxiety) as a catalyst towards the emergence of the more specific auditory sensitivities of misophonia (e.g., chewing). Given this hypothesis, we will examine more closely the sensory, attentional and cognitive profiles of misophonics. We will be careful to assess characteristics of misophonia that distinguish it from hyperacusis including the nature of the trigger (e.g. sound type, loudness) and response (e.g. emotion, pain) [14]. AIMS & HYPOTHESES The first three hypotheses are more confirmatory in nature (motivated by prior research) and the last three take a more exploratory and data-driven approach: 1) People with misophonia will have increased clinical traits in the domain of anxiety (measured by Anxiety Sensitivity Index (ASI-3) [45]), autism spectrum traits (measured by the Autism Quotient (AQ) [18]), obsessive-compulsive tendencies (measured by the Obsessive-Compulsive Inventory (OCI) [21]), and increased headache/migraine (measured by the Penn Online Evaluation of Migraine (POEM) [37]). 2) People with misophonia will have heightened sensory sensitivity outside of their set of particular misophonic triggers as measured by the Glasgow Sensory Questionnaire (GSQ) [17] and visual pattern glare test (where mid spatial frequency gratings elicit discomfort and visual distortions) [48, 49]. 3) Interoceptive sensibility can be regarded as a particular form of (embodied) sensory sensitivity and we expect misophonics to have higher scores than control participants on MAIA [22] subscales of Noticing, Emotional Awareness, and Body Listening. Given evidence of heightened emotional salience/reactivity in misophonia coupled with increased interoceptive awareness [11], we also expect that individuals with misophonia will score lower on the subscales of MAIA that measure regulation of internal states, such as Not-Distracting, Not-Worrying, Attention-Regulation, Self-Regulation, and Trusting, relative to controls. 4) To determine whether misophonia has different subtypes as indicated by cluster analysis of the five factors of the Sussex Misophonia Scale [46] and, if so, whether these subtypes are linked to a different profile on the clinical measures and sensory sensitivity measures that are linked to misophonia more generally (see the measures above). 5) To create a symptom network profile of misophonia that incorporates the relationship between different symptoms of their misophonia and co-occurring clinically-relevant traits. 6) To determine which sounds (e.g. apple crunching, tapping) and which responses to sounds (e.g. annoyance, pain) discriminate people with misophonia from those who lack it. REFERENCES [1] P. J. Jastreboff and M. M. Jastreboff, “Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia),” Semin. Hear., vol. 35, no. 2, pp. 105–120, 2014. [2] M. M. . J. P. J. Jastreboff, “Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia.,” ITHS Newsl., no. July, pp. 1–5, 2001. [3] A. Schroeder, N. Vulink, and D. Denys, “Misophonia: Diagnostic Criteria for a New Psychiatric Disorder,” PLoS One, vol. 8, no. 1, 2013. [4] R. Rouw and M. Erfanian, “A Large-Scale Study of Misophonia,” J. Clin. Psychol., vol. 74, no. 3, pp. 453–479, 2018. [5] M. Edelstein, D. Brang, R. Rouw, and V. S. Ramachandran, “Misophonia: physiological investigations and case descriptions,” Front. Hum. Neurosci., vol. 7, no. June, pp. 1–11, 2013. [6] M. S. Wu, A. B. Lewin, T. K. Murphy, and E. A. Storch, “Misophonia: Incidence, phenomenology, and clinical correlates in an undergraduate student sample,” J. Clin. Psychol., vol. 70, no. 10, pp. 994–1007, 2014. [7] T. G. Sanchez and F. E. da Silva, “Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?,” Braz. J. Otorhinolaryngol., vol. 84, no. 5, pp. 553–559, 2018. [8] A. E. Cavanna and S. Seri, “Misophonia: Current perspectives,” Neuropsychiatr. Dis. Treat., vol. 11, pp. 2117–2123, 2015. [9] L. J. Miller et al., “Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda,” Front. Neurosci., vol. 12, no. February, 2018. [10] A. Schroeder et al., “Diminished N1 Auditory Evoked Potentials to Oddball Stimuli in Misophonia Patients,” Front. Behav. Neurosci., vol. 8, no. April, pp. 1–6, 2014. [11] S. Kumar et al., “The Brain Basis for Misophonia,” Curr. Biol., vol. 27, no. 4, pp. 527–533, 2017. [12] J. Ward, “Individual differences in sensory sensitivity: A synthesizing framework and evidence from normal variation and developmental conditions,” Cogn. Neurosci., vol. 00, no. 00, pp. 1–19, 2019. [14] D. M. 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Most people in the current situation may suffer from misophonia but are unable to identify it because they are unaware of the condition. Misophonia is a condition in which certain sounds can cause an outburst of irritation, anger, or aggression. In this context, the current study sought to assess and confirm the presence of misophonia in people of various occupations. The study included 30 participants ranging in age from 23 to 54 years. All participants were given a developed Misophonia Assessment Questionnaire in Telugu, and the data was analyzed using SPSS 20 and qualitative analysis was performed to check other aspects such as condition and associated problems. According to the findings, homemakers (17%), ASLP (13%), students (13%), teachers (13%), special educators (10%), conductors (10%), correspondents (10%), musicians (7%), and AWT (7%) all participated. Participants reported misophonia in the following situations: stress (30%), shouting (27%), group (23%), dialysis (10%), tiredness (7%), and television (3%). Out of all the participants 47% fall under Subclinical i.e normal, 23% Moderate, 20% Mild and 10% are Severe. ANOVA followed by post hoc reveals that no significant difference found between occupation except for student and correspondent and ASLP and correspondent in age condition where as other factors such as gender and condition showed no significant difference. According to the current study findings, nearly 53% of participants reported mild to severe misophonia based on the misophonia assessment questionnaire, and it was also discovered that stress levels are higher when compared to others. Finally, the authors stated that misophonia may be a part of daily life where most of the people will be addressed and ignored, it must be assessed and treated appropriately before it has an impact on quality of life.

Openly-available data from DVMSQ validation study, collected from Prolific Academic.

Misophonia is a condition of abnormal emotional responses to specific auditory stimuli. There is limited information available on the prevalence of this condition. This study aimed to estimate the prevalence of misophonia in an undergraduate medical student population at the University of Nottingham. A secondary aim of this study was to assess the psychometric validity of the Amsterdam Misophonia Scale (A-Miso-S) questionnaire tool in this population. The A-Miso-S was administered online to medical students at the University of Nottingham. To assess the validity of the A-Miso-S, a factor analysis was conducted. To determine prevalence and severity the results of the questionnaire were quantitatively analysed using SPSS. Actor analysis was conducted. Free text responses to one questionnaire item were analysed using a thematic approach. Responses were obtained from 336 individuals. Clinically significant misophonic symptoms appear to be common, effecting 49.1% of the sample population. This is statistically significantly higher prevalence than previous studies have found (p

Misophonia is a scarcely known disorder. This systematic review (1) offers a quantitative and qualitative analysis of the literature since 2001, (2) identifies the most relevant aspects but also controversies, (3) identifies the theoretical and methodological approaches, and (4) highlights the outstanding advances until May 2022 as well as aspects that remain unknown and deserve future research efforts. Misophonia is characterized by strong physiological, emotional, and behavioral reactions to auditory, visual, and/or kinesthetic stimuli of different nature regardless of their physical characteristics. These misophonic responses include anger, general discomfort, disgust, anxiety, and avoidance and escape behaviors, and decrease the quality of life of the people with the disorder and their relatives. There is no consensus on the diagnostic criteria yet. High comorbidity between misophonia and other psychiatric and auditory disorders is reported. Importantly, the confusion with other disorders contributes to its underdiagnosis. In recent years, assessment systems with good psychometric properties have increased considerably, as have treatment proposals. Although misophonia is not yet included in international classification systems, it is an emerging field of growing scientific and clinical interest.

Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.

Misophonia is a condition characterized by marked distress following the perception of innocuous sounds and is often accompanied by behavioral avoidance. This presentation is currently absent from the Diagnostic and Statistical Manual of Mental Disorders, as it remains poorly understood and understudied. Despite these limitations, there have been recent efforts to develop empirically supported assessment tools and intervention. Interventions for misophonia predominantly incorporate principles of cognitive-behavioral interventions. This article describes in detail the assessment and intervention process of working with an individual with misophonia.

Misophonia is a neurophysiological disorder in which certain sounds trigger an intensely emotional or physiological response caused by an increased autonomic nervous system reaction to the triggers. Misophonia is a relatively new condition, and the neurophysiological mechanism behind this condition is not known yet. The assessment and management of misophonia need a team approach. Audiologists are vital members of the team. However, their roles in this condition are not well-understood. The study aims to review the neurophysiological mechanism of misophonia, highlighting the mechanism involved in the audiological pathway and directing the discussion toward applications of findings in the assessment and management of misophonia from the audiological perspective.We reviewed 12 articles from different databases to understand the neurophysiological mechanisms of misophonia. Most of the studies selected were experimental designs involving individuals with misophonia.The result of the review revealed abnormal activation and connection among the different higher cortical structures in participants with misophonia. By signifying various neurophysiological and neuroradiological findings, the review confirms that misophonia is a neurophysiological disorder that may border between audiology, neurology, and psychiatry. Assessment of study quality reported an overall low risk of bias.This review highlights the need to include an audiologist as a team member in the evaluation and management of misophonia.

Misophonia is a complex disorder characterized by a heightened reaction to certain sounds and associated stimuli. While there is no uniformly accepted treatment to date, different intervention approaches are being investigated. Individual's perceptions of different misophonia treatment methods may affect compliance and satisfaction with treatment options. We sought to gather data on patient perceptions of currently available misophonia treatments.Using an online survey, we collected data about treatment preferences, treatment usage, and diagnosis history from parents of children with misophonia (N = 141) and adults with misophonia (N = 252).Most respondents were not satisfied with misophonia treatments that they or their children had previously received. Audiologic interventions including active and passive noise cancelling and lifestyle modifications were rated as most appropriate for treatment of misophonia by both parent and adult respondents.Because of the descriptive nature of this study, we chose to use a completer-only approach to ensure the data reflect the true responses of participants, though this did result in a meaningful proportion of missing data. Participants were selected through convenience sampling and responses were self-reported. Individuals with more severe misophonia symptoms may be more likely to participate and complete a research survey.Most interventions are considered inappropriate by parents of youth with misophonia and by adults with misophonia. This should be interpreted in the light of a general lack of misophonia-specific interventions. Findings suggest dissatisfaction with currently available treatments and an opportunity for development of effective treatment strategies corresponding to participants' preferences. Deeper understanding of treatment preferences has the potential to guide future treatment development.

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Misophonia is characterized by an autonomic response (e.g., increased heart rate) that is elicited by certain innocuous or repetitive sounds, and individuals with misophonia may display an extreme, overt response commonly associated with rage, hatred, and a loss of self-control. In this investigation, we used a combined respondent and operant approach to treat problem behavior evoked by bodily sounds (i.e., coughing, sneezing, sniffling, and clearing throat) for an adult with autism spectrum disorder. The intervention produced immediate reductions of problem behavior and the effects of treatment maintained during progressively lean schedules of reinforcement. The results of this study will be discussed in light of past research, along with limitations, and future directions for research and clinical practice.

Misophonia is a newly recognized condition involving adverse emotional reactions to environmental sounds, most often produced by other people. This study reports results of a survey describing the phenomenology of misophonia based on a large sample. Survey data were collected from individuals self-identified as having misophonia. A total of 1,061 individuals reported specific distressing reactions to sounds, and responses indicating severity of misophonia and perceived comorbidity. Over 82% of respondents were female. The average age of the study participants was 37.49 years (SD = 12.24; range from 18 to 72). Most respondents reported multiple triggers and adverse emotional reactions, as well as multiple coping responses. The majority of respondents reported comorbid diagnoses. Misophonia severity is described, as well as impact on quality of life. A minority of respondents had some experience with treatment and most reported no change in symptoms. Treatments reported for misophonia were typically ineffective, and once developed, misophonia symptoms persist. The results of the study showed that misophonia is a newly recognized condition that appears to have important impact on people’s lives. It typically develops in early life, and is associated with a reduced quality of life, substantial comorbidity, negative emotional experiences, and behaviors that are likely to impact interpersonal relationships.

The Amsterdam Misophonia Scale-Revised (AMISOS-R) is a self-report scale that measures the presence and severity of symptoms experienced in response to specific auditory stimuli. This cross-sectional, descriptive study aims to evaluate psychometric properties of the AMISOS-R in the Turkish language and to examine psychosocial factors associated with misophonia. A total of 374 individuals (female/male: 154/220) between 15 and 45 years of age were included in the study. Confirmatory factor analysis showed that the fit indices were at a good level, and they supported the single-factor structure. Test-retest results and Cronbach's alpha coefficient showed that the scale had high reliability. Misophonia scores were also found to be moderately correlated with obsessive-compulsive disorder and neuroticism. The AMISOS-R was found to be a valid and reliable tool to evaluate misophonia in the Turkish language.

Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as those associated with eating or breathing, causing avoidance of cue related situations resulting in significant functional impairment. Functional magnetic resonance imaging studies suggest misophonia is associated with increased activity in the auditory cortex and salience network, which might reflect increased vigilance toward specific misophonia triggers. New treatments have been developed and investigated in the last years in which this vigilance plays an important role. This is a synopsis of the first group protocol for systemic Cognitive Behavioral Therapy (G-CBT) for misophonia. We discuss the model of CBT for misophonia, provide a detailed guide to the treatment illustrated with a case study, discuss advantages, limitations, and possible pitfalls by a qualitative evaluation of the protocol, and review evidence for the protocol.

Misophonia is an understudied condition that is commonly viewed as an extreme sensitivity to specific soft sounds and visual stimuli which elicit strong negative emotions and physiological arousal. Recent research using self-report measures indicates that misophonia includes an elicited physical respondent (e.g. skeletal muscle flinch). Using electromyography (EMG) and direct observation, an immediate physical response to trigger stimuli was verified in three misophonic participants. Consistent movement of the body was observed in each subject when the subject reported having a moderate to strong response, though the location was unique for each subject. The response appeared to be immediate with the onset of a brief auditory stimulus and occurred at the start and throughout longer visual trigger stimuli. Additionally, an EMG measured response was consistent in one participant, and occurred in another participant when there was a strong self-reported response. Response latency for the EMG measured response was several hundred milliseconds, indicating the responses were elicited by the misophonic trigger stimulus and not general physiological arousal. This provides empirical evidence of an elicited physical response to misophonic stimuli in these individuals with misophonia. This supports conceptualization of misophonia as a condition which includes a respondent behavior (e.g. muscle flinch) elicited by the misophonic trigger stimulus. This highlights the need for additional research on the elicited physical response to misophonic stimuli and classical conditioning as a mechanism for the development of such a response.

This article reviews the evidence related to the efficacy of Cognitive Behavioral Therapy (CBT) for alleviating the distress caused by tinnitus, hyperacusis and misophonia. Where available, the review was focused on meta-analyses of randomized controlled trials (RCTs) using either passive control groups (typically waiting list or education only) or active control groups (receiving some other form of treatment). Where data from RCTs were not available, case studies and retrospective studies were reviewed. Analyses were conducted separately for studies of patients with tinnitus, hyperacusis and misophonia. RCTs show that CBT is effective in alleviating the distress caused by tinnitus in comparison to passive control groups and sometimes active control groups. CBT for tinnitus can be effective both in individual and in group settings, whether delivered by psychiatrists, clinical psychologists, or specially trained audiologists. CBT for tinnitus can also be effective when delivered via the internet, when combined with help from audiologists. Usually, CBT does not reduce the loudness of tinnitus but it can improve quality of life. Case studies and some limited RCTs suggest that CBT can also be effective in alleviating the distress caused by hyperacusis and misophonia. However, RCTs with active control groups are currently lacking. There is strong evidence supporting the effectiveness of CBT in alleviating the distress caused by tinnitus. However, it is not yet clear whether CBT is more effective than some other forms of treatment. RCTs with active control groups are needed to establish more clearly the extent to which CBT is effective in alleviating the distress caused by hyperacusis and misophonia.

Background and Objectives Misophonia is a condition characterised by the experience of negative emotional and physiological reactions to specific sounds, such as chewing, pen tapping or sniffing (Potgieter et al., 2019). People suffering from misophonia experience irrational and disproportionate feelings of anger, disgust, and harm ideation that negatively impact their lives. The current study aims to address a gap in the literature by exploring people’s lived experience with self-diagnosed misophonia in educational, work, and everyday settings. Methods Five interviews were conducted with individuals who self-diagnosed as having misophonia. Interview transcripts were analysed using Interpretative Phenomenological Analysis. Results The analysis revealed four superordinate themes: ‘Phenomenology of the misophonia reaction’, ‘Susceptibility to triggering sounds’, ‘Coping strategies when triggered’, and ‘Levels of attention and concentration’. Misophonia was reported as having wide-ranging effects on mental health and familial/social relationships. Coping strategies that re-direct attention and concentration, such as mindfulness techniques, were reported to be effective in ameliorating aversive reactions. Conclusions The findings provide the first phenomenological insight into misophonia through ideographical analysis of a small number of cases. Future research and implications of the study are discussed.

Misophonia is a debilitating disorder characterized by decreased sound tolerance. While it typically begins in childhood, research on its characteristics in this population is limited. We assessed 90 children aged 7–18 with and without misophonia, along with their mothers, using interviews, questionnaires, and performance-based tests. Younger children with misophonia were more likely to use aggression in response to triggers than older, while adolescents largely reported self-harm during triggers. Children with misophonia did not differ from their peers in terms of ADHD, ODD, ASD, dyslexia, social and emotional competencies, head injuries, epilepsy, tinnitus, being prematurely born, or delivered via cesarean sections. However, they had significantly higher symptoms of anxiety and depression, more frequent occurrences of OCD, migraines, and psychosomatic complaints. Their mothers self-reported postpartum depression significantly more frequently than mothers in the control group. There is a need for further research on pediatric misophonia, with the involvement and assessment of parents.

More information about the project can be found in this publication, please cite when using the cutoffs in your research: Möllmann A, Heinrichs N, Illies L, Potthast N and Kley H (2023). The central role of symptom severity and associated characteristics for functional impairment in misophonia. Front. Psychiatry. 14:1112472. doi: 10.3389/fpsyt.2023.1112472

Purpose: For some people, exposure to everyday sounds presents a significant problem. The purpose of this tutorial was to define and differentiate between the various sound tolerance conditions and to review some options for their clinical management. Method: We informally reviewed the literature regarding sound tolerance conditions. The terminology and definitions provided are mostly consistent with how these terms are defined. However, many inconsistencies are noted. Methods of assessment and treatment also differ, and different methodologies are briefly described. Results: Hyperacusis describes physical discomfort or pain when any sound reaches a certain level of loudness that would be tolerable for most people. Misophonia refers to intense emotional reactions to certain sounds (often body sounds such as chewing and sniffing) that are not influenced by the perceived loudness of those sounds. Noise sensitivity refers to increased reactivity to sounds that may include general discomfort (annoyance or feeling overwhelmed) due to a perceived noisy environment, regardless of its loudness. Phonophobia, as addressed in the audiology profession, describes anticipatory fear of sound. Phonophobia is an emotional response such as anxiety and avoidance of sound due to the “fear” that sound(s) may occur that will cause a comorbid condition to get worse (e.g., tinnitus) or the sound itself will result in discomfort or pain. (Note that phonophobia is a term used by neurologists to describe “migraineur phonophobia”—a different condition not addressed herein.) Conclusions: The literature addresses sound tolerance conditions but reveals many inconsistencies, indicating lack of consensus in the field. When doing an assessment for decreased sound tolerance, it is important to define any terms used so that the patient and all health care professionals involved in the care of the patient are aligned with the goals of the treatment plan. Treatment generally involves gradual and systematic sound desensitization and counseling. Supplemental Material: https://doi.org/10.23641/asha.20164130

Misophonia, a condition marked by extreme intolerance to certain classes of sounds (e.g., respiratory or gustatory noises), has recently attracted increased research attention. As yet there are no evidence-based treatments, although some promising options are under empirical consideration. This paper presents a stress management and exposure therapy-based treatment protocol for adults with misophonia. The protocol details considerations specific to exposure therapy for misophonia, including unique considerations for developing hierarchies and example misophonia exposure exercises and exposure homework. Stress management approaches employed to facilitate engagement with exposure are also described. Two case examples are included, which illustrate the application of the misophonia treatment protocol. The first case describes treatment for a client whose misophonia symptoms are the primary focus and the second case describes treatment for a client whose misophonia symptoms are secondary to relationship difficulties. This protocol can be used to stimulate further treatment research for misophonia and guide treatment for individuals with misophonia.

Misophonia is a recently described condition that is marked by extreme adverse reactions to select classes of trigger sounds. It has recently received attention as a putative diagnosable condition, and specifically as a member of the class of obsessive-compulsive and related disorders. Adverse reactions may include physiological responses, emotional responses, and behaviors. Common trigger sounds include gustatory and respiratory noises and other sounds created by humans but vary widely among affected individuals. This chapter describes misophonia, including coverage of other audiological conditions that need to be ruled out in potential cases, the current state of assessment, and brief consideration of treatment approaches. Future clinical and research directions are highlighted.

Objective A large number of people experience misophonia. In 2013, the Amsterdam Study Group recommended diagnostic criteria for misophonia. However, misophonia is not yet included in the Diagnostic and Statistical Manual of Mental Disorders. This report is the first report on drug use that directly affects misophonia and demonstrates a 14-year-old adolescent girl with misophonia successfully treated with fluoxetine. Methods The patient's misophonia symptoms had been continuing for approximately 2 years, and her quality of life was significantly reduced. Psychotherapy conditions could not be applied, and fluoxetine 10 mg/d was started and increased to 20 mg/d after a week. At the second-month follow-up, because of partial improvement, fluoxetine dose was increased to 30 mg/d. Results At the fourth-month follow-up, there was a 40% decrease in Amsterdam Misophonia Scale score with a 70% decrease in the children's global assessment scale scores. By the 16th week, the overall functionality level was good at the end. Conclusions Fluoxetine may be used as an effective drug in the treatment of misophonia.

Recent scientific studies have noted that misophonia is a complex neurophysiological and behavioural syndrome characterised by high physiological and emotional reactivity, resulting from an intolerance to specific auditory stimuli. People with this distress have emotional and behavioural responses, excessive in relation to the auditory stimulus that provokes them; in fact, these people may have outbursts of anger, severe anxiety crises, and even panic attacks. One of the questions that the first studies of this syndrome have asked was what link occurred between misophonia and certain psychological disorders such as anxiety, depression, and personality disorders. Another important research objective was to examine the differential diagnosis between misophonia and hearing disorders such as tinnitus. In view of the current literature on misophonia, it has become important to define the comorbidity and differential diagnosis of misophonia with other disorders. The next step is, through further research on clinical cases, to define the most effective psychotherapeutic techniques on misophonic symptoms, and the psychoeducational tools needed to intervene in family systems with misophonic patients. Keywords: comorbidity, differential diagnosis, psychological disorders, hearing disorders, misophonia, behavioural response, emotional response, psychoeducational tools, psychotherapeutic techniques

Misophonia is an unusually strong aversion to everyday sounds such as chewing, crunching, or breathing. Previous studies have suggested that rates of autism might be elevated in misophonia, and here we examine this claim in detail. We present a comprehensive review of the relevant literature, and two empirical studies examining children and adults with misophonia. We tested 142 children and 379 adults for traits associated with autism (i.e., attention-to-detail, attention-switching, social processing, communication, imagination, emotion regulation, and sensory sensitivity across multiple domains). Our data show that autistic traits are indeed elevated in misophonics compared to controls. We discuss our findings in relation to models of the interface between autism, sensory sensitivities, and the specific features of misophonia.

This article presents a case study of conceptualization of misophonia as a conditioned aversive reflex disorder consisting of a physical (e.g., muscle) reflex elicited by the misophonic trigger stimulus and subsequent emotional, physiological, and behavioral responses. This case describes a successful behavioral treatment of a middle-aged woman who was disabled by severe misophonia. The treatment included identifying the initial physical reflex, progressive muscle relaxation, and counterconditioning the initial physical reflex. Counterconditioning was accomplished by relaxing the initial physical reflex muscle during exposure to in vivo trigger stimuli, while using ambient sound as needed to reduce the severity of the misophonic response. The overall severity of misophonia reduced over the course of the 13-week treatment, based on client self-report. Data were analyzed using recovery percentage formula. The recovery percentage average of 3 scales was 82.1% at end of treatment and 93.1% at 1-year follow-up. In this case, when the initial physical reflex’s muscle was held relaxed by the patient when exposed to trigger stimuli, the initial physical reflex and the emotional reflex diminished and extinguished.

Background: In the UK, audiologist-delivered cognitive behavioral therapy (CBT) is a key intervention to alleviate the distress caused by tinnitus and its comorbid hyperacusis. However, the availability of face-to-face CBT is limited, and such therapy involves significant costs. CBT provided via the internet provides a potential solution to improve access to CBT for tinnitus. Purpose: The aim was to perform a preliminary assessment of the effect of a specific program of non-guided internet-based CBT for tinnitus, denoted iCBT(T), in alleviating the problems caused by tinnitus alone or tinnitus combined with hyperacusis. Research Design: This was a retrospective cross-sectional study. Study Sample: The data for 28 people with tinnitus who completed the iCBT(T) program and answered a series of questions about their tinnitus and hearing status were included in the study. Twelve patients reported also having hyperacusis (including five also with misophonia). Data collection and analysis: The iCBT(T) program has seven self-help modules. Anonymous data were collected retrospectively from patients’ answers to the questions in the iCBT(T) initial and final assessment modules. Questionnaires administered within the iCBT(T) program were: 4C Tinnitus Management Questionnaire (4C), Screening for Anxiety and Depression in Tinnitus (SAD-T), and the CBT Effectiveness Questionnaire (CBT-EQ). Results: Responses to the 4C showed a significant improvement from pre- to post-treatment, with a medium effect size. The mean improvement was similar for those with and without hyperacusis. Responses to the SAD-T questionnaire also showed a significant improvement from pre- to post-treatment with a medium effect size. The improvement was significantly greater for participants with tinnitus alone than for participants who also had hyperacusis. For both the 4C and the SAD-T, the improvements were not significantly related to age or gender. Participants’ views of the effectiveness of the iCBT(T) program were assessed using the CBT-EQ. The mean score was 50 out of a maximum of 80, indicating moderately high effectiveness. CBT-EQ scores did not differ for those with and without hyperacusis. Conclusions: Based on this preliminary analysis, the iCBT(T) program showed promising result in improving the ability to manage tinnitus and decreasing symptoms of anxiety and depression. Future studies with larger samples and control group(s) are required to further assess various aspects of this program.

Clinical observations of hundreds of patients who exhibited decreased tolerance to sound showed that many of them could not be diagnosed as having hyperacusis when negative reactions to a sound depend only on its physical characteristics. In the majority of these patients, the physical characteristics of bothersome sounds were secondary, and patients were able to tolerate other sounds with levels higher than sounds bothersome for them. The dominant feature determining the presence and strength of negative reactions are specific to a given patient's patterns and meaning of bothersome sounds. Moreover, negative reactions frequently depend on the situation in which the offensive sound is presented or by whom it is produced. Importantly, physiological and emotional reactions to bothersome sounds are very similar (even identical) for both hyperacusis and misophonia, so reactions cannot be used to diagnose and differentiate them. To label this non-reported phenomenon, we coined the term misophonia in 2001. Incorporating clinical observations into the framework of knowledge of brain functions allowed us to propose a neurophysiological model for misophonia. The observation that the physical characterization of misophonic trigger was secondary and frequently irrelevant suggested that the auditory pathways are working in identical manner in people with as in without misophonia. Descriptions of negative reactions indicated that the limbic and sympathetic parts of the autonomic nervous systems are involved but without manifestations of general malfunction of these systems. Patients with misophonia could not control internal emotional reactions (even when fully realizing that these reactions are disproportionate to benign sounds evoking them) suggesting that subconscious, conditioned reflexes linking the auditory system with other systems in the brain are the core mechanisms of misophonia. Consequently, the strength of functional connections between various systems in the brain plays a dominant role in misophonia, and the functional properties of the individual systems may be perfectly within the norms. Based on the postulated model, we proposed a treatment for misophonia, focused on the extinction of conditioned reflexes linking the auditory system with other systems in the brain. Treatment consists of specific counseling and sound therapy. It has been used for over 20 years with a published success rate of 83%.

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 continuous spectrum disorder (subthreshold, mild, moderate to severe) instead of a categorical diagnosis.

Several previous studies have found an association between misophonia and obsessive-compulsive (O-C) symptoms. The goal of the present research was to examine the relationship between O-C symptoms and two different types of sound sensitivities: misophonia and hyperacusis. We did so in a large on-line sample of university students (N = 1,094), a subset of whom completed in-person audiological and psychological assessments (N = 102). We utilized a multi-trait, multi-method approach, measuring misophonia, hyperacusis, and O-C symptoms using both questionnaires and either clinician ratings or laboratory assessment. For the sake of examining specificity, interview-based depression ratings were also examined. The associations were generally consistent regardless of how O-C symptoms, misophonia, and hyperacusis were measured – O-C symptoms were associated with both types of sound sensitivities. Thus, the results suggest that sensory sensitivities, rather than misophonia specifically, are associated with O-C symptoms. Depression symptoms were not significantly associated with hyperacusis and were less strongly associated with misophonia than were O-C symptoms, suggesting that the associations between O-C symptoms and sound sensitivities are not simply artifacts of shared variance with general psychological distress.

Avoidant/Restrictive Food Intake Disorder and misophonia seem to be overrepresented in autism spectrum disorder. Literature is mute on psychopharmacotherapy in these complex presentations. Here, authors report on a challenging case of low-functioning ASD child with comorbid ARFID and misophonia that responded favorably to a low-dose risperidone. This is followed by a brief discussion of purported pharmacodynamic mechanisms and relevant literature.

BackgroundMisophonia is often referred to as a disorder that is characterized by excessive negative emotional responses, including anger and anxiety, to “trigger sounds” which are typically day-to-day sounds, such as those generated from people eating, chewing, and breathing. Misophonia (literally ‘hatred of sounds’) has commonly been understood within an auditory processing framework where sounds cause distress due to aberrant processing in the auditory and emotional systems of the brain. However, recent evidence from brain imaging showing involvement of the motor system while listening to trigger sounds suggests that it is the perception of action (e.g., mouth movement) of the trigger person, and not the sounds per se, that drives the distress in misophonia. Since observation or listening to sounds of actions of others are known to prompt automatic mimicry/imitations in perceivers, we hypothesized that mimicking the action of the trigger person may be prevalent in misophonia. Apart from a few case studies and anecdotal information, a relation between mimicking and misophonia has not been systematically evaluated. MethodIn this work, we addressed this limitation by collecting data on misophonia symptoms and mimicry behaviour using online questionnaires from 676 participants. ResultsAnalysis of these data shows that (i) the tendency to mimic varies in direct proportion to misophonia severity assessed using a self-reported questionnaire, (ii) compared to other human and environmental sounds, trigger sounds of eating and chewing are more likely to trigger mimicking, and (iii) the act of mimicking provides relief from distress to most people with misophonia. LimitationsThe format of the study as an online survey used questionnaires to assess misophonia status. The questionnaire has been used extensively in misophonia research, however it is not fully validated for use in clinical populations, therefore we cannot be certain on the degree of severity of symptoms reported in this study population.ConclusionThis study shows that mimicry is widely prevalent in misophonia and is elicited by the most common trigger sounds of eating and chewing. These data reinforce the idea of hyper-mirroring in misophonia proposed in our earlier work (Kumar et al., 2021). Thus, providing crucial implications for how we treat and interpret misophonia moving forward.

One of the core processes presumably underlying misophonia – a condition characterized by decreased tolerance for specific sounds – is associative learning. The goal of this project is to evaluate whether interference with the reconsolidation of a reactivated misophonia memory with propranolol or counterconditioning can alleviate aversive reaction to misophonia-related cues.