Misophonia

Pawel Jastreboff and Margaret M. Jastreboff coined the term "misophonia" in 2001 with the assistance of Guy Lee,{{Cite web |title=Misophonia |url=https://www.tinnitus-pjj.com/misophonia/ |access-date=2022-10-08 |website=Tinnitus & Hyperacusis Center |language=en-US |url-status=live |archive-url=https://web.archive.org/web/20230122101944/https://www.tinnitus-pjj.com/misophonia/ |archive-date= 22 January 2023}}{{cite news | vauthors = de Freytas-Tamura K |date=3 February 2017 |title=Misophonia Sufferers: Scientists May Have Found the Root of Your Pain |work=The New York Times |url=https://www.nytimes.com/2017/02/03/health/sounds-people-hate.html |access-date=6 October 2022 |url-status=live |archive-url=https://web.archive.org/web/20221125122252/https://www.nytimes.com/2017/02/03/health/sounds-people-hate.html |archive-date= 25 November 2022}} introducing it in their article "Hyperacusis",{{Cite web | vauthors = Jastreboff MM, Jastreboff PJ |date=2001-06-18 |title=Hyperacusis |url=https://www.audiologyonline.com/articles/hyperacusis-1223 |url-status=live |archive-url=https://web.archive.org/web/20230222161927/https://www.audiologyonline.com/articles/hyperacusis-1223 |archive-date=22 February 2023 |access-date=2022-10-08 |website=AudiologyOnline |language=en}} with further explanation in the International Tinnitus and Hyperacusis Society's ITHS Newsletter.

"Misophonia" comes from the Ancient Greek words μῖσος (IPA: {{IPA|/mîː.sos/}}), meaning "hate", and φωνή (IPA: {{IPA|/pʰɔː.nɛ̌ː/}}), meaning "voice" or "sound", loosely translating to "hate of sound", and was coined to differentiate the condition from other forms of decreased sound tolerance, such as hyperacusis (hypersensitivity to certain frequencies and volume ranges) and phonophobia (fear of sounds).{{cite journal | vauthors = Cavanna AE | title = What is misophonia and how can we treat it? | journal = Expert Review of Neurotherapeutics | volume = 14 | issue = 4 | pages = 357–359 | date = April 2014 | pmid = 24552574 | doi = 10.1586/14737175.2014.892418 | s2cid = 36026220 }}

The term "misophonia" was first used in a peer-reviewed journal in 2002.{{Cite journal | vauthors = Jastreboff MM, Jastreboff PJ |date= November 2002 |title=Decreased Sound Tolerance and Tinnitus Retraining Therapy (TRT) |url=https://access.portico.org/stable?au=pgf1b75bc57 |journal=Australian and New Zealand Journal of Audiology |volume=24 |issue=2 |pages=74–84 |doi=10.1375/audi.24.2.74.31105 |url-status=live |archive-url=https://web.archive.org/web/20230319153906/https://access.portico.org/Portico/auView?auId=ark:%2F27927%2Fpgf1b75bc57 |archive-date= 19 March 2023|url-access=subscription }} Before that, the disorder was more commonly called "selective sound sensitivity syndrome", or "4S", a term coined by audiologist Marsha Johnson. Other names formerly used for the condition include "soft sound sensitivity symptom", "select sound sensitivity syndrome", "decreased sound tolerance", and "sound-rage".{{cite journal | vauthors = Palumbo DB, Alsalman O, De Ridder D, Song JJ, Vanneste S | title = Misophonia and Potential Underlying Mechanisms: A Perspective | journal = Frontiers in Psychology | volume = 9 | pages = 953 | date = 2018-06-29 | pmid = 30008683 | pmc = 6034066 | doi = 10.3389/fpsyg.2018.00953 | doi-access = free }}

In their seminal 2013 case series of patients with misophonia, Schröder and colleagues coined the term "misokinesia" (a term analogous to misophonia translating to "hatred of movement") to describe misophonia-like reactions that occur when people are "triggered" by specific repetitive visual stimuli, such as another person's foot shaking, fingers tapping, or gum chewing.{{cite journal | vauthors = Jaswal SM, De Bleser AK, Handy TC | title = Misokinesia is a sensitivity to seeing others fidget that is prevalent in the general population | journal = Scientific Reports | volume = 11 | issue = 1 | pages = 17204 | date = August 2021 | pmid = 34446737 | pmc = 8390668 | doi = 10.1038/s41598-021-96430-4 | bibcode = 2021NatSR..1117204J }} Other authors have proposed "Conditioned Aversive Response Disorder" (C.A.R.D.) as a more suitable name, which seeks to incorporate both the respective auditory and non-auditory aspects of misophonia and misokinesia into a single condition.{{cite journal | vauthors = Dozier T, Mitchell N | title = Novel five-phase model for understanding the nature of misophonia, a conditioned aversive reflex disorder | journal = F1000Research | volume = 12 | pages = 808 | date = 4 October 2023 | pmid = 37881332 | pmc = 10594049 | doi = 10.12688/f1000research.133506.3 | doi-access = free }}

Adopting DSM-5-like terminology, some research groups have also advocated the term "misophonic disorder"{{cite journal | vauthors = Möllmann A, Heinrichs N, Illies L, Potthast N, Kley H | title = The central role of symptom severity and associated characteristics for functional impairment in misophonia | journal = Frontiers in Psychiatry | volume = 14 | pages = 1112472 | date = 2023-03-28 | pmid = 37056403 | pmc = 10086372 | doi = 10.3389/fpsyt.2023.1112472 | doi-access = free }} to distinguish clinically significant and disabling misophonia from what they term "misophonic reactions" (i.e., sub-clinical manifestations of misophonia that do not cause marked distress or substantially impair a person's daily life, relationships, or activities).

Notably, of the above terms, only "misophonia" is widely used by researchers, clinicians, and sufferers of the condition. It is the primary term used for the condition in mainstream journalistic coverage{{Cite news | vauthors = Moyer MW |date=2022-09-09 |title=When You Can't Stand the Sound of Chewing (or Crunching, or Sniffling) |url=https://www.nytimes.com/2022/09/08/well/misophonia-chewing-noise-treatment.html |access-date=2024-11-09 |work=The New York Times |issn=0362-4331}}{{Cite news | vauthors = Dresden D |date=2023-11-10 |title=Misophonia: What it is, symptoms, and triggers |url=https://www.medicalnewstoday.com/articles/320682 |access-date=2024-11-09 |work=Medical News Today}}{{Cite news | vauthors = Blackwelder C |date=2024-08-21 |title='Little House on the Prairie' alum Melissa Gilbert details life with misophonia |url=https://abcnews.go.com/GMA/Culture/little-house-prairie-alum-melissa-gilbert-details-life-misophonia/story?id=113029552 |access-date=2024-11-09 |work=ABC News}}{{Cite news | vauthors = Cohen J |date=2016-06-17 |title=Misophonia: When a crunch, chew, or a sniffle triggers hot rage |url=https://www.statnews.com/2016/06/17/misophonia-noise-rage/ |access-date=2024-11-09 |work=Stat News}} and by the primary philanthropic agency funding research into it (The Misophonia Research Fund [MRF]),{{cite web |title=Understanding Misophonia |url=https://www.misophoniaresearchfund.org/understanding-misophonia |website=Misophonia Research Fund |publisher=Misophonia Research Fund |access-date=9 November 2024}} and the term selected for use in an (MRF-funded) project to derive a field-wide consensus definition of the condition for clinical and research use.

Misophonia is a disorder of sound tolerance characterized by extreme and disproportionate emotional reactions to specific sounds (or less commonly, visual stimuli) in one's environment, termed "triggers." Trigger stimuli are experienced as extremely unpleasant or distressing and tend to evoke a "misophonic reaction" that consists of both unpleasant negative emotions (i.e., extreme irritation, anger, anxiety, or disgust; less commonly rage or panic) and increased sympathetic arousal (manifested in physical symptoms such as muscle tension, increased heart rate, and sweating).

There may also be a feeling of unwanted sexual arousal, similar to the obsessive-compulsive complex known as groinal response,{{cite web | url=https://www.the-ncip.org/articles/understanding-groinal-responses-in-ocd-insights-for-professionals-and-individuals#:~:text=A%20groinal%20response%20is%20a%20physical%20reaction%20in,emotional%2C%20and%20cognitive%20responses%20driven%20by%20genuine%20desire | title=Understanding Groinal Responses in OCD: Insights for Professionals and Individuals }}{{cite web | url=https://impulsetherapy.com/groinal-responses-in-ocd-what-they-are-and-why-they-happen/ | title=Groinal Responses in OCD: What They Are and Why They Happen | date=25 January 2021 }} upon encountering the trigger stimulus. This symptom is often grossly misunderstood and misinterpreted but not uncommon or unusual.{{cite web | url=http://www.misophonia-uk.org/dealing-with-misophonia.html | title=Dealing with misophonia }}{{cite web | url=https://misophoniatreatment.com/misophonia-activation-scale-3/ | title=Misophonia Activation Scale – Misophonia Treatment }}{{cite web | url=https://www.misophoniainternational.com/misophonia-and-sexual-urges-a-poorly-understood-symptom/ | title=Misophonia and Sexual Urges, a Poorly Understood Symptom | date=29 May 2024 }}{{cite web | url=https://rachelkuipers.wordpress.com/misophonia-a-daily-struggle-with-sounds/ | title=Misophonia Project | date=8 May 2015 }}

Trigger stimuli are highly varied and sometimes idiosyncratic, but certain stimuli such as chewing and other oronasal sounds are among the most commonly reported triggers in both clinically referred and population-based samples. The Duke Misophonia Questionnaire,{{cite journal | vauthors = Rosenthal MZ, Anand D, Cassiello-Robbins C, Williams ZJ, Guetta RE, Trumbull J, Kelley LD | title = Development and Initial Validation of the Duke Misophonia Questionnaire | journal = Frontiers in Psychology | volume = 12 | pages = 709928 | date = 2021-09-29 | pmid = 34659024 | pmc = 8511674 | doi = 10.3389/fpsyg.2021.709928 | doi-access = free }} a commonly used misophonia symptom measure, groups misophonia triggers into the following categories:

• People making mouth sounds while eating or drinking (e.g., chewing, crunching, slurping).
• People making nasal/throat sounds (e.g., sniffing, sneezing, nose-whistling, coughing, throat clearing).
• People making mouth sounds when not eating (e.g., making the "tsk" sound, heavy breathing, snoring, whistling).
• People making repetitive sounds (e.g., typing, tapping nails on table, pen clicking, writing, construction work, using machinery).
• Rustling or tearing objects (e.g., paper, plastic).
• Sounds produced during speech (e.g., "p" sounds, hissing "s" sounds, someone speaking with a lisp, high-pitched voices).
• Body or joint sounds (e.g., finger snapping, joint cracking, jaw clicking).
• Rubbing sounds (e.g., hands on pants, hands against one another, Styrofoam rubbing together).
• Stomping or loud walking (e.g., heels clicking, flip flops, etc.).
• Muffled sounds (e.g., voices separated by a wall, TV/music in another room).
• People talking in the background (e.g., phone calls in public, many people talking at once).
• Repetitive or continuous sounds made by inanimate objects (e.g., clock ticking, air conditioner humming, running water).
• Animals making repetitive sounds (e.g., licking, chirping, barking, eating, drinking).
• Seeing someone making or about to make a specific sound that causes distress, even if the sound itself isn't audible (e.g., seeing someone reach into a bag of chips, seeing someone eating on TV with the volume off).
• Hearing any sound from selective despised individuals or specific races (e.g., hearing verbal conversation from hated neighbors).

Although less well studied, reported visual triggers in misokinesia include another person's repetitive movements (foot/leg shaking, arms swinging, hands rubbing together, hair twirling, fidgeting), as well as the sight of an auditory trigger that one cannot actually hear (such as someone chewing with their mouth open or tapping their fingers on a desk).

Reactions to triggers can range from mild (extreme irritation, anxiety, disgust, and/or physical discomfort) to severe (anger, rage, hatred, fear, panic, and/or profound emotional distress). A number of physical symptoms may also accompany the misophonic response, including muscle tension, increased heart rate, sweating, and a feeling of pressure in one's body. Other idiosyncratic physical and cognitive symptoms are also possible.

The five dimensions of cognitive-behavioral responses to "triggers", as empirically derived from the "S-Five" (another misophonia questionnaire that was used in the first large-scale prevalence study of the condition in the UK),{{Cite journal |last1=Vitoratou |first1=Silia |last2=Uglik-Marucha |first2=Nora |last3=Hayes |first3=Chloe |last4=Gregory |first4=Jane |date=2021-10-28 |title=Listening to People with Misophonia: Exploring the Multiple Dimensions of Sound Intolerance Using a New Psychometric Tool, the S-Five, in a Large Sample of Individuals Identifying with the Condition |journal=Psych |language=en |volume=3 |issue=4 |pages=639–662 |doi=10.3390/psych3040041 |doi-access=free |issn=2624-8611}}{{Cite journal |last=Vitoratou |first=Silia |date=2023-01-04 |title=Misophonia in the UK: Prevalence and Norms for the S-Five in a UK Representative Sample, 2020-2022 |url=https://reshare.ukdataservice.ac.uk/856149/ |journal=[Data Collection] |location=Colchester, Essex |publisher=UK Data Service |doi=10.5255/UKDA-SN-856149}}{{cite journal | vauthors = Vitoratou S, Hayes C, Uglik-Marucha N, Pearson O, Graham T, Gregory J | title = Misophonia in the UK: Prevalence and norms from the S-Five in a UK representative sample | journal = PLOS ONE | volume = 18 | issue = 3 | pages = e0282777 | date = 2023-03-22 | pmid = 36947525 | pmc = 10032546 | doi = 10.1371/journal.pone.0282777 | doi-access = free | bibcode = 2023PLoSO..1882777V }} are as follows:

• Internalizing appraisals such as self-critical thoughts, feeling guilty about one's reactions, and feeling ashamed for reacting to triggers
• Externalizing appraisals such as blaming others for making triggering sounds, feeling that others are being selfish or disrespectful, and believing that specific sounds are "just bad manners" and should never be made by anyone
• Anxiety/avoidance responses such as isolating oneself, moving away from the sound, or limiting opportunities to avoid potential trigger exposure
• Feeling threatened/overwhelmed such as feeling trapped, having thoughts of helplessness, or panicking when one can't escape a trigger
• Aggressive outbursts such as yelling, screaming, pushing, hitting, throwing things, or (rarely in adults) becoming physically violent

People with misophonia, particularly adults, are typically aware that their emotional reactions and behaviors in response to triggers are disproportionate to the situation, and this frequently causes some degree of internal conflict due to a desire to suppress these reactions.

The first misophonic reaction typically occurs when a person is young, often between the ages of 9 and 13. But misophonia can have an onset at any age, with cases as young as two years old and a number of adult-onset cases reported in the literature. The initial misophonic reaction will often originate from someone in a close relationship or a pet.

Fear and anxiety associated with trigger sounds can cause people with this condition to avoid important social and other interactions that may expose them to these sounds. This avoidance and other behaviors can make it harder for them to achieve their goals and enjoy interpersonal interactions. It can also have a significant adverse effect on their careers and relationships. Many people with misophonia experience worsening mental health, and some develop psychopathology secondary to their misophonia, including depression, anxiety, phonophobia, self-harm behaviors, and suicidality.{{Cite journal |last1=Simner |first1=Julia |last2=Rinaldi |first2=Louisa J. |date=2023-12-01 |title=Misophonia, self-harm and suicidal ideation |journal=Psychiatry and Clinical Neurosciences Reports |language=en |volume=2 |issue=4 |pages=e142 |doi=10.1002/pcn5.142 |issn=2769-2558 |pmc=11114359 |pmid=38868724}}{{Cite journal |last1=Alekri |first1=Jehad |last2=Al Saif |first2=Feras |date=2019-04-03 |title=Suicidal misophonia: a case report |url=https://psychiatry-psychopharmacology.com/en/suicidal-misophonia-a-case-report-13340 |journal=Psychiatry and Clinical Psychopharmacology |language=en |volume=29 |issue=2 |pages=232–237 |doi=10.1080/24750573.2019.1597585 |issn=2475-0573|doi-access=free }}

Misophonia's mechanism is not yet fully understood, and all proposed causes of the disorder are hypothesized based on a combination of clinical observation and the limited existing empirical research. Although misophonia is a disorder of sound tolerance, work to date has not typically demonstrated any peripheral audiologic abnormalities in people with the condition,{{Cite journal |last1=Muñoz |first1=Karen |last2=Woolley |first2=Mercedes G. |last3=Velasquez |first3=Doris |last4=Ortiz |first4=Diana |last5=San Miguel |first5=Guadalupe G. |last6=Petersen |first6=Julie M. |last7=Twohig |first7=Michael P. |date=2024-09-30 |title=Audiological Characteristics of a Sample of Adults With Misophonia |url=https://pubs.asha.org/doi/10.1044/2024_AJA-24-00111 |journal=American Journal of Audiology |volume=33 |issue=4 |language=en |pages=1202–1211 |doi=10.1044/2024_AJA-24-00111 |pmid=39348505 |issn=1059-0889|url-access=subscription }}{{Cite journal |last1=Suraj |first1=Urs |last2=Nisha |first2=Kavassery Venkateswaran |last3=Prabhu |first3=Prashanth |date=2024-04-01 |title=Normal linear and non-linear cochlear mechanisms and efferent system functioning in individuals with misophonia |url=https://link.springer.com/10.1007/s00405-023-08273-6 |journal=European Archives of Oto-Rhino-Laryngology |language=en |volume=281 |issue=4 |pages=1709–1716 |doi=10.1007/s00405-023-08273-6 |pmid=37837477 |issn=0937-4477|url-access=subscription }}{{Citation |last=Williams |first=Zachary James |title=Investigating the Nature of Decreased Sound Tolerance in Autistic and Non-autistic Adults |date=2024-06-21 |pages=197–249 |url=https://ir.vanderbilt.edu/items/a9e54a3e-61db-467b-b2cf-2eb0e9f8b977 |place=Nashville, TN, USA |publisher=Vanderbilt University |department=Neuroscience}} suggesting that any "auditory" abnormalities may be caused by a dysfunction of the central auditory system or other parts of the brain that govern "higher-order" perceptor or cognition, rather than the ears per se.

Some research has found evidence consistent with the idea that there are genetic contributions to misophonia, but more research is needed.{{cite journal | vauthors = Edelstein M, Brang D, Rouw R, Ramachandran VS | title = Misophonia: physiological investigations and case descriptions | journal = Frontiers in Human Neuroscience | volume = 7 | issue = | pages = 296 | date = 2013 | pmid = 23805089 | pmc = 3691507 | doi = 10.3389/fnhum.2013.00296 | doi-access = free }} An unpublished study suggests a genetic locus is associated with responses to a single question asking about the misophonic symptom of experiencing rage to sounds of people chewing.{{Citation | vauthors=((Fayzullina, S.)), ((Smith, R. P.)), ((Furlotte, N.)), ((Hu, Y.)), ((Hinds, D.)), ((Tung, J. Y.)) | year=2015 | title=Genetic Associations with Traits in 23andMe Customers | publisher=23andMe | url=https://permalinks.23andme.com/pdf/23-08_genetic_associations_with_traits.pdf | access-date=3 January 2025}}

The first mechanistic theory of misophonia, proposed by Jastreboff and Jastreboff in 2014,{{Cite journal |last1=Jastreboff |first1=Pawel |last2=Jastreboff |first2=Margaret |date=2014-04-29 |title=Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia) |url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1372527 |journal=Seminars in Hearing |language=en |volume=35 |issue=2 |pages=105–120 |doi=10.1055/s-0034-1372527 |issn=0734-0451|url-access=subscription }}{{Cite journal |last1=Jastreboff |first1=Pawel J. |last2=Jastreboff |first2=Margaret M. |date=2023-03-23 |title=The neurophysiological approach to misophonia: Theory and treatment |journal=Frontiers in Neuroscience |volume=17 |doi=10.3389/fnins.2023.895574 |doi-access=free |issn=1662-453X |pmc=10076672 |pmid=37034168}} is based on the authors' clinical experience and little empirical data. This model, which the authors call the "neurophysiological model", seeks to contrast misophonia with hyperacusis, another disorder of sound tolerance that primarily manifests as excessive loudness perception (or the experience of physical pain in one's ears or head) in response to soft or moderate-intensity everyday sounds.{{Cite journal |last1=Salvi |first1=Richard |last2=Chen |first2=Guang-Di |last3=Manohar |first3=Senthilvelan |date=2022-12-01 |title=Hyperacusis: Loudness intolerance, fear, annoyance and pain |url=https://linkinghub.elsevier.com/retrieve/pii/S0378595522002167 |journal=Hearing Research |language=en |volume=426 |pages=108648 |doi=10.1016/j.heares.2022.108648|pmid=36395696 }} The Jastreboffs' neurophysiological model posits that the fundamental difference between misophonia and hyperacusis is that decreased sound tolerance in hyperacusis is closely coupled to the physical properties of the sound stimulus (i.e., intensity, frequency) while, in misophonia, decreased tolerance of "trigger" sounds has little to do with acoustic properties (beyond louder sounds perhaps being easier to perceive and respond to) and arguably depends almost exclusively on the meaning of the sound(s) to a given person.{{Citation |last=Jastreboff |first=Pawel J. |title=The Neurophysiological Model of Tinnitus and Decreased Sound Tolerance |date=2024 |work=Textbook of Tinnitus |pages=231–249 |editor-last=Schlee |editor-first=Winfried |url=https://link.springer.com/chapter/10.1007/978-3-031-35647-6_20 |access-date=2024-11-04 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-031-35647-6_20 |isbn=978-3-031-35647-6 |editor2-last=Langguth |editor2-first=Berthold |editor3-last=De Ridder |editor3-first=Dirk |editor4-last=Vanneste |editor4-first=Sven|url-access=subscription }} Its creators have used this model to explain certain aspects of the misophonia phenotype, such as that most people with misophonia do not present with peripheral hearing loss and that context (including whether a trigger is produced by oneself) plays a large role in response to a trigger sound.

Although entirely speculative and not based on any empirical neuroscientific data on misophonia, the "neurophysiologic" model also postulates several putative neural mechanisms for the condition from a systems neuroscience perspective. Namely, when processing a trigger stimulus, the brain's central auditory system is thought to have enhanced functional connections with its limbic and autonomic control areas, and downstream overactivity of these areas is theorized to be responsible for the excessive emotional responses and certain physical symptoms of the condition, respectively. These preliminary neuroscientific hypotheses form the basis of the Jastreboffs' signature intervention for sound tolerance conditions (Tinnitus Retraining Therapy, an unproven combination of structured counseling and sound therapy originally developed for tinnitus and now available in modified form to treat misophonia).

Notably, there has been relatively little empirical support for the central neuroscientific hypotheses of the neurophysiologic model. Although there has been a relative lack of neuroimaging research on misophonia thus far, functional connectivity between auditory cortical and limbic or autonomic control areas is not typically increased either at rest or during the experience of trigger sound perception. Though many of these same limbic and autonomic control areas may still be relevant in the pathophysiology of misophonia (with anterior insula being one of the most strongly implicated nodes thus far), recent reviews of human neuroimaging research in this condition{{Cite journal |last1=Berger |first1=Joel I. |last2=Gander |first2=Phillip E. |last3=Kumar |first3=Sukhbinder |date=2024-08-26 |title=A social cognition perspective on misophonia |journal=Philosophical Transactions of the Royal Society B: Biological Sciences |language=en |volume=379 |issue=1908 |doi=10.1098/rstb.2023.0257 |issn=0962-8436 |pmc=11444241 |pmid=39005025}} indicate that (a) their activation may be driven by other pathways than simple auditory→limbic or auditory→limbic→autonomic hyper-connectivity and (b) additional structures outside of the Jastreboffs' model (such as premotor cortex){{cite journal | vauthors = Kumar S, Dheerendra P, Erfanian M, Benzaquén E, Sedley W, Gander PE, Lad M, Bamiou DE, Griffiths TD | title = The Motor Basis for Misophonia | journal = The Journal of Neuroscience | volume = 41 | issue = 26 | pages = 5762–5770 | date = June 2021 | pmid = 34021042 | pmc = 8244967 | doi = 10.1523/JNEUROSCI.0261-21.2021 | doi-access = free }} may play a central role in this disorder. The "neurophysiologic" model has also been criticized by other theorists for its vagueness and unwillingness to specify the specific neural structures/processes involved in the "limbic system" portion of the model, as well as its inability to account for non-sound trigger stimuli.

A more recently developed model of misophonia was published by neuroscientist Sukhbinder Kumar and colleagues at the University of Iowa in 2024. This model, not formally named by the authors but termed the "action perception" model of misophonia by other researchers using it{{Citation |last=Williams |first=Zachary James |title=Investigating the Nature of Decreased Sound Tolerance in Autistic and Non-autistic Adults |date=2024-06-21 |url=https://ir.vanderbilt.edu/items/a9e54a3e-61db-467b-b2cf-2eb0e9f8b977 |place=Nashville, TN, USA |publisher=Vanderbilt University |department=Neuroscience}} (alternatively the Berger-Gander-Kumar model), sought to build on the perceived shortcomings of earlier models{{Cite journal |last=Norena |first=Arnaud |date=2024-02-14 |title=Did Kant suffer from misophonia? |journal=Frontiers in Psychology |volume=15 |doi=10.3389/fpsyg.2024.1242516 |doi-access=free |issn=1664-1078 |pmc=10899398 |pmid=38420172}} by explicitly incorporating more up-to-date empirical findings in the behavioral, clinical and neuroimaging literature on misophonia; providing explanations for the presence of non-auditory (i.e., visual) and multi-sensory trigger stimuli; and considering perspectives from social cognitive theory and social neuroscience in the broader theory. Although the action perception model is consistent with many of the findings in the misophonia neuroimaging literature, it is important to note that it was generated specifically to explain those findings and therefore represents something of a "just-so story" until its predictions can be empirically validated.{{Cite journal |last1=Borsboom |first1=Denny |last2=van der Maas |first2=Han L. J. |last3=Dalege |first3=Jonas |last4=Kievit |first4=Rogier A. |last5=Haig |first5=Brian D. |date=2021-07-01 |title=Theory Construction Methodology: A Practical Framework for Building Theories in Psychology |url=https://journals.sagepub.com/doi/10.1177/1745691620969647 |journal=Perspectives on Psychological Science |language=en |volume=16 |issue=4 |pages=756–766 |doi=10.1177/1745691620969647 |pmid=33593167 |issn=1745-6916}}{{Cite journal |last1=Robinaugh |first1=Donald J. |last2=Haslbeck |first2=Jonas M. B. |last3=Ryan |first3=Oisín |last4=Fried |first4=Eiko I. |last5=Waldorp |first5=Lourens J. |date=2021-07-01 |title=Invisible Hands and Fine Calipers: A Call to Use Formal Theory as a Toolkit for Theory Construction |journal=Perspectives on Psychological Science |language=en |volume=16 |issue=4 |pages=725–743 |doi=10.1177/1745691620974697 |issn=1745-6916 |pmc=8273080 |pmid=33593176}}

Based on what is known from neuroimaging and behavioral studies of misophonia, the action perception model conceptualizes the disorder as follows:

• Sensory information about any stimulus travels from the ear (eye in the case of visual information) through lemniscal/non-lemniscal auditory pathways (or analogous visual pathways) to arrive at and be processed by primary and higher-level auditory cortex (visual cortex).
• Information is transmitted from a sensory cortex (auditory or visual) to the (pre)motor cortex to form a motor representation of a given action (putatively related to the human "mirror neuron" system).
• Under pathological conditions (e.g., when an individual with misophonia hears a sound that "triggers" them):
• The strength or quality of the "motor representation" may be fundamentally different than in non-misophonic people, as demonstrated by hyperactivity of regions responsible for creating these representations.{{cite journal | vauthors = Kumar S, Tansley-Hancock O, Sedley W, Winston JS, Callaghan MF, Allen M, Cope TE, Gander PE, Bamiou DE, Griffiths TD | title = The Brain Basis for Misophonia | journal = Current Biology | volume = 27 | issue = 4 | pages = 527–533 | date = February 2017 | pmid = 28162895 | pmc = 5321671 | doi = 10.1016/j.cub.2016.12.048 | bibcode = 2017CBio...27..527K }}
• The aberrant motor representation conveys an abnormally strong signal to the (anterior) insular cortex, which is then hyperactive relative to non-misophonic controls.
• Although it is less clear whether this pathway is aberrant or hyperactive due to mixed/limited empirical findings, the insula communicates this signal to (a) the amygdala (putatively responsible for the extreme emotional responses during a misophonic reaction) and (b) autonomic control centers such as the periaqueductal gray and several hypothalamic nuclei (putatively responsible for physiologic aspects of a misophonic reaction, such as changes in heart rate, skin conductance, and potentially other subjective symptoms of being triggered).
• Though the action perception model denotes the "information flow" through the central nervous system as unidirectional, the authors note that more complex bidirectional interactions between the various nodes of the implicated brain network are likely.

The action perception model arguably represents a major advance over previous theoretical work in this area, particularly in its ability to explain the neuroimaging data on misophonia published before 2024, when the theory was first proposed. Additionally, by focusing on higher-order "motor representations" of objects/actions that are abstracted from their initial sensory information and represented in association cortex (i.e., motor/premotor and limbic areas), the model can be applied to both the auditory and non-auditory triggers of misophonia (i.e., misokinesia) just as easily. But the action perception model appears to apply only to misophonic reactions to human-generated trigger sounds. The action perception model appears consistent with certain clinical features of misophonia, such as the extreme context-specificity of the condition, given that the perceived (even if incorrectly perceived) source of the sound{{Cite journal |last1=Samermit |first1=Patrawat |last2=Young |first2=Michael |last3=Allen |first3=Allison K. |last4=Trillo |first4=Hannah |last5=Shankar |first5=Sandhya |last6=Klein |first6=Abigail |last7=Kay |first7=Chris |last8=Mahzouni |first8=Ghazaleh |last9=Reddy |first9=Veda |last10=Hamilton |first10=Veronica |last11=Davidenko |first11=Nicolas |date=2022-07-22 |title=Development and Evaluation of a Sound-Swapped Video Database for Misophonia |journal=Frontiers in Psychology |volume=13 |doi=10.3389/fpsyg.2022.890829 |doi-access=free |issn=1664-1078 |pmc=9355709 |pmid=35936325}} and whether the source can be identified{{Cite journal |last1=Savard |first1=Marie-Anick |last2=Sares |first2=Anastasia G. |last3=Coffey |first3=Emily B. J. |last4=Deroche |first4=Mickael L. D. |date=2022-05-26 |title=Specificity of Affective Responses in Misophonia Depends on Trigger Identification |journal=Frontiers in Neuroscience |volume=16 |doi=10.3389/fnins.2022.879583 |doi-access=free |issn=1662-453X |pmc=9179422 |pmid=35692416}} appear to be among the largest drivers of the severity of a given misophonic reaction. Last, although still largely speculative, the action perception model provides an explanation for the peculiar observation that many people with misophonia (46.7% of this population in a recent study by Kumar's group){{Cite journal |last1=Ash |first1=Paris A. |last2=Benzaquén |first2=Ester |last3=Gander |first3=Phillip E. |last4=Berger |first4=Joel I. |last5=Kumar |first5=Sukhbinder |date=2024-01-01 |title=Mimicry in misophonia: A large-scale survey of prevalence and relationship with trigger sounds |url=https://onlinelibrary.wiley.com/doi/10.1002/jclp.23605 |journal=Journal of Clinical Psychology |language=en |volume=80 |issue=1 |pages=186–197 |doi=10.1002/jclp.23605 |pmid=37850971 |issn=0021-9762}} engage in mimicry (deliberate or unconscious imitation of the trigger sound). As the anterior insula is engaged when counter-imitating an action (i.e., performing the opposite of the imitated movement),{{Cite journal |last1=Campbell |first1=Megan E.J. |last2=Mehrkanoon |first2=Steve |last3=Cunnington |first3=Ross |date=2018-03-01 |title=Intentionally not imitating: Insula cortex engaged for top-down control of action mirroring |journal=Neuropsychologia |language=en |volume=111 |pages=241–251 |doi=10.1016/j.neuropsychologia.2018.01.037|pmid=29408525 |doi-access=free }} Kumar and colleagues theorize that this mimicry conveys an "error signal" that helps inhibit the hyperactive insular cortex involved in the triggering process, thereby reducing the intensity of the misophonic response.

Despite its apparent success in explaining findings in the misophonia literature, the action perception model's predictions are largely untested, and many aspects of the model rely on empirical studies with substantial methodological limitations. The basic neural mechanisms of action perception, mimicry, and the role (if any) of the "human mirror neuron system" within a broader social cognition framework in non-clinical populations must be further explored. The role of other co-occurring conditions, particularly those such as autism that are known to both affect social cognition and cooccur with misophonia at exceptionally high rates,{{Cite journal |last1=Williams |first1=Zachary J. |last2=He |first2=Jason L. |last3=Cascio |first3=Carissa J. |last4=Woynaroski |first4=Tiffany G. |date=February 2021 |title=A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms |journal=Neuroscience & Biobehavioral Reviews |language=en |volume=121 |pages=1–17 |doi=10.1016/j.neubiorev.2020.11.030 |pmc=7855558 |pmid=33285160}} is also an area for future research to explore and test the model. The evidence supporting the action perception model is essentially correlational, not causal; that is, it is unclear whether motor representations cause misophonic reactions or misophonia is a primarily auditory experience sometimes accompanied by motor representations.

In 2022, clinical and scientific leaders convened to create a consensus definition of misophonia, agreeing that it is a disorder of decreased tolerance to specific sounds and their associated stimuli. During the early phase of research on misophonia, it was defined by different criteria, and different methods were used to diagnose it and assess symptom severity. As a result of lack of consensus about how to define and evaluate misophonia, comparisons between study cohorts were difficult, measurement tools were not psychometrically well-validated, and the field could not rigorously assess the efficacy of different treatment approaches. The consensus definition is still not universally accepted by misophonia experts.

Despite some early proposals,{{cite journal | vauthors = Dozier TH, Lopez M, Pearson C | title = Proposed Diagnostic Criteria for Misophonia: A Multisensory Conditioned Aversive Reflex Disorder | journal = Frontiers in Psychology | volume = 8 | pages = 1975 | date = 2017-11-14 | pmid = 29184520 | pmc = 5694628 | doi = 10.3389/fpsyg.2017.01975 | doi-access = free }} there is no scholarly consensus about diagnostic criteria or assessment procedures for misophonia. Many doctors are unaware of the disorder.

It appears that misophonia can occur on its own or with other health, developmental, and psychiatric problems. These comorbid conditions include anxiety disorders, post-traumatic stress disorder,{{cite medrxiv | vauthors = Smit DJ, Bakker M, Abdellaoui A, Hoetink AE, Vulink NC, Denys D |title=Genetic evidence for the link of misophonia with psychiatric disorders and personality |date=9 September 2022 |medrxiv=10.1101/2022.09.04.22279567 }} OCD,{{cite journal | vauthors = Zai G, Dembo J, Levitsky N, Richter MA | title = Misophonia: A Detailed Case Series and Literature Review | journal = The Primary Care Companion for CNS Disorders | volume = 24 | issue = 5 | date = September 2022 | pmid = 36179361 | doi = 10.4088/PCC.21cr03124 | s2cid = 252645598 }}{{cite book | veditors = Storch EA, Mckay D, Abramowitz JS |title=Advanced Casebook of Obsessive-Compulsive and Related Disorders: Conceptualizations and Treatment |date=2019 |publisher=Academic Press |isbn=978-0-12-816557-7 }}{{page needed|date=February 2024}}{{cite journal | vauthors = Webber TA, Johnson PL, Storch EA | title = Pediatric misophonia with comorbid obsessive-compulsive spectrum disorders | journal = General Hospital Psychiatry | volume = 36 | issue = 2 | pages = 231.e1–231.e2 | date = March 2014 | pmid = 24333158 | doi = 10.1016/j.genhosppsych.2013.10.018 }} and depressive disorders.{{cite journal | vauthors = Guzick AG, Cervin M, Smith EE, Clinger J, Draper I, Goodman WK, Lijffijt M, Murphy N, Lewin AB, Schneider SC, Storch EA | title = Clinical characteristics, impairment, and psychiatric morbidity in 102 youth with misophonia | journal = Journal of Affective Disorders | volume = 324 | pages = 395–402 | date = March 2023 | pmid = 36584703 | pmc = 9878468 | doi = 10.1016/j.jad.2022.12.083 }}{{cite journal | vauthors = Cassiello-Robbins C, Anand D, McMahon K, Brout J, Kelley L, Rosenthal MZ | title = A Preliminary Investigation of the Association Between Misophonia and Symptoms of Psychopathology and Personality Disorders | journal = Frontiers in Psychology | volume = 11 | pages = 519681 | date = 2021 | pmid = 33519567 | pmc = 7840505 | doi = 10.3389/fpsyg.2020.519681 | doi-access = free }} Misophonia is distinguishable from hyperacusis, which is not specific to a given sound and need not involve a similarly strong emotional reaction, and from phonophobia, the fear of sounds, but it may occur with either.{{cite book |vauthors=Jastreboff PJ, Jastreboff MM |veditors=Aminoff MJ, Boller F, Swaab DF | title = The Human Auditory System - Fundamental Organization and Clinical Disorders | chapter = Decreased sound tolerance | year = 2015 | volume = 129 | pages = 375–87 | doi = 10.1016/B978-0-444-62630-1.00021-4 | pmid = 25726280 | series = Handbook of Clinical Neurology |publisher=Elsevier | isbn = 978-0-444-62630-1 }} When attempting to diagnose a patient with misophonia, doctors sometimes mistake its symptoms for an anxiety disorder, bipolar disorder, obsessive-compulsive disorder, or obsessive-compulsive personality disorder.{{cite SSRN | vauthors = Holtz Z, Rosenthal MZ, Trumbull J |title=Disentangling the Relationship between Misophonia, Anxiety, and Obsessive-Compulsive Personality Disorder |date=2023 |ssrn=4356614 }}{{cite thesis | vauthors = Szykowny N |date=2020 |title=The Relationship Between Misophonia and Perfectionism |url=https://www.proquest.com/openview/22003ce8a9ef83093a3bb1718e7b0534/1 | degree = Doctor of Psychology| publisher = Palo Alto University }}{{page needed|date=February 2024}}{{cite journal | vauthors = Castro A, Lindberg RR, Kim G, Brennan C, Jain N, Khan RA, Husain F, Berenbaum H |journal=PsyArXiv Preprints |title=Obsessive-Compulsive Symptoms and Sound Sensitivities: Comparing Misophonia and Hyperacusis |date=10 March 2023 |doi=10.31234/osf.io/92yas |url=https://psyarxiv.com/92yas/ }}{{cite book |doi=10.1016/B978-0-12-816563-8.00001-2 |chapter=Chew on this: Considering misophonia and obsessive-compulsive disorder |title=Advanced Casebook of Obsessive-Compulsive and Related Disorders |date=2020 |pages=1–19 |isbn=978-0-12-816563-8 |s2cid=213436071 | vauthors = Wu MS, Banneyer KN |publisher=Academic Press }}{{cite journal | vauthors = Reid AM, Guzick AG, Gernand A, Olsen B |title=Intensive cognitive-behavioral therapy for comorbid misophonic and obsessive-compulsive symptoms: A systematic case study |journal=Journal of Obsessive-Compulsive and Related Disorders |date=July 2016 |volume=10 |pages=1–9 |doi=10.1016/j.jocrd.2016.04.009 }}

Due in part to the need for differential diagnosis with other psychiatric and audiological conditions, academic commentaries make various recommendations regarding misophonia assessment, including that misophonia diagnoses be made by multidisciplinary groups and draw upon multiple sources of data.{{cite journal | vauthors=((Campbell, J.)) | journal=Journal of the American Academy of Audiology | title=Misophonia: A Need for audiologic diagnostic guidelines | pages=a-2125-7645 | date=10 July 2023 | volume=34 | issue=7–08 | issn=2157-3107 | doi=10.1055/a-2125-7645| pmid=37429565 | pmc=11586086 }}

The diagnosis of misophonia is not recognized in the DSM-5-TR or the ICD-11 and it is not classified as a hearing or psychiatric disorder.{{cite journal |vauthors=Duddy DF, Oeding KA | year = 2014 | title = Misophonia: An Overview | journal = Semin Hear | volume = 35 | issue = 2| pages = 084–091 | doi = 10.1055/s-0034-1372525 | s2cid = 76090599 }}

The consensus of misophonia experts is that the relationship between misophonia and other conditions is not yet clear. Scholars debate whether misophonia should be considered an audiological or psychiatric disorder, with some evidence favoring the latter view. It has been tentatively suggested that misophonia belongs to the spectrum of obsessive-compulsive-and-related disorders, although the authors of this proposal also describe it as "premature".

Misophonia has generally been measured using adult self-report questionnaires.{{cite journal | vauthors=((Kula, F. B.)), ((Cropley, M.)), ((Aazh, H.)) | journal=Journal of the American Academy of Audiology | title=Hyperacusis and Misophonia: A Systematic Review of Psychometric Measures | volume=33 | issue=7/08 | pages=417–428 | date= July 2022 | issn=2157-3107 | doi=10.1055/a-1896-5032| pmid=35817311 | url=https://openresearch.surrey.ac.uk/view/delivery/44SUR_INST/12171940600002346/13171940590002346 }} A 2021 review of misophonia and hyperacusis measures found only three misophonia instruments with reported psychometric properties, all of which were adult self-report measures; the review called the evidence regarding the measures' psychometrics "limited". Psychometric properties of a number of additional adult self-report misophonia measures have since been reported in the scholarly literature.{{cite journal | vauthors=((Dibb, B.)), ((Golding, S. E.)), ((Dozier, T. H.)) | journal=Journal of Psychosomatic Research | title=The development and validation of the Misophonia response scale | volume=149 | pages=110587 | publisher=Elsevier Inc. | date= 2021 | issn=0022-3999 | doi=10.1016/j.jpsychores.2021.110587| pmid=34390941 | doi-access=free }}{{cite journal | vauthors = Naylor J, Caimino C, Scutt P, Hoare DJ, Baguley DM | title = The Prevalence and Severity of Misophonia in a UK Undergraduate Medical Student Population and Validation of the Amsterdam Misophonia Scale | journal = The Psychiatric Quarterly | volume = 92 | issue = 2 | pages = 609–619 | date = June 2021 | pmid = 32829440 | pmc = 8110492 | doi = 10.1007/s11126-020-09825-3 }}{{cite journal | vauthors=((Remmert, N.)), ((Schmidt, K. M. B.)), ((Mussel, P.)), ((Hagel, M. L.)), ((Eid, M.)) | journal=PLOS ONE | title=The Berlin Misophonia Questionnaire Revised (BMQ-R): Development and validation of a symptom-oriented diagnostical instrument for the measurement of misophonia | volume=17 | issue=6 | pages=e0269428 | date=21 June 2022 | issn=1932-6203 | doi=10.1371/journal.pone.0269428| doi-access=free | pmid=35727794 | pmc=9212156 | bibcode=2022PLoSO..1769428R }}{{cite journal | vauthors=((Simner, J.)), ((Rinaldi, L. J.)), ((Ward, J.)) | journal=Assessment | title=An Automated Online Measure for Misophonia: The Sussex Misophonia Scale for Adults | volume=31 | issue=8 | pages=1598–1614 | date=27 February 2024 | issn=1552-3489 | doi=10.1177/10731911241234104| pmid=38414185 | pmc=11528938 }}{{cite journal | vauthors=((Williams, Z. J.)), ((Cascio, C. J.)), ((Woynaroski, T. G.)) | journal=Frontiers in Psychology | title=Psychometric validation of a brief self-report measure of misophonia symptoms and functional impairment: The duke-vanderbilt misophonia screening questionnaire | volume=13 | pages=897901 | date=22 July 2022 | issn=1664-1078 | doi=10.3389/fpsyg.2022.897901| doi-access=free | pmid=35936331 | pmc=9355318 }} Further unvalidated misophonia questionnaires are available on the internet.{{cite journal | vauthors=((Siepsiak, M.)), ((Sliwerski, A.)), ((Dragan, W. Ł.)) | journal=International Journal of Environmental Research and Public Health | title=Development and psychometric properties of MisoQuest — A new self-report questionnaire for misophonia | volume=17 | pages=1797 | date= 2020 | issue=5 | doi=10.3390/ijerph17051797| doi-access=free | pmid=32164250 | pmc=7084437 }}

More recently, self-report and caregiver proxy-report measures intended to measure misophonia in children and youth have begun to appear in the scholarly literature.{{cite journal | vauthors=((Cervin, M.)), ((Guzick, A. G.)), ((Clinger, J.)), ((Smith, E. E. A.)), ((Draper, I. A.)), ((Goodman, W. K.)), ((Lijffijt, M.)), ((Murphy, N.)), ((Rast, C. E.)), ((Schneider, S. C.)), ((Storch, E. A.)) | journal=Journal of Affective Disorders | title=Measuring misophonia in youth: A psychometric evaluation of child and parent measures | volume=39 | pages=180–186 | date= May 2023 | issn=0165-0327 | doi=10.1016/j.jad.2023.05.093| pmid=37263358 | pmc=11165319 }}{{cite journal | vauthors=((Rappoldt, L. R.)), ((Kan, K. J.)), ((Dalmeijer, L.)), ((Rutten, S. A.)), ((Van Horen, R.)), ((Van Der Pol, M. M.)), ((De Wit, C.)), ((Denys, D.)), ((Vulink, N. C. C.)), ((Utens, E. M. W. J.)) | journal=Child Psychiatry & Human Development | title=Psychometric Validation of the New Misophonia Screening List—Child and Youth and AMISOS-Y (Dutch Child- and Parent-Report Versions) for Assessing Misophonia in Youth | date=14 November 2024 | issn=1573-3327 | doi=10.1007/s10578-024-01781-4 | pmid=39540976 | doi-access=free }}{{cite journal | vauthors=((Rinaldi, L. J.)), ((Smees, R.)), ((Ward, J.)), ((Simner, J.)) | journal=Frontiers in Psychology | title=Poorer Well-Being in Children With Misophonia: Evidence From the Sussex Misophonia Scale for Adolescents | volume=13 | pages=808379 | date=6 April 2022 | issn=1664-1078 | doi=10.3389/fpsyg.2022.808379| doi-access=free | pmid=35465571 | pmc=9019493 }} At least one study uses interviews with caregivers, and sometimes their children, to assess misophonia in children and adolescents.{{cite journal | vauthors=((Siepsiak, M.)), ((Turek, A.)), ((Michałowska, M.)), ((Gambin, M.)), ((Dragan, W. Ł.)) | journal=Child Psychiatry & Human Development | title=Misophonia in Children and Adolescents: Age Differences, Risk Factors, Psychiatric and Psychological Correlates. A Pilot Study with Mothers' Involvement | date=8 September 2023 | volume=56 | issue=3 | pages=758–771 | issn=0009-398X|eissn=1573-3327 | doi=10.1007/s10578-023-01593-y | pmid=37684420 | pmc=12095346 }}

Another relatively novel development in misophonia assessment is a psychoacoustic measure, which uses adults' self-reported ratings of the pleasantness of sounds to identify a set of sounds that appear to distinguish between people with and without misophonia.{{cite journal | vauthors=((Enzler, F.)), ((Loriot, C.)), ((Fournier, P.)), ((Noreña, A. J.)) | journal=Scientific Reports | title=A psychoacoustic test for misophonia assessment | volume=11 | pages=11044 | date= 2021 | issue=1 | issn=2045-2322 | doi=10.1038/s41598-021-90355-8| pmid=34040061 | pmc=8155015 | bibcode=2021NatSR..1111044E }}

Due to the difficulty of distinguishing misophonia from other psychiatric and audiological conditions, it is unclear whether any single tool can be relied upon to diagnose misophonia. It has been suggested that assessment should involve collection of multiple sources of data, such as patient case histories, interviews, audiological examination, and self-report tools.

Despite high demand in the community,{{cite journal | vauthors=((Abraham, K. L.)), ((Rast, C. E.)), ((Storch, E. A.)), ((Guzick, A. G.)) | journal=Personalized Medicine in Psychiatry | title=What's next for misophonia? Child and parent priorities for misophonia advocacy, treatment, and research | volume=51–52 | pages=100160 | date= July 2025 | issn=2468-1717 | doi=10.1016/j.pmip.2025.100160}} there has been relatively limited research into misophonia treatment and intervention, and few clinical providers have extensive knowledge of it. People seeking misophonia treatment often rate it unsatisfactory.{{cite journal | vauthors = Smith EE, Guzick AG, Draper IA, Clinger J, Schneider SC, Goodman WK, Brout JJ, Lijffijt M, Storch EA | title = Perceptions of various treatment approaches for adults and children with misophonia | journal = Journal of Affective Disorders | volume = 316 | pages = 76–82 | date = November 2022 | pmid = 35970326 | pmc = 9884516 | doi = 10.1016/j.jad.2022.08.020 }} Indeed, no misophonia treatments or interventions currently qualify as evidence-based. But several recent studies investigated cognitive-behavioural therapy (CBT) as an option, and there are reports of other approaches, including tinnitus retraining therapy (TRT), exposure therapy, third-wave psychotherapies such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT), and some pharmacological treatments.

CBT-based programs have the strongest evidentiary support of any misophonia treatment so far. Trials of a group-based CBT program,{{cite journal | vauthors=((Schröder, A. E.)), ((Vulink, N. C.)), ((Van Loon, A. J.)), ((Denys, D. A.)) | journal=Journal of Affective Disorders | title=Cognitive behavioral therapy is effective in misophonia: An open trial | volume=217 | pages=289–294 | date= August 2017 | issn=0165-0327 | doi=10.1016/j.jad.2017.04.017}}{{cite journal | vauthors=((Jager, I. J.)), ((Vulink, N. C. C.)), ((Bergfeld, I. O.)), ((Loon, A. J. J. M.)), ((Denys, D. A. J. P.)) | journal=Depression and Anxiety | title=Cognitive behavioral therapy for misophonia: A randomized clinical trial | volume=38 | issue=7 | pages=708–718 | date= 2020 | issn=1091-4269 | doi=10.1002/da.23127| pmid=33336858 | pmc=8359510 }} one of them a randomized clinical trial, have found reductions in misophonia symptoms, and reductions in misophonia symptoms appeared to be maintained one year later. Another randomized clinical trial evaluated a CBT-based mobile health app, which also appeared to reduce misophonia symptoms.{{cite journal | vauthors=((Podoly, T. Y.)), ((Even-Ezra, H.)), ((Doron, G.)) | journal=Journal of Affective Disorders | title=A randomized controlled trial evaluating an mHealth intervention for anger-related cognitions in misophonia | volume=379 | pages=350–361 | date= June 2025 | issn=0165-0327 | doi=10.1016/j.jad.2025.03.060| pmid=40081589 }}

Several case reports on third-wave psychotherapies such as DBT or ACT have found preliminary evidence of possible benefits. A small-scale randomized pretest-posttest study has compared online group-based CBT to online group-based mindfulness and ACT, reporting improvements in both treatment conditions and no significant differences in outcome between the two treatments.{{cite journal | vauthors=((Ghorbani, S.)), ((Ashouri, A.)), ((Gharraee, B.)), ((Farahani, H.)) | journal=Iranian Journal of Psychiatry and Behavioral Sciences | title=Effectiveness of Online Group-mindfulness and Acceptance-based Therapy and Cognitive-behavioral Therapy on Misophonia | volume=16 | issue=2 | date=18 May 2022 | url=https://brieflands.com/articles/ijpbs-120159.html | issn=1735-8639 | doi=10.5812/ijpbs-120159 | access-date=14 June 2025}} Additional research is needed to understand the potential utility of ACT and DBT approaches for misophonia intervention.

Investigations of pharmacological treatments for misophonia have been limited to case studies, most frequently of selective serotonin reuptake inhibitors (SSRIs) such as sertraline and fluoxetine. Other case reports discuss how misophonia symptoms may have been secondarily affected by propranolol, risperidone, or methylphenidate prescribed to address other conditions. These case studies may provide directions for further research, such as understanding neurophysiological mechanisms and processes that could be targeted through medication and conducting larger randomized controlled trials. No medications for misophonia can be considered evidence-based.

Many approaches to misophonia treatment leverage the idea that negative evaluations of trigger sounds can be disrupted and replaced by more positive associations. This is the main focus of TRT for misophonia, and it has also been leveraged in CBT-based approaches. A report from a clinical service suggests that most patients with misophonia benefited from TRT, a result that has been called good or promising. But counterconditioning and stimulus manipulation—changing trigger sounds or pairing them with pleasant or humorous stimuli to disrupt negative affective evaluations—were infrequently used by participants in a misophonia CBT trial, and the patients considered these less effective than other strategies used in the program. Traditional habituation-based exposure therapy is not recommended for misophonia.

Several studies report that a very common approach to misophonia management is to amend one's lifestyle and avoid trigger sounds,{{cite journal | vauthors = Cavanna AE, Seri S | title = Misophonia: current perspectives | journal = Neuropsychiatric Disease and Treatment | volume = 11 | pages = 2117–2123 | date = Aug 2015 | pmid = 26316758 | pmc = 4547634 | doi = 10.2147/NDT.S81438 | doi-access = free }} and people with misophonia generally perceive lifestyle changes as highly appropriate. Noise-cancelling headphones and passive sound protection are frequently used and rated by community members as highly appropriate. But there is clinical concern that avoidance might be dysfunctional and could even inadvertently tend to exacerbate some sound intolerance, although some evidence suggests people with misophonia who avoid triggers more often may later have fewer role limitations due to emotional problems,{{cite journal | vauthors=((Dibb, B.)), ((Golding, S. E.)) | journal=Frontiers in Neuroscience | title=A longitudinal investigation of quality of life and negative emotions in misophonia | volume=16 | pages=900474 | date=22 July 2022 | issn=1662-453X | doi=10.3389/fnins.2022.900474| doi-access=free | pmid=35937869 }} which may suggest that at least some level of avoidance is beneficial. There are other approaches to management and coping; some people with misophonia mimic trigger sounds, either to retaliate or cancel them out in a way they can control. People with misophonia may attempt cognitive strategies such as self-talk and diverting their attention. Relaxation is also commonly attempted. Participants in a CBT program considered relaxation, training to shift attention away from triggers, and peer support the most successful parts of the intervention.

Given the limited nature of the misophonia intervention evidence base, it has been suggested that providers work collaboratively and flexibly with patients to identify strategies that are useful to them. It is speculated that treatment methods vary significantly in effectiveness from patient to patient. Where there are gaps in the misophonia-specific literature, transdiagnostic research on interventions found to be efficacious or effective for other conditions may be relevant. Multidisciplinary approaches to treatment, incorporating insights from diverse experts such as audiologists, mental health professionals, and occupational therapists, may also improve the quality of support.

Research is still being conducted on misophonia's global prevalence, but a 2023 study found its prevalence in the UK to be around 18%. This study has been cited in popular outlets, including BBC,{{Cite news |date=2023-03-23 |title=What sounds drive you crazy? |language=en-GB |work=BBC Newsround |url=https://www.bbc.com/newsround/65035879 |access-date=2023-06-14}} Medscape,{{Cite web |title=About a Fifth of Us Are Hypersensitive to Sounds |url=https://www.medscape.com/viewarticle/991451 |access-date=2023-06-14 |website=Medscape |language=en}} and Medical Xpress.{{Cite web |author=Public Library of Science |title=Nearly 1 in 5 UK adults may have misophonia, experiencing significant negative responses to sounds |url=https://medicalxpress.com/news/2023-03-uk-adults-misophonia-experiencing-significant.html |access-date=2023-06-14 |website=medicalxpress.com |language=en}} Studies of misophonia's global prevalence have found it to be as low as 5% and as high as 20%. Its prevalence and severity seem to be similar across genders. In the U.S., it is estimated that 3% of people are affected by misophonia. But in multiple studies, it was determined misophonia may be underdiagnosed (it is not yet an officially diagnosable condition), as it is correlated with other auditory disruptions; 92% of patients who are hyperaware of sounds also have misophonia. There is evidence that significant numbers of undergraduate students in some psychology and medical-science departments suffer from misophonia.{{cite journal | vauthors = Yektatalab S, Mohammadi A, Zarshenas L | title = The Prevalence of Misophonia and Its Relationship with Obsessive-compulsive Disorder, Anxiety, and Depression in Undergraduate Students of Shiraz University of Medical Sciences: A Cross-Sectional Study | journal = International Journal of Community Based Nursing and Midwifery | volume = 10 | issue = 4 | pages = 259–268 | date = October 2022 | pmid = 36274664 | pmc = 9579453 | doi = 10.30476/IJCBNM.2022.92902.1888 }} The University of Nottingham conducted a study of misophonia in one sample of undergraduate medical students. In 2017, similar rates were found in one university in China,{{cite journal | vauthors = Zhou X, Wu MS, Storch EA |title=Misophonia symptoms among Chinese university students: Incidence, associated impairment, and clinical correlates |journal=Journal of Obsessive-Compulsive and Related Disorders |date=July 2017 |volume=14 |pages=7–12 |doi=10.1016/j.jocrd.2017.05.001 }} suggesting that the disorder is not specific to a culture.

It may be the case that people with misophonia are more likely to have high fluid intelligence.{{cite thesis | vauthors = Watson L |title=Investigation of a Misophonia and Fluid Intelligence Relationship: Sound Spectrum Variation Impact on Fluid Intelligence Task Responses |date=2022 |doi=10.58809/MYID1761 }}{{page needed|date=February 2024}}

Some people{{Cite journal |last1=Jakubovski |first1=Ewgeni |last2=Müller |first2=Astrid |last3=Kley |first3=Hanna |last4=de Zwaan |first4=Martina |last5=Müller-Vahl |first5=Kirsten |date=2022-11-21 |title=Prevalence and clinical correlates of misophonia symptoms in the general population of Germany |journal=Frontiers in Psychiatry |language=English |volume=13 |doi=10.3389/fpsyt.2022.1012424 |doi-access=free |pmid=36479555 |pmc=9720274 |issn=1664-0640}} have sought to relate misophonia to autonomous sensory meridian response, or auto-sensory meridian response (ASMR), a pleasant form of paresthesia, a tingling sensation that typically begins on the scalp and moves down the back of the neck and upper spine.{{cite journal | vauthors = Mahady A, Takac M, De Foe A | title = What is autonomous sensory meridian response (ASMR)? A narrative review and comparative analysis of related phenomena | journal = Consciousness and Cognition | volume = 109 | pages = 103477 | date = March 2023 | pmid = 36806854 | doi = 10.1016/j.concog.2023.103477 | s2cid = 256874981 }} ASMR is described as the opposite of what can be observed in reactions to specific audio stimuli in misophonia.{{cite journal | vauthors = Rouw R, Erfanian M | title = A Large-Scale Study of Misophonia | journal = Journal of Clinical Psychology | volume = 74 | issue = 3 | pages = 453–479 | date = March 2018 | pmid = 28561277 | doi = 10.1002/jclp.22500 | hdl-access = free | hdl = 11245.1/c9c45e84-3c70-407e-aa2f-782ccdb79791 | url = https://dare.uva.nl/personal/pure/en/publications/a-largescale-study-of-misophonia(c9c45e84-3c70-407e-aa2f-782ccdb79791).html }} There are plentiful anecdotal reports of people who claim to have both misophonia and ASMR. Common to these reports is the experience of ASMR in response to some sounds and misophonia in response to others.{{cite web |url=https://sites.psu.edu/siowfa15/2015/09/16/asmr-and-misophonia-sounds-crazy/ |title=ASMR and Misophonia: Sounds-Crazy! |series=Science in our world: certainty and controversy |publisher=Pennsylvania State University |date=16 September 2015 |url-status=live |archive-url=https://web.archive.org/web/20230130133103/https://sites.psu.edu/siowfa15/2015/09/16/asmr-and-misophonia-sounds-crazy/ |archive-date= 30 January 2023 }}{{cite web |url=http://neuwritesd.org/2015/06/11/technicalities-of-the-tingles-the-science-of-sounds-that-feel-good-asmr/ |title=Technicalities of the Tingles: The science of sounds that feel good. #ASMR |work=Neuwrite | vauthors = Higa K |date=11 June 2015 |access-date=20 January 2016 |url-status=live |archive-url=https://web.archive.org/web/20230130133046/http://neuwritesd.org/2015/06/11/technicalities-of-the-tingles-the-science-of-sounds-that-feel-good-asmr/ |archive-date= 30 January 2023}}

People who experience misophonia have formed online support groups.{{cite news|url=https://www.nytimes.com/2011/09/06/health/06annoy.html |title=When a Chomp or a Slurp is a Trigger for Outrage | vauthors = Cohen J |date=5 September 2011|newspaper=The New York Times|access-date=5 February 2012 |url-status=live |archive-url=https://web.archive.org/web/20221220162932/https://www.nytimes.com/2011/09/06/health/06annoy.html |archive-date= 20 December 2022}}{{cite journal | vauthors = Schröder A, Vulink N, Denys D | title = Misophonia: diagnostic criteria for a new psychiatric disorder | journal = PLOS ONE | volume = 8 | issue = 1 | pages = e54706 | date = 23 January 2013 | pmid = 23372758 | pmc = 3553052 | doi = 10.1371/journal.pone.0054706 | doi-access = free | bibcode = 2013PLoSO...854706S }}{{Cite web |title=Misophonia Peer Support Meetings |url=https://www.soquiet.org/groups |access-date=2025-01-20 |website=soQuiet Misophonia Advocacy |language=en-US}}

In 2016, a documentary about the condition, Quiet Please, was released.{{cite news| vauthors = Jeffries A |title=There's a New Film About Misophonia, Where People Get Enraged by Certain Sounds|url=https://www.vice.com/en/article/theres-a-new-film-about-misophonia-where-people-are-enraged-by-certain-sounds/|work=Motherboard|date=17 June 2016|language=en-us|access-date=18 September 2020 |url-status=live |archive-url=https://web.archive.org/web/20220701195101/https://www.vice.com/en/article/bmv7ez/theres-a-new-film-about-misophonia-where-people-are-enraged-by-certain-sounds |archive-date= 1 July 2022}}

In 2020, a team of misophonia researchers received the Ig Nobel Prize in medicine "for diagnosing a long-unrecognized medical condition".{{Cite web|url=https://improbable.com/ig/winners/|title=Past Ig Winners|date=1 August 2006|website=improbable.com}}

The 2022 film Tár depicts a conductor with misophonia.{{Cite web |date=2023-01-09 |title=Cate Blanchett Can't Imagine Her Life Without Lydia Tár |url=https://www.wmagazine.com/culture/cate-blanchett-lydia-tar-interview |access-date=2023-06-14 |website=W Magazine |language=en}}

Season 1, episode 4 of Hulu's The Old Man has a brief discussion of misophonia.{{Citation |title="The Old Man" IV (TV Episode 2022) - Trivia - IMDb |url=https://www.imdb.com/title/tt13062110/trivia/ |access-date=2023-06-14 |language=en-US}}

In 2024, numerous misophonia advocacy organizations declared July 9 World Misophonia Awareness Day.{{Cite web |title=Home |url=https://www.misophoniaday.com/ |access-date=2025-05-23 |website=World Misophonia Awareness Day {{!}} July 9th |language=en}}

{{Dynamic list}}

• Melissa Gilbert{{cite news| vauthors = Blackwelder C |title='Little House on the Prairie' alum Melissa Gilbert details life with misophonia|work=Good Morning America|date=21 August 2024|url=https://www.goodmorningamerica.com/culture/story/little-house-prairie-alum-melissa-gilbert-details-life-misophonia-113029552|access-date=22 August 2024}}
• Richard E. Grant{{cite web | title=Off the Menu with Ed Gamble and James Acaster | url=https://pca.st/episode/a72fa3e1-6461-4166-a20f-881acc35fa18 }}
• Barron H. Lerner{{cite web | vauthors = Lerner BH | title=Please Stop Making That Noise | work=Well | publisher=New York Times | date=2 March 2015 | url=http://well.blogs.nytimes.com/2015/02/23/please-stop-making-that-noise/ | access-date=18 October 2016}}
• Lisa Loeb{{Cite web |title=S6E19 - Lisa Loeb {{!}} The Misophonia Podcast |url=https://misophoniapodcast.com/episodes/s6e19-lisa-loeb |access-date=2023-06-14 |website=S6E19 - Lisa Loeb {{!}} The Misophonia Podcast}}
• Melanie Lynskey{{Cite news|url=https://www.theguardian.com/tv-and-radio/2015/mar/10/melanie-lynskey-on-realism-radical-nudity-and-new-zealands-tall-poppy-syndrome|title=Melanie Lynskey on Togetherness, realism and 'radical' nudity| vauthors = Bisley A |date=10 March 2015|work=The Guardian|access-date=30 June 2017|language=en-GB|issn=0261-3077}}
• Laila McQueen{{Cite news|url=https://www.queerty.com/10-things-you-never-knew-about-laila-mcqueen-20160330|title= 10 Things You Never Knew About Laila McQueen| vauthors =Allen T |date=30 March 2016|website=Queerty |access-date=31 October 2023}}
• Pharrell Williams{{Cite web |last=sourspice |date=2024-10-10 |title=Pharrell 🤝 Misophonia |url=https://www.reddit.com/r/misophonia/comments/1g0rct3/pharrell_misophonia/?rdt=50456 |access-date=2024-10-23 |website=r/misophonia}}
• Kelly Osbourne{{cite news | vauthors = Desborough J |date=26 July 2018 |title=Kelly Osbourne reveals strange phobia which causes her to rip food from people's mouths |work=mirror.co.uk |url=https://www.mirror.co.uk/tv/tv-news/kelly-osbourne-reveals-strange-phobia-12984327 |quote=As the Loose Women panel discussed irritating habits that their husbands might have, she told Jane Moore: "I have misophonia, it's a phobia of mouth noises. I can't handle it." Kelly revealed she can't bear the sound of loud eating, which is a problem for her dating as she as men often have "bigger mouths" than women .. Misophonia is technically a phobia of sounds in general, and is sometime referred to as "sound rage" as people become enraged just by noises which seem to rub them up the wrong way.}}
• Kelly Ripa{{Cite AV media |url=https://abcnews.go.com/2020/video/ripa-kelly-misophonia-medical-mystery-disorder-mental-health-2020-16383771 |title=Misophonia: Kelly Ripa Has Rare Disorder |date=18 May 2012 |publisher=ABC News |access-date=18 October 2016 |archive-url=https://web.archive.org/web/20120619082203/https://abcnews.go.com/2020/video/ripa-kelly-misophonia-medical-mystery-disorder-mental-health-2020-16383771 |archive-date=2012-06-19 |url-status=dead |work=20/20}}
• Sarah Silverman{{cite AV media|title=Dogshit, Comedy and Pain|medium=YouTube video|publisher=The Sarah Silverman Podcast|date=17 March 2022|url=https://www.youtube.com/watch?v=6ce4wTE2_b4&t=27m39s|access-date=8 February 2023}}

• Active noise control
• Chalkboard scraping
• Hearing protection device
• Hyperacusis
• Noise control
• Phonophobia
• Safe listening
• Sensory processing disorder
• Stimulus control
• Tinnitus retraining therapy

{{Reflist}}

{{refbegin}}

• {{cite book | vauthors = Jastreboff PJ | chapter = Tinnitus, Hyperacusis, Misophonia☆ |date= January 2017 | chapter-url= https://www.sciencedirect.com/science/article/pii/B9780128093245020289 | title = Reference Module in Neuroscience and Biobehavioral Psychology |publisher=Elsevier | doi = 10.1016/B978-0-12-809324-5.02028-9 |language=en |isbn=978-0-12-809324-5}}

{{refend}}

• [https://www.misophonia.duke.edu/ The Duke Center for Misophonia and Emotion Regulation], part of Duke University Health System
• [https://misophoniaresearchfund.org/ Misophonia Research Fund], initiative of a private family foundation
• [http://www.quietpleasefilm.com/ Quiet Please], official website of 2016 documentary about misophonia, with trailer

{{Medicine|state=collapsed}}

{{Authority control}}

Category:Central nervous system disorders

Category:Diseases of the ear and mastoid process

Category:Mental disorders

Category:Synesthesia