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Perception–Action Network Model: Auditory-Motor-Insula Pathway Linking Mimicry to Misophonic Distress

In their 2024 literature review, Berger outlines a social cognitive perspective of misophonia in which auditory stimuli are conveyed through lower auditory pathways to both higher-order auditory regions, such as the superior temporal sulcus, and to motor regions, where the sounds are transformed into motor representations of action. Individuals with misophonia show increased connectivity between the auditory system and motor cortex, suggesting an enhanced perception–action coupling. This aberrant motor-related signal is then communicated to the anterior insula, supported by findings of stronger motor–insula connectivity and increased insula activation in response to trigger sounds. Neuroimaging evidence further indicates that the anterior insula is engaged when countering mirrored actions, implying a role in processing error signals or conflict within the perception–action system. From there, the insula may relay signals to the amygdala, generating emotional responses, and to autonomic regions such as the periaqueductal gray, producing physiological changes including altered heart rate and skin conductance. Within this framework, the perception–action network offers a potential explanation for the high prevalence of mimicry in misophonia, as unconscious or deliberate imitation may serve to relieve distress by dampening insula hyperactivity (Berger et al., 2024).