Ozuer 2025 on Defensive rage in misophonia

in a 2025 study of a focus group of 8 people, they described overwhelming anger when exposed to trigger sounds, especially when produced by known individuals (e.g., partners, family). They often interpreted these sounds as boundary violations, not just annoying, but as assaults on their autonomy or personal space. The paper links these experiences to defensive rage, noting: The anger is rapid and reflexive, not deliberative. It is often described as an internal surge, intense and physiological, but not always acted upon. People with misophonia may perceive themselves as under attack, and their response is a self-defensive emotional reflex. (Ozuer et al., 2025)

central role of anger and disgust in Misophonia

In a 2022 study, Dibb and Golding conducted a longitudinal study looking at which negative emotions (anger, disgust, or anxiety) are most strongly associated with misophonia. they found that Anger and disgust emerged as the primary emotions associated with misophonia, with both predicting misophonic responses over time even after controlling for depression. Disgust specifically predicted stronger emotional responses to triggers and greater perceived impact on participation in life at follow-up, while anger predicted longer recovery times and stronger physiological responses. Both anger and disgust predicted overall misophonia severity scores longitudinally, whereas anxiety did not predict any misophonic responses over time, indicating that anger and disgust are more central to the misophonic experience than anxiety (Dibb & Golding, 2022). Also note that This directly contradicts (Jager et al., 2021) finding of no association between disgust and misophonia

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4 themes to experience of caregivers of Misophonics

Molthrop et al. (2026) surveyed 22 US caregivers of individuals with misophonia and used reflexive thematic analysis on open-ended responses to characterize the caregiver experience through four interrelated themes. The household itself is reshaped by the disorder, with disrupted mealtimes, family members serving as trigger sources, a chronically tense atmosphere, and the child's withdrawal from shared activities. Caregivers in turn carry a heavy emotional toll of grief, guilt, and depletion alongside sustained lifestyle sacrifice, though a few report positive impacts such as validation through shared diagnosis. Layered onto this are financial pressures from treatment and accommodation costs, insufficient insurance coverage, and lost work time, as well as non-financial barriers including a scarcity of misophonia-aware providers, a lack of effective interventions, and limited family awareness of the disorder itself (Molthrop et al., 2026).

Secondary emotional and somatic consequences of misophonia in youth

Guzick et al. (2024) thematically analyzed focused interviews with 20 youth-parent dyads and found that beyond acute trigger reactions, youth experienced chronic stress, anxiety, depression, emotional exhaustion, somatic complaints attributed to muscle tension, guilt over aggressive responses, and negative self-perception, with high emotional burden carrying through the school day. The authors concluded that these secondary consequences contribute substantially to the disorder's burden and warrant clinical attention independent of trigger reactivity itself (Guzick et al., 2024).

Kook 2024 findings on youths quality of life with Misophonia

A 2024 survey of 102 youth with impairing misophonia symptoms examined Quality of life (QoL) compared to a general U.S. sample and tested clinical correlates of QoL. Youth with misophonia showed significantly lower QoL overall (small effect), with moderately lower QoL among adolescents (≥14 years) but no significant difference among younger children. Internalizing symptoms (24.9% unique variance) and misophonia-related pessimism (13.3%) were the strongest correlates of poorer QoL, whereas age, number of triggers, and gender contributed minimally. The authors concluded that adolescents with misophonia are particularly vulnerable to reduced QoL, that internalizing symptoms and pessimism are the primary correlates of impairment, and that age-related declines in QoL may be driven by increases in internalizing symptoms. Externalizing symptoms were not uniquely associated with QoL. (Kook et al., 2024)

Dibb and Golding 2022 findings on Quality of life in Misophonia

In a 2022 study, Dibb and Golding conducted a longitudinal study looking at quality of life for Misophonics vs controls. they found that People with self-reported misophonia had significantly lower quality of life than the general population across all eight measured health domains (physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional wellbeing, social functioning, pain, and general health), with the largest differences in role limitations due to emotional problems, energy/fatigue, emotional wellbeing, and social functioning. Compared to other conditions, the misophonia group scored lower than people with long-term physical conditions and similar to those with tinnitus, but higher than those with obsessive compulsive disorder on several domains. Longitudinally, misophonia predicted quality of life over time on only two domains (role limitations due to emotional problems and pain), with depression remaining the strongest predictor across most quality of life domains (Dibb & Golding, 2022).

a theme of Coping Behaviors in Misophonia

Dibb et al. (2026) conducted 24 semi-structured interviews with adults reporting misophonia (screened with the Misophonia Response Scale), analysing them inductively with reflexive thematic analysis, and found that coping formed a central strand of their "influencing factors" theme, spanning avoidance, active environmental control, earplug use, and distraction, alongside a sense of relief and validation from encountering other misophonics after prolonged isolation. The authors concluded that avoidant coping and awareness of available support are the two most tractable targets for reducing the condition's negative impact, framing both as points of leverage for intervention (Dibb et al., 2026).

coping strategies in treatment seeking youth

In a 2026 study, Pfeiffer et al. examined treatment-seeking youth with probable misophonia across four inpatient and outpatient mental health facilities in Germany and Austria. In the absence of any misophonia-specific evidence-based treatment available in either country, the most commonly self-generated coping strategies were listening to music (57.81%) and leaving the room (25.00%). The authors note these strategies reflect resourcefulness but may carry the long-term risk of social avoidance and reduced opportunities for healthy socio-emotional development (Pfeiffer et al., 2026).

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Berger et al. (2024): Mimicry Prevalence, Severity Scaling, and Distress Relief Effects Demand Integration into Misophonia Models

In their 2024 literature review on misophonia and the role of social cognition, Berger describes mimicry as a frequently reported feature of misophonia that poses a challenge to existing conceptual frameworks. Early case studies had already identified mimicry as a key characteristic of the condition, and initial self-report data suggested that approximately 55% of sufferers engaged in mimicry, although this estimate was based on a small sample. A larger online study with 676 participants replicated this pattern, finding a similar incidence rate of over 45%. Importantly, mimicry was shown to increase with greater misophonia severity, to be more commonly triggered by orofacial sounds such as eating and chewing than by environmental or other human-produced sounds, and to provide relief from distress for some individuals. Together, these findings raise important theoretical questions about why mimicry occurs and why it may alleviate distress, underscoring the need to incorporate mimicry into models of misophonia (Berger et al., 2024)

a theme of Subjective Experience of Triggers in Misophonia

Dibb et al. (2026) interviewed 24 adults reporting misophonia (screened with the Misophonia Response Scale) and, using reflexive thematic analysis, documented the self-reported bodily experience accompanying triggers, including a raised heart rate, body-wide electric-shock sensations, and, for some participants, unwanted sexual arousal, together with involuntary behavioural responses such as staring, mimicking, fleeing, and hypervigilance. The authors concluded that the misophonic response is experienced as a whole-body phenomenon combining visceral physiological change with reflexive, hard-to-suppress behavior (Dibb et al., 2026).

focus on subjective experience of triggers

In a 2026 study, Pfeiffer et al. examined treatment-seeking youth with probable misophonia across four inpatient and outpatient mental health facilities in Germany and Austria. The most commonly reported trigger sounds were mouth/nose sounds (96.97%), eating sounds (93.94%), and background sounds (87.88%), consistent with prior misophonia literature. The majority of participants (83.08%) reported that their most severe misophonic problems occurred in the presence of other people, with classmates identified as the most frequent trigger persons (68.18%), followed by mothers (62.12%) and fathers (56.06%), extending prior evidence that had focused primarily on family members as trigger sources (Pfeiffer et al., 2026).

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Characterizing real time course of Misophonic responses

In a 2026 study, Shan attempted to characterize real-time emotional responses to misophonia triggers in naturalistic settings and examine their temporal dynamics and individual variability, by having 40 adults with misophonia complete smartphone surveys five times daily for 10 days, rating 16 negative emotions during both trigger and no-trigger periods. They found that triggers elicited significant elevations in negative emotions (particularly irritability and anger, with large effect sizes), most emotions returned to baseline within 31-60 minutes, but substantial individual variability existed in both reactivity magnitude and recovery speed, with greater reactivity associated with higher baseline negative affect, misophonia severity, and co-occurring psychopathology. From this they concluded that misophonia involves phasic context-dependent emotional reactivity centered on anger rather than chronic distress or primarily fear-based responses, and that treatment should move beyond one-size-fits-all fear-based approaches toward personalized, process-based interventions targeting individual emotional patterns, anger regulation, and distress tolerance. (Shan et al., 2026)

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strong link between physiological and affective dimensions of Misophonia

In a 2026 study, Woolley aimed to qualitatively characterize negative cognitions during and after misophonia triggers by analyzing interview responses from 60 treatment-seeking adults. they found that many of the self reported thoughts during and immediately after trigger exposure acted to appraise the emotional responses they were suffering, suggesting a tight link between the physiological and affective dimensions of Misophonia (Woolley et al., 2026a page 10)

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commentary on the nature of Misophonic triggers as generally aversive

in their 2024 paper, Simner Author highlights that has been coming up more and more in recent years, the fact that a lot of Misophonia triggers are slightly disturbing even to people without Misophonia. Because of this there’s an inherent difficulty in separating the Misophonic effect from just general aversiveness. (Simner et al., 2024 )

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Savard 2022 findings against generalized sound sensitivity in Misophonia

In a 2022 study examining subjective aversiveness ratings and sound-source identification across trigger and non-trigger sounds at varying signal-to-noise ratios, Savard and colleagues found that, on trials where triggers were correctly identified, individuals with higher misophonia severity reported the strongest aversive responses. Although this pattern was also present for generally unpleasant sounds, it was markedly stronger for trigger sounds, suggesting that misophonic reactivity is trigger-specific rather than a reflection of generalized sound sensitivity. (Savard et al., 2022)

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a 2023 study looking at how machine learning applied to general sound response profiles can be used to categorize Misophonics from other conditions and controls. The authors examined whether specific acoustic features, such as energy in the 2500 to 5500 Hz range and 1 to 16 Hz temporal modulations, could explain why some sounds consistently receive higher aversive ratings. While a few significant correlations were found, none remained after correction for multiple comparisons. Stronger correlations were observed for scrambled, unrecognizable sounds, suggesting that these features may partly account for aversive responses when the sound lacks clear meaning. In contrast, correlations were weak or absent for natural, recognizable sounds. A reanalysis of a larger dataset confirmed this pattern. The authors conclude that although these acoustic properties may contribute to aversiveness in abstract sounds, their influence is likely overshadowed by factors such as meaning and context when the sounds are easily identifiable. (Andermane et., 2023)

central role of anger and disgust in Misophonia

In a 2022 study, Dibb and Golding conducted a longitudinal study looking at which negative emotions (anger, disgust, or anxiety) are most strongly associated with misophonia. they found that Anger and disgust emerged as the primary emotions associated with misophonia, with both predicting misophonic responses over time even after controlling for depression. Disgust specifically predicted stronger emotional responses to triggers and greater perceived impact on participation in life at follow-up, while anger predicted longer recovery times and stronger physiological responses. Both anger and disgust predicted overall misophonia severity scores longitudinally, whereas anxiety did not predict any misophonic responses over time, indicating that anger and disgust are more central to the misophonic experience than anxiety (Dibb & Golding, 2022). Also note that This directly contradicts (Jager et al., 2021) finding of no association between disgust and misophonia

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old separate atom

originally the main idea of this atom was split into two atoms, with one only differentiated by the mention of the contrast to Jager. for the sake of clean notes I removed the other note and am putting its text below for future reference if needed

Dibb and Golding 2022 contradict Jager 2022 Disgust findings

In a 2022 study, Dibb and Golding attempted to clarify which negative emotions (anger, disgust, or anxiety) are most strongly associated with misophonia and to assess quality of life in people with self-reported misophonia longitudinally. they found that disgust WAS significantly associated with misophonia both cross-sectionally and longitudinally. Specifically, Dibb and Golding found that stronger feelings of disgust at baseline predicted a stronger emotional response to triggers and more perceived impact on participation in life at follow-up, and disgust remained a significant predictor even after controlling for depression. Also note that This directly contradicts (Jager et al., 2021) finding of no association between disgust and misophonia (Dibb & Golding, 2022).

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a 2017 study by Kumar and colleagues examined structural and functional brain abnormalities in Misophonics. this was accomplished through controlled exposure to 3 sound classes ( triggers, generally aversive, neutral) while fMRI, heart rate, galvanic skin response, and subjective self reports were collected. analysis of the self report data showed no significant difference between Misophonic trigger ratings for the Misophonic group and the ratings of annoyance for the  unpleasant sounds in the control group. however the authors suggest that this is a result of the two groups using different subjective scales when rating the sounds.  (Kumar et al., 2017)

predicting sound tolerance via acoustic summary statistics in Misophonia

In a 2025 study, Clonan predicted misophonia discomfort ratings and characterized individual acoustic sensitivities by deriving midbrain modulation power spectra from FOAMS sounds and fitting individualized GPR models, then projecting model weights into interpretable perceptual transfer functions. They found that acoustic summary statistics predicted tolerance ratings across participants with distinct aversion profiles, that transfer function gain and intercept tracked DMQ and S-Five scores, and that the models extrapolated to untested ESC50 sounds and detected triggers in continuous audio. From this they concluded that bottom-up spectrotemporal modulation features can characterize individualized misophonic aversion and may have applications in precision diagnosis and management (Clonan et al., 2025).

Generalized perceptual Regression framework applied to Misophonia

Clonan et al. (2025) applied Generalized Perceptual Regression (GPR), a framework that maps a sound's statistical features onto a listener's behavioral ratings, to model misophonic sound aversion in 19 listeners (of 21) from the Free Open-Access Misophonia Stimuli (FOAMS) database who rated discomfort for 82 natural sounds and were assessed with the Duke Misophonia Questionnaire (DMQ) and the S-Five. Within GPR, each sound was represented by midbrain modulation power spectrum (mMPS) summary statistics derived from a cochlear and auditory midbrain model, reduced with principal component analysis, then fit with an individualized generalized linear model whose weights were projected back into the acoustic space to yield interpretable perceptual transfer functions for each participant. The authors concluded that GPR produces sound-computable, individualized models of misophonia that predict tolerance ratings, pinpoint the specific spectrotemporal features driving each listener's aversion, and yield gain and intercept parameters that correlate with established diagnostic scores, indicating potential for precision diagnosis (Clonan et al., 2025).

Trigger phenomenology in youth misophonia

Guzick et al. (2024) characterized triggers in 20 youth-parent dyads using the Misophonia Assessment Interview and found the most common triggers were breathing, sniffing, and yawning, followed by eating/chewing, tapping, and throat clearing, with anger, annoyance, distress, and disgust as the most common emotional responses and loss of self-control and yelling as the most common reactive behaviors. The authors concluded that sounds were upsetting most often due to the nature and specific pattern of the sound rather than its volume (Guzick et al., 2024).

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In a 2024 study, Woolley attempted to characterize the onset, symptom progression, triggers, and psychiatric comorbidities in treatment-seeking adults with misophonia by conducting structured clinical interviews (Duke Misophonia Interview and DIAMOND) and administering self-report questionnaires to 60 adults meeting clinical criteria for misophonia. . While 60% reported reactions specific to certain people or situations, 40% experienced distress from triggers produced by anyone. Individuals with generalized (non-person-specific) reactions reported significantly higher self-reported misophonia severity on the MQ (β=4.78, p=.024). This generalization may increase severity through heightened hypervigilance and more frequent triggering episodes. All participants were bothered by human-produced sounds, with eating sounds being nearly universal (97%), though additional non-human triggers did not increase overall severity (Woolley et al., 2024).

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possible overlap in acoustics of generally aversive sounds and Misophonic triggers

in a 2022 study, Aazh found a significantly steeper ULL slope for Misophonics vs controls. they relate this finding as being consistent with previous works describing sounds with strong concentrations in the 2.5-5.5 kHZ range to be associated as generally aversive in normal subjects. they note a general maximal sensitivity for sounds over this level, and suggest that Misophonics may be enhanced in those with Misophonia, as it is win people with other sound sensitivities (Aazh et al., 2022).

focus on onset and progression

In a 2026 study, Pfeiffer et al. examined treatment-seeking youth with probable misophonia across four inpatient and outpatient mental health facilities in Germany and Austria. Among the probable misophonia subsample, the mean age of onset was approximately 9.4 years, consistent with prior reports of childhood onset and supporting the characterization of misophonia as a condition that typically emerges in middle childhood (Pfeiffer et al., 2026).

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In a 2024 study, Woolley attempted to characterize the onset, symptom progression, triggers, and psychiatric comorbidities in treatment-seeking adults with misophonia by conducting structured clinical interviews (Duke Misophonia Interview and DIAMOND) and administering self-report questionnaires to 60 adults meeting clinical criteria for misophonia. they found that in there sample, Misophonia typically emerged between ages 6-14 (79% of sample), paralleling early-onset psychiatric disorders rather than later-onset anxiety or mood conditions. Symptoms worsened over time for 63% of participants, while only 5% reported improvement. New triggers developed across the lifespan for 85% of individuals, suggesting a progressive expansion of sensitivity. This developmental trajectory indicates misophonia is likely a chronic condition requiring long-term management strategies (Woolley et al., 2024).

Guetta 2024 findings on perceived stress and traumatic events in Misophonia

In a 2024 survey study, Guetta et al. aimed to examine the relationships among misophonia, perceived stress, traumatic life events, and PTSD symptoms in a community sample of adults. They assessed 143 U.S. adults with self-identified misophonia using structured clinical interviews and validated self-report measures of stress, trauma exposure, and misophonia severity. They found that perceived stress and hyperarousal symptoms predicted misophonia severity, whereas PTSD diagnosis and lifetime traumatic events did not. From this they concluded that transdiagnostic stress processes, rather than traumatic stress itself, are more strongly related to misophonia severity. from this the authors suggest future work Test transdiagnostic stress-reduction interventions in misophonia. (Guetta et al., 2024).

Spencer 2023 findings on trait mindfulness and cognitive emotional regulation in pediatric Misophonia

In a 2023 study, Spencer and colleagues examined trait mindfulness and cognitive emotion regulation as candidate psychological mechanisms in pediatric misophonia using a cross-sectional correlational and moderation design in 102 youth. They found that greater misophonia severity was associated with lower trait mindfulness and greater maladaptive CER (especially self-blame), and that trait mindfulness uniquely predicted misophonia features and buffered the association between misophonia severity and peer relationship functioning. From this they concluded that trait mindfulness and, to a lesser extent, self-blame are potentially relevant processes in pediatric misophonia and represent candidate targets for psychosocial intervention (Spencer et al., 2023).

CNG test identified three factors. mood, social, and Miso-OC

Banker et al. (2022) investigated misophonia’s transdiagnostic structure and social controllability using large-scale self-report data and a modified ultimatum game, analyzed via factor analysis and a 2-step forward thinking model. Factor analysis using the Cattell–Nelson–Gorsuch test revealed three latent dimensions, separating general affective distress (mood), social impairment traits (social), and a distinct cluster combining misophonia and obsessive-compulsive symptoms (Miso-OC), indicating that misophonia does not primarily align with social dysfunction but instead with control-related psychopathology (Banker et al., 2022).

Misophonia Symptom Severity Linked to Stress, Not Awareness, in Health Sciences Students

In a 2026 study, Aktan Yilmaz measured misophonia awareness and its link to symptom severity and perceived stress in 196 occupational therapy and audiology students using a demographic form, the MQ, and the PSS. They found higher MQ and PSS scores among occupational therapy students, those reporting stress, and those receiving psychological support. Women scored higher on the emotional/behavioural MQ subscale. Students who were unsure about their family history of misophonia, and those with heavier caffeine use, also scored higher on the MQ. Across the sample, misophonia symptoms correlated positively with perceived stress. From this they concluded that misophonia is a multidimensional condition tied to emotional regulation and stress response rather than a purely auditory sensitivity, and called for a multidisciplinary, sensory-holistic approach to training and treatment (Aktan Yilmaz et al., 2026).

• It is worth noting that, despite awareness being one of the main constructs in the aims, it is not discussed much. they no relationship between educational level and knowledge of misophonia was found, nor was there any significant difference in misophonia knowledge between the two departments. (Aktan Yilmaz et al., 2026).
• I honestly feel like there might have been some translation issues, because there are a lot of parts of this paper that read weird to me. And the fact that awareness is so downplayed in the discussion, considering the title and aims, makes me feel like something must have been lost in translation.

emotional dysregulation facets predicting and identifying Misophonia and as targets for future interventions

In a 2024 study, Dixon et al. characterized and tested the unique predictive role of emotion dysregulation facets in misophonia symptoms across sound sensitivity, emotional/behavioral reactions, and functional impairment domains in a probability-based national sample. They found that clinical misophonia was associated with broadly elevated emotion dysregulation, and that specific DERS-16 facets, particularly Clarity, Goals, and Impulse, uniquely predicted misophonia reactions and impairment above demographics and stress. From this they concluded that emotion dysregulation is a robust and clinically meaningful feature of misophonia and that targeting specific regulatory capacities (clarity, goal engagement, impulse control) may improve treatment outcomes (Dixon et al., 2024).

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Misophonia severity, driven by emotional-behavioral responses, linked to slower processing and worse cognitive control during trigger sounds, likely reflecting trait anxiety.

In a 2020 study, Daniels et al. examined whether misophonia severity predicts reduced cognitive control (Stroop task) and increased anxiety during trigger exposure in a non-clinical sample. Emotional reactions to trigger sounds were positively associated with larger Stroop effects under misophonia sounds (r = .25, p = .03), and this remained significant after controlling for neuroticism and baseline anxiety. This association was not present in the universally unpleasant control condition, and sound sensitivity alone was not related to the Stroop effect in either condition. Both sound sensitivity and emotional behaviors were linked to slower overall reaction times in the trigger condition only. A significant overall Stroop effect was observed (109 ms, p < .001), with marginally slower RTs under misophonia sounds (p = .053) but no difference in Stroop interference across sound conditions (p = .33). Emotional behaviors, but not sound sensitivity, were associated with higher baseline anxiety (r = .25, p = .03), and both MQ subscales predicted higher state anxiety under both sound conditions. The authors concluded that misophonia severity, particularly emotional-behavioral responses, is associated with slower processing during trigger exposure and may reflect higher trait anxiety (Daniels et al., 2020).

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in a 2025 study looking at the general sensory sensitivities of Misophonics vs controls beyond the standard auditory issues, the authors found evidence of broader sensory sensitivity in Misophonics. specifically, they found higher general sensory sensitivity and sensory avoidance in the Misophonic group, with 80% of Misophonics endorsing at least one non-auditory sensitivity, with tactile and olfaction being the most reported. despite these sensitivities, reported impartments from non-auditory stimuli was generally low and Misophonia related distress was mainly driven by the auditory domain. additionally, the authors concluded that these findings suggest a comorbidity of sensory overresponsive (SOR) with Misophonia, thought the two are not synonymous. (Woolley et al., 2025)

sensory sensitivity as a the bridge between Misophonia and other conditions

Andermane et al. (2023), modeling data from 419 online participants across non-misophonic, moderate, and severe misophonia in a symptom network built from the Sussex Misophonia Scale (SMS), Glasgow Sensory Questionnaire (GSQ), Autism Spectrum Quotient (AQ), Obsessive-Compulsive Inventory (OCI), Anxiety Sensitivity Index (ASI-3), and other clinical measures, found that sensory sensitivity as indexed by the GSQ occupied a central position on all centrality measures and remained central even when auditory items were removed. They identified sensory sensitivity as the main bridge linking misophonia to other clinical symptoms, noting that this includes but is not limited to auditory sensitivity and that the misophonia Pain subscale carried the strongest connection outward. The authors concluded that sensory sensitivity is the central trait connecting the misophonic experience to the broader profile of sensory and clinical traits, though they cautioned that the network is not a causal model (Andermane et al., 2023b).

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In a 2022 study, Rinaldi et al. examined autistic traits in individuals with misophonia and found that adults with misophonia scored significantly higher than controls on the Autism Spectrum Quotient (AQ) overall and across all five subscales, with 21.4% exceeding the clinical cutoff compared to 2.8% of controls. In a population-screened child sample, children with misophonia also showed elevated autistic traits, along with greater negative emotional reactivity (but not positive reactivity) and increased sensory hyper-sensitivity across multiple sensory domains, with no differences in hypo-sensitivity. The authors concluded that autistic traits are elevated in misophonia across development, that misophonia and autism are distinct but non-trivially related conditions, and that these findings have implications for models linking autism, sensory sensitivities, and the specific features of misophonia. (Rinaldi et al., 2022)

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Paunović and Milenković 2021 findings on misophonia symptoms, noise sensitivity, and noise annoyance

Paunović and Milenković (2021) found that high perceived misophonia was associated with greater annoyance from several common environmental noise sources, except entertainment venues, and that misophonia symptoms were positively related to noise sensitivity, anxiety, and depression. High noise sensitivity predicted annoyance across most sources, depression was linked specifically to annoyance from humans and animals, anxiety showed no association, and males reported greater annoyance from construction noise. The authors conclude that misophonia and noise sensitivity independently contribute to noise annoyance, operate independently of age, gender, anxiety, and depression, and may lie on a broader spectrum of environment-related intolerances, while acknowledging that reverse causation cannot be ruled out. (Paunović & Milenković, 2021)

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Vijayakumar & Ahmmed 2025 implications for audiological traits in Misophonia

A 2025 study evaluating audiometric assessments found that while high-frequency thresholds were lower than low-frequency thresholds across all groups, only the misophonia with hyperacusis group showed a significantly steeper high-to-low slope in the right ear. SRTs did not differ between groups. ULLs were lower in DST groups, especially at 4 kHz, but did not correlate with daily life impact. Tinnitus was more common in DST groups and, in the no DST group, was linked to lower 4 kHz ULLs in the right ear. Past OME history showed no group differences. Overall, routine audiological measures could not reliably differentiate misophonia from hyperacusis. (Vijayakumar & Ahmmed, 2025)

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a study looking at the auditory processing of Misophonics vs controls found evidence for altered cortical auditory processing for those with mild-severe Misophonia BUT no differences in brainstem processing. (Karupaiah & Prabhu, 2025)

• this is consistent with Aryal & Prabhu, 2023 brainstem paper

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In their 2024 literature review on misophonia and the role of social cognition, Berger discusses how the findings of (Kumar et al., 2017) which reported no differences in primary auditory cortex activation, appear to contrast with those of (Schröder et al., 2019)’s, who observed increased activity in the posterior right superior temporal cortex in individuals with misophonia. However, Schröder et al. localized this effect to the lateral posterior superior temporal gyrus/sulcus, a higher-order multimodal region implicated in visual motion and social perception rather than primary auditory processing. Importantly, this increased activation was not found in the core auditory cortex. The absence of differential activation in primary auditory regions therefore suggests that misophonia trigger sounds are not processed differently at early stages of auditory processing compared to controls (Berger et al., 2024).

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using a Attention Network Test (ANT):, frank and colleagues found evidence that Misophonics show impaired alerting attention, possibly indicating a stable neuropsychological weakness. additionally, they found No evidence that symptom provocation alone accounts for attentional deficits. these findings led them to conclude that Misophonia may involve a chronic deficit in attentional vigilance. (Frank et al., 2020)

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Banker et al. (2022) used psychiatric questionnaires and a controllability-based ultimatum task in a large online sample to examine misophonia, employing factor analysis and computational modeling. Individuals scoring high on the Miso-OC factor exhibited elevated perceived control specifically in objectively uncontrollable environments, alongside a greater mismatch between perceived and actual influence, reflecting an illusory sense of control that parallels prior findings in OCD populations showing overestimation of environmental controllability (Banker et al., 2022).

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Black et al. (2026) examined three forms of rumination (perseverative thinking, brooding, and anger rumination) in relation to misophonia severity, finding that all three were positively associated with S-Five total scores and all five subscales even after controlling for depression, anxiety, and hyperacusis. From this they conclude that rumination in misophonia is not reducible to comorbid affective symptoms but represents a unique and pervasive cognitive tendency, one that extends beyond trigger-specific replay to reflect a broader disposition toward perseverative negative thought in daily life (Black et al., 2026) .

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Banker et al. (2022) characterized misophonia and its relation to social control through survey measures and a behavioral task, applying factor analysis and a forward thinking computational framework. they found that high Miso-OC individuals overestimate control specifically in uncontrollable contexts and show increased aversion to unexpected social outcomes, indicating a mismatch between perceived and actual control. from this, the authors propose that heightened control beliefs may function as a compensatory mechanism, where an underlying need to regain control over internal or symptomatic experiences leads to exaggerated perceptions of external control, causing strong negative reactions when unpredictable social stimuli violate these expectations (Banker et al., 2022).

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appraisal style impact on treatment seeking in Misophonia

Wooly describes past work showing that Misophonics can respond to triggers with either self-blame (internalizing) or blaming others for being rude (externalizing appraisals). In clinical, treatment-seeking populations, these two styles appear at roughly equal rates, whereas community samples tend to show more externalizing appraisals. from this observation the authors suggest that internalizing responses may drive greater distress and impairment, making those individuals more likely to seek treatment. they go onto to suggest that Understanding these distinct appraisal styles could help build better cognitive models of misophonia and explain why different people follow different clinical trajectories. (Woolley et al., 2026a)

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one study found lower rates of self reported Misophonia in musicians that practice at 1-7 hours a day. could this mean that musical training is protective against Misophonia? (Mednicoff et al., 2022)