The central role of symptom severity and associated characteristics for functional impairment in misophonia

Abstract

Misophonia is characterized by a preoccupation with and strong emotional and behavioral reactions to certain triggers, mostly sounds related to eating and breathing. We applied functional impairment due to misophonic symptoms as a central criterion to investigate differences between clinical misophonia and normative decreased sound tolerance in a large non-random sample of n = 1,881 individuals from an online survey. We assessed the frequency of self-reported misophonia symptoms across various symptom measures, compared severity, triggers and emotional reactions, general psychopathology, interpersonal emotion regulation, and quality of life between both groups with and without functional impairing misophonia. Individuals with functional impairment due to misophonia (n = 839) revealed significantly higher general psychopathology symptoms, lower interpersonal emotion regulation skills, and lower quality of life than individuals without impairment (n = 1,042). Anxious/distressed and annoyed reactions to triggers were experienced more frequently compared to emotional reactions of disgust and sadness or depression in both groups. Overall, the group differences were primarily quantitative in nature. We discuss practical implications regarding classification and treatment and provide cutoffs for each symptom measure derived from group assignment for functional impairment.

Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of U.S. adults.

“…& Erfanian, 2018); however, there is very little research in this area, and additional studies are needed to further understand the potential biological and environmental influences of the development of misophonia.Regarding other sensory sensitivities, 41.6% of the misophonia sample endorsed that they experienced everyday sounds as too loud, which is much higher than hyperacusis rates observed in previous studies (e.g., 0.7%-1.9%;Jager et al, 2020;Möllmann et al, 2023), suggesting that the high rate observed in this study is likely an overestimation due to measurement rather than the true rate of co-occurrence of this disorder. Conversely, the rates of tinnitus and ASMR were generally consistent with the range of rates reported by previous studies, which have shown 13.8%-50.4% of individuals with misophonia experience ASMR(Jakubovski et al, 2022;Möllmann et al, 2023;Rouw & Erfanian, 2018) and 1.7%-43.5% experience tinnitus(Jager et al, 2020;Kılıç et al, 2021;Möllmann et al, 2023).Finally, with regard to impairment, a large portion of the sample endorsed significant or clinical levels of overall impairment, and most of the sample reported substantial impairment in at least one life area. In particular, impairment in social activities with others was the most frequently endorsed area of concern.…”

“…Scores ≥ 7 indicate significant interference caused by clinically significant symptoms (Wu et al, 2014). Möllmann et al (2023) found this cutoff score was the optimal balance for detecting misophonia-related impairment with 78% sensitivity and 77% specificity. In this study, the MQ was used to characterize misophonia symptoms in the sample, and the MQ Severity Scale was used as a clinical criterion.…”

“…Consistent with Jakubovski et al (2022), two criterion were used to identify clinical levels of misophonia. Specifically, participants who scored in the clinical range on the A-MISO-S (total scores ≥ 10; Möllmann et al, 2023; Schröder et al, 2013) and the MQ Severity Scale (scores ≥ 7; Möllmann et al, 2023; Wu et al, 2014) were identified as having misophonia. Descriptive analyses were used to examine demographic characteristics, misophonia symptom history, and impairment due to misophonia symptoms (WSAS) among those with misophonia.…”

“…The items are summed to compute the A-MISO-S total score, and scores correspond to severity ranges, indicating subclinical misophonia symptoms (0-4), mild symptoms (5-9), moderate symptoms (10-14), severe symptoms (15-29), or extreme symptoms (20)(21)(22)(23)(24). Previous research has used a clinical cutoff of ≥10 to identify individuals with misophonia (Naylor et al, 2021;Schröder et al, 2013), which has been found to detect misophonia-related functional impairment with 89% sensitivity and 67% specificity (Möllmann et al, 2023). In this study, the A-MISO-S was used as a measure of misophonia symptom severity and to characterize clinical levels of misophonia.…”

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

“…Avoidance of eating due to misophonia sounds can reduce social contact and strain interpersonal relationships. Furthermore, people with functional impairment due to misophonia report higher psychopathology symptoms, lower interpersonal emotion regulation, and lower quality of life than individuals without impairment (Möllmann et al, 2023). Even though misophonia only appeared in the clinical literature as recently as 2001 (Jastreboff and Jastreboff, 2001), research suggests that close to 20% of individuals experience at least moderate symptoms of the condition (Wu et al, 2014;Mattson et al, 2023;Vitoratou et al, 2023).…”