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Id f29b3d14-a466-4fe7-9c0c-7fe78789d859
Year 2025
Abstract Misophonia is a prevalent and impairing sound intolerance condition that shares symptom overlap and high rates of co-morbidity with hyperacusis. Research demarcating these sound intolerance conditions is critical for the development of accurate diagnostic tools and treatment matching. Previous research suggests difficulties with emotion regulation may be a core feature of misophonia, but its relationship to hyperacusis is unknown. As a first step in exploring whether emotion regulation may be a clinical feature that differentiates misophonia from hyperacusis, the current study examined the relationship between difficulties with emotion regulation and both misophonia and hyperacusis symptom severity in a sample of adults with clinically significant misophonia.
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Dv Authors Sajana Aryal, Ashley Moskovich, Prashanth Prabhu, M. Zachary Rosenthal,
Dv Initial Source Misophonia MOC
Dv Status #status/Bare-bones-review
Dv Limitations • Study conducted with a sample of adults with clinically significant misophonia and varying levels of hyperacusis severity; results may not generalize to individuals with hyperacusis without misophonia. • Study relied entirely on self-report questionnaires, which may have introduced bias. • Psychometric concerns with the MQ have been reported. • The MQ and HQ may measure overlapping aspects of sound sensitivity. • DERS is a broad measure of emotion regulation that does not capture context-specific difficulties in regulation relevant to sound-triggered distress. • Cross-sectional design precludes causal inferences.
Dv Future Directions • Future studies conducted with larger samples that include individuals with hyperacusis without misophonia are warranted. • Future studies using psychometrically validated tools and analyzing responses at the item level or through factor analysis are needed. • Real-time assessment methods like ecological momentary assessment and task-based emotion regulation assessments could offer deeper insight into regulatory dynamics. • Longitudinal studies are needed to assess whether emotional regulation difficulties precede or follow the onset of misophonia symptoms. • Future studies assessing emotional experience and reactions in real time are needed to parse whether difficulties with emotion regulation reflect general deficits and/or challenges that specifically arise in the context of misophonic triggers.
Dv Relevance • study looked at links between hyperacusis, Misophonia, and difficulties with emotional regulations, finding a relationship between Misophonia and difficulties with emotion regulation, but not with hyperacusis • a good source showing possible clinical features of Misophonia that could be used in diagnostics, specifically to help separate Misophonics from hyperacusis.
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Examining the relationship between difficulties with emotion regulation and misophonia and hyperacusis symptom severity in adults with clinically significant misophonia
Status:: #status/Bare-bones-review
Metadata
- Item Type: #journalArticle
- Authors:: Sajana Aryal, Ashley Moskovich, Prashanth Prabhu, M. Zachary Rosenthal,
- Date:
- Date Added: 1763506233000
- URL: https://linkinghub.elsevier.com/retrieve/pii/S0378595525002758
- DOI: 10.1016/j.heares.2025.109457
- Cite Key: aryalExaminingRelationshipDifficulties2025
- Topics: [object Object]
- Tags:: #Misophonia, #Bare-bones-review-🦴, #Emotion-Regulation, #hyperacusis, #sound-tolerance,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia is a prevalent and impairing sound intolerance condition. • Misophonia shares symptom overlap and high rates of co-morbidity with hyperacusis. • Whether misophonia is a distinct condition or a subtype of hyperacusis remains unclear. • High rates of co-morbidity further complicate differentiation. • Common audiological assessments cannot effectively differentiate misophonia from hyperacusis. • Hearing sensitivity is typically within normal limits for both conditions. • Commonly used self-report measures may not effectively discriminate these two conditions. • Research demarcating misophonia and hyperacusis is needed for accurate diagnostic tools and treatment matching. • Studies suggest difficulties with emotion regulation may be a key process underlying misophonia symptom severity. • Although increased levels of anxiety and depression have been reported in hyperacusis, the role of emotion regulation in hyperacusis is unknown. Purpose- • Examine the relationship between difficulties with emotion regulation and both misophonia and hyperacusis symptom severity in a sample of adults with clinically significant misophonia. • Explore general emotion regulation capacity. • Examine individual domains of emotion regulation to identify whether specific facets are uniquely associated with symptom severity. |
| Participants/samples | • N=143 participants eligible; 137 included in final analysis (7 excluded due to missing HQ data). • 103 identified as female; 34 identified as male. • Age range not specified; mean age 37.02 years (SD 12.05). • 87.59% identified as white Americans; 3.64% African Americans. • Inclusion criteria: 18–65 years; able to read English; no current psychotic disorder, anorexia nervosa, or mania; score above 6 on MQ Severity Scale (indicating clinically significant misophonia). • Recruited through online platforms including Duke Center for Misophonia and Emotion Regulation website. |
| Measures | • Misophonia Questionnaire (MQ): self-report measure assessing sensory sensitivity and emotional/behavioral responses to misophonic trigger sounds; includes Sounds Scale, Emotions and Behaviors Scale, and Severity Scale; MQ Total Score range 0–68; MQ Severity Scale range 0–15 (scores >6 indicate clinically significant symptoms). • Hyperacusis Questionnaire (HQ): 14-item self-report tool assessing extent to which normal environmental sounds are perceived as overly loud, intrusive, or distressing; 4-point Likert scale; total score range 0–42 (scores >28 indicate clinically significant hyperacusis). • Difficulties in Emotion Regulation Scale (DERS): 36-item self-report questionnaire assessing emotion regulation difficulties; 5-point Likert scale; total score range 36–180; includes six subscales: Nonacceptance, Goals (goal-directed behavior), Impulse, Awareness, Strategies (access to effective strategies), and Clarity. |
| Procedures | • Participants completed online and telephone screens to assess eligibility. • Eligible participants completed questionnaires assessing misophonia, hyperacusis, and emotion regulation. |
| Results | Descriptive statistics and correlations • MQ Total Scores ranged from 14 to 62 (mean 40.34, SD 8.07). • HQ Total Scores ranged from 2 to 42 (mean 24.20, SD 8.99). • DERS Total Scores ranged from 40 to 133 (mean 79.51, SD 20.75). • 32.85% of participants with clinically significant misophonia also met criteria for clinically significant hyperacusis. • Small positive correlation between MQ Total Score and DERS Total Score. • Small non-significant trend between HQ Total Scores and DERS Total Scores. • Moderate positive correlation between HQ and MQ Total Scores. Hierarchical regression predicting misophonia severity (Model 1) • Greater difficulties with emotion regulation were significantly associated with misophonia symptom severity after controlling for age and hyperacusis severity. • Hyperacusis severity and emotion regulation difficulties both significantly predicted misophonia severity. Hierarchical regression predicting hyperacusis severity (Model 2) • Emotion regulation difficulties were not significantly associated with hyperacusis symptom severity after controlling for age and misophonia severity. • Misophonia severity significantly predicted hyperacusis severity; emotion regulation did not. Emotion regulation domains and misophonia severity • Misophonia symptom severity was associated with difficulties in goal-directed behavior, impulse control, nonacceptance of emotional responses, and limited access to emotion regulation strategies. • Misophonia symptom severity was not associated with emotional awareness or emotional clarity. • Fisher's Z-tests indicated no significant differences among the strength of correlations between misophonia and the four significant emotion regulation domains. |
| Discussion/Limits | Conclusion- • The authors conclude that emotion regulation may be uniquely related to misophonia symptomatology among individuals with clinically significant misophonia. • The authors conclude that greater difficulties with emotion regulation were associated with greater misophonia symptom severity after accounting for age and hyperacusis. • The findings indicate that emotion regulation was not associated with hyperacusis symptom severity after controlling for age and misophonia severity. • The authors conclude that difficulties regulating behavior in the context of emotional distress may be central to misophonia. • The authors conclude that nonacceptance of emotions, rather than difficulties identifying or differentiating emotions, is particularly relevant to misophonia. • The findings suggest that intervening on difficulties with emotion regulation may be useful as part of a multidisciplinary treatment approach for misophonia. • The data support the use of interventions targeting specific facets of emotion regulation in the treatment of misophonia. |
| Limitations:: | • Study conducted with a sample of adults with clinically significant misophonia and varying levels of hyperacusis severity; results may not generalize to individuals with hyperacusis without misophonia. • Study relied entirely on self-report questionnaires, which may have introduced bias. • Psychometric concerns with the MQ have been reported. • The MQ and HQ may measure overlapping aspects of sound sensitivity. • DERS is a broad measure of emotion regulation that does not capture context-specific difficulties in regulation relevant to sound-triggered distress. • Cross-sectional design precludes causal inferences. |
| Future Directions:: | • Future studies conducted with larger samples that include individuals with hyperacusis without misophonia are warranted. • Future studies using psychometrically validated tools and analyzing responses at the item level or through factor analysis are needed. • Real-time assessment methods like ecological momentary assessment and task-based emotion regulation assessments could offer deeper insight into regulatory dynamics. • Longitudinal studies are needed to assess whether emotional regulation difficulties precede or follow the onset of misophonia symptoms. • Future studies assessing emotional experience and reactions in real time are needed to parse whether difficulties with emotion regulation reflect general deficits and/or challenges that specifically arise in the context of misophonic triggers. |
| Relevance:: | • study looked at links between hyperacusis, Misophonia, and difficulties with emotional regulations, finding a relationship between Misophonia and difficulties with emotion regulation, but not with hyperacusis • a good source showing possible clinical features of Misophonia that could be used in diagnostics, specifically to help separate Misophonics from hyperacusis. |
Notes
key terms and concepts
- misophonia – a sound intolerance condition characterized by intense physiological, emotional, and behavioral responses to aversive stimuli or "triggers" (typically repetitive or pattern-based auditory stimuli such as chewing, sniffling, or pen clicking, but can also include associated visual cues).
- hyperacusis – a sound intolerance condition characterized by disruption in loudness perception more generally; patients often perceive everyday sounds as excessively loud and demonstrate lower tolerance to sounds, reporting discomfort at sound levels that individuals without hyperacusis typically find acceptable.
- emotion regulation – a broad construct that includes the capacity to identify and accept feelings, regulate behavior, and engage in goal-directed activities when in the presence of emotional distress.
- sound intolerance – conditions characterized by aberrant or heightened aversive reactions to sounds.
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In a 2025 study, Aryal attempted to examine whether difficulties with emotion regulation differentiate misophonia from hyperacusis by assessing the relationship between emotion regulation and both misophonia and hyperacusis symptom severity in adults with clinically significant misophonia using the Misophonia Questionnaire, Hyperacusis Questionnaire, and Difficulties in Emotion Regulation Scale.