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Id 48e07cfb-1e2c-4431-aa97-4b0096a931a9

Year 2026

Abstract Misophonia is a sound sensitivity disorder characterized by heightened emotional, physiological, and behavioral reactions to specific auditory stimuli. Although prior research has linked misophonia to maladaptive personality traits and internalizing symptoms, the role of early maladaptive schemas (EMSs) remains underexplored. The present study examined the associations between misophonia severity, EMSs, personality trait domains, and psychological symptoms, and tested whether EMSs accounted for incremental variance beyond these factors. A total of 144 adults (72 with misophonia and 72 matched controls) completed self-report measures of misophonia, EMSs, personality traits, depression, and anxiety. Misophonia severity was positively associated with most EMSs, as well as with negative affectivity, detachment, psychoticism, and symptoms of depression and anxiety. In dividuals with misophonia reported significantly higher levels across all EMSs, personality domains, and psy chological symptoms compared to controls. Regression analyses indicated that several EMSs predicted misophonia severity, with Entitlement and Emotional Inhibition emerging as the strongest independent pre dictors. In a hierarchical regression model, EMSs accounted for additional variance beyond personality traits and psychological symptoms. In the final model, Entitlement and Negative Affectivity remained significant pre dictors. These findings support a hierarchical framework in which personality trait domains reflect a broad dispositional vulnerability, whereas EMSs represent more specific cognitive-emotional processes that may shape the appraisal and perceived meaning of trigger sounds. Targeting EMSs may enhance psychological interventions by addressing maladaptive appraisals and emotional regulation difficulties underlying misophonic responses.

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Early maladaptive schemas and misophonia
(Fazi et al., 2026)

Import Date 08-25-2026

Initial Source

Misophonia

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Dv Authors Michela Fazi, Francesco Mancini, Allison Uvelli, Sofia Mattioli, Chiara Tonasso, Lucia Fiumalbi, Giuseppe Romano,

Dv Status #status/reviewed

Dv Limitations • Cross-sectional design precludes causal inference. • Reliance on self-report and self-identified (not clinically diagnosed) misophonia may introduce response biases and limit generalizability. • Online recruitment via misophonia support groups may bias toward higher severity and reduced representativeness; asymmetric recruitment channels for cases and controls raises potential help-seeking selection bias. • Sample size may limit detection of small effects and stability of complex multivariate models. • Predominantly female sample and group differences in sexual orientation limit generalizability.

Dv Future Directions • Longitudinal designs to establish temporal/causal relationships. • Multimethod assessments and clinically diagnosed samples. • Control groups drawn from other health or support-related online communities to address recruitment bias. • Dimension reduction approaches (PCA, factor analysis) in larger samples to examine whether broader schema dimensions account for misophonia severity.

Dv Relevance • study looked at how the presence of early maladaptive schemes (EMS) act as risk factors for Misophonia, and how this is independent of broader dispositional traits/gen psychological symptoms. • authors use there findings of strong associations between Misophonia ( as indicated by scores on DMQ composite symptoms scale) and EMSs related to disconnection, rejection, and impaired autonomy, suggesting that interventions focused on addressing these schemes may be beneficial.

Early maladaptive schemas and misophonia: Incremental contributions beyond personality traits and general psychopathology

Status:: #status/reviewed

Metadata

Item Type: #journalArticle
Authors:: Michela Fazi, Francesco Mancini, Allison Uvelli, Sofia Mattioli, Chiara Tonasso, Lucia Fiumalbi, Giuseppe Romano,
Date:
Date Added: 1785895169000
URL: https://linkinghub.elsevier.com/retrieve/pii/S0378595526002273
DOI: 10.1016/j.heares.2026.109756
Cite Key: faziEarlyMaladaptiveSchemas2026
Tags:: #clinical, #Misophonia, #reviewed, #to-review, #trait,
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Abstract


Background/Purpose	Background- • Misophonia involves strong affective, physiological, and behavioral responses shaped by trigger meaning, context, controllability, and relationship to the sound producer (Swedo et al., 2022). • Although not classified in DSM-5 or ICD-11, misophonia can cause significant distress and functional impairment. • Misophonia is associated with mood, anxiety, obsessive-compulsive, eating, neurodevelopmental, and personality disorders. • Associated traits include neuroticism, conscientiousness, threat anticipation, perfectionism, and intolerance of ambiguity, but these may not capture trigger-specific cognitive-affective processes. • Triggers are often interpreted as intentional or disrespectful and accompanied by self-perceptions of inadequacy, vulnerability, or inferiority. • These patterns resemble early maladaptive schemas (EMSs; Young et al., 2003), which may be shared vulnerability factors across misophonia and related disorders. • Evidence is limited: Stalias-Mantzikos et al. (2023) linked social isolation to distress and insufficient self-control to behavioral reactions, while Natalini et al. (2020) identified several elevated EMSs. • It remains unknown whether EMSs explain variance beyond personality traits and general psychopathology. Purpose- • Examine associations between misophonia severity, EMSs, personality trait domains, and psychological symptoms. • Compare individuals with and without misophonia on EMSs, personality trait domains, and psychological symptoms. • Determine which EMSs independently predict misophonia severity and whether effects remain when controlling for anxiety, depression, and personality trait domains.
Participants/samples	• N = 144 adults (72 misophonia, 72 matched controls), aged 18 to 65. • Misophonia group self-identified and met DMQ cut-offs (DMSS ≥ 43 and Impairment ≥ 12); controls scoring in moderate/high DMQ risk ranges were excluded. • Groups matched on age, gender, and education; sexual orientation differed significantly (higher bisexual representation in misophonia group). • Exclusion criteria: current psychotropic medication, hearing loss, failed attention checks. • Predominantly female (80.6% in both groups). • Recruited via online support groups (misophonia) and general social media (controls).
Measures	• Duke Misophonia Questionnaire (DMQ; Rosenthal et al., 2021), Italian translation: DMSS (symptoms) and Impairment scale. • Young Schema Questionnaire Short Form-3 (YSQ-S3; Young and Brown, 2005): 18 EMSs. • Personality Inventory for DSM-5 Brief Form (PID-5-BF): Negative Affectivity, Detachment, Antagonism, Disinhibition, Psychoticism. • Beck Depression Inventory-II (BDI-II). • Abbreviated State-Trait Anxiety Inventory (STAI-Y short): STAI-S-8 and STAI-T-8.
Procedures	• Single online session, fixed questionnaire order, no counterbalancing. • Three embedded attention-check items. • No compensation provided.
Results	• Misophonia severity (DMSS) positively correlated with most EMSs; strongest correlations for Entitlement, Social Isolation, Insufficient Self-control, and Emotional Inhibition; nonsignificant for Dependence, Enmeshment, and Recognition-seeking. • Misophonia positively correlated with Negative Affectivity, Detachment, and Psychoticism; not with Antagonism or Disinhibition. • Misophonia positively correlated with depression (BDI), state anxiety, and trait anxiety. • Misophonia group scored significantly higher than controls on all 18 EMSs (largest effects: Social Isolation, Emotional Inhibition, Entitlement, Pessimism), all personality trait domains, and all depression/anxiety measures; all group differences survived FDR correction. • In a multiple regression with Entitlement, Social Isolation, Emotional Inhibition, and Pessimism, the model explained 37% of variance; Entitlement and Emotional Inhibition were significant independent predictors, Pessimism marginal, Social Isolation nonsignificant; no problematic multicollinearity. • In hierarchical regression, EMSs added 7% variance beyond depression, anxiety, and personality traits; in the final model Entitlement and Negative Affectivity were significant predictors, Emotional Inhibition marginal, all others nonsignificant.
Discussion/Limits	Conclusion- • Misophonia severity reflects both broad personality traits and specific cognitive-emotional patterns. • Misophonia correlated with numerous EMSs, maladaptive personality traits, and internalizing symptoms, but fewer variables independently predicted severity. • Negative Affectivity may confer broad vulnerability, while EMSs more directly shape how triggers are interpreted and experienced. • EMSs explained variance beyond personality traits and psychological symptoms, supporting their distinct clinical relevance. • Entitlement was the strongest independent predictor, possibly increasing appraisals of triggers as norm violations or disrespect and amplifying internal reactivity. This finding aligns with research on perceiving sound producers as intentional or provocative (Gregory & Foster, 2023; Natalini et al., 2024; Woolley et al., 2026). Its contrast with Stalias-Mantzikos et al. (2023) may reflect the NYMS’s behavioral focus versus the DMSS’s broader assessment of internal responses. • Emotional Inhibition may intensify distress by limiting the expression and processing of trigger-related affect. Its nonsignificance in Stalias-Mantzikos et al. (2023) may also reflect that study’s behavioral measure. • Social Isolation correlated with misophonia but did not independently predict severity, suggesting overlapping effects or withdrawal as a consequence of misophonia. • Overall, Negative Affectivity may represent broad dispositional vulnerability, while EMSs filter the meaning and appraisal of triggers (Aldao et al., 2010; Cludius et al., 2020). • Clinically, targeting Entitlement and Emotional Inhibition through Schema Therapy or Metacognitive Interpersonal Therapy may reduce reactivity by modifying rigid expectations and improving emotional awareness, expression, and regulation.
Limitations::	• Cross-sectional design precludes causal inference. • Reliance on self-report and self-identified (not clinically diagnosed) misophonia may introduce response biases and limit generalizability. • Online recruitment via misophonia support groups may bias toward higher severity and reduced representativeness; asymmetric recruitment channels for cases and controls raises potential help-seeking selection bias. • Sample size may limit detection of small effects and stability of complex multivariate models. • Predominantly female sample and group differences in sexual orientation limit generalizability.
Future Directions::	• Longitudinal designs to establish temporal/causal relationships. • Multimethod assessments and clinically diagnosed samples. • Control groups drawn from other health or support-related online communities to address recruitment bias. • Dimension reduction approaches (PCA, factor analysis) in larger samples to examine whether broader schema dimensions account for misophonia severity.
Relevance::	• study looked at how the presence of early maladaptive schemes (EMS) act as risk factors for Misophonia, and how this is independent of broader dispositional traits/gen psychological symptoms. • authors use there findings of strong associations between Misophonia ( as indicated by scores on DMQ composite symptoms scale) and EMSs related to disconnection, rejection, and impaired autonomy, suggesting that interventions focused on addressing these schemes may be beneficial.

Notes

key terms and concepts

Misophonia – a condition characterized by reduced tolerance for specific auditory stimuli ("trigger" sounds), involving strong affective reactions (anger, disgust, anxiety), heightened physiological arousal, and behavioral responses such as avoidance, escape, or confrontation.
Early maladaptive schemas (EMSs) – pervasive dysfunctional cognitive-emotional patterns originating in childhood when basic psychological needs are insufficiently met, shaping beliefs about self, others, and the world; organized into 18 schemas across 5 domains (Young et al., 2003).
Entitlement/Grandiosity – schema reflecting the belief that one is superior and entitled to special rights or exceptions to ordinary rules.
Emotional Inhibition – schema reflecting the tendency to suppress emotional expression to avoid disapproval, shame, or loss of control.
Negative Affectivity – DSM-5 AMPD personality trait domain conceptualized as a disposition to experience aversive emotional states.
Hierarchical framework – model in which broad personality traits reflect general dispositional vulnerability while EMSs represent more specific cognitive-emotional processes shaping appraisal.

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Fazi 2026 speechify notes

This research article, published in Hearing Research (2026), explores the role of Early Maladaptive Schemas (EMSs) in individuals experiencing misophonia. The study provides a comprehensive analysis of how these cognitive-emotional patterns contribute to symptom severity beyond standard personality traits and general psychopathology.

1. Understanding Misophonia and Vulnerability

Clinical Nature: Misophonia involves intense emotional, physiological, and behavioral reactions—such as anger, disgust, and physical tension—to specific trigger sounds, often human-generated.
Transdiagnostic Perspective: The authors view misophonia through a lens that connects it to various psychiatric comorbidities, including mood and anxiety disorders, suggesting that stable cognitive vulnerabilities play a key role.
The Role of Schemas: Early Maladaptive Schemas are defined as pervasive, dysfunctional patterns originating in childhood that shape how individuals interpret their environment, potentially influencing the subjective meaning attributed to trigger sounds.

2. Study Methodology

Participants: The researchers compared 72 adults with misophonia against 72 matched control participants.
Assessment Tools: Participants completed measures including the Duke Misophonia Questionnaire (DMQ), the Young Schema Questionnaire (YSQ-S3), the Personality Inventory for DSM-5 (PID-5-BF), and standard anxiety and depression inventories.
Analytical Approach: The study utilized hierarchical regression models to determine if specific schemas (like Entitlement or Emotional Inhibition) provide incremental value in predicting misophonia severity after controlling for personality domains and psychological symptoms.

3. Key Findings

Schema Associations: Misophonia severity was strongly associated with elevated levels of numerous EMSs, particularly those related to disconnection, rejection, and impaired autonomy.
Independent Predictors:
1. Entitlement/Grandiosity: This emerged as the strongest independent predictor of misophonia severity, suggesting that individuals with this schema may interpret trigger sounds as intentional violations of their personal standards or social norms.
2. Emotional Inhibition: This schema also uniquely predicted symptom severity, indicating that an inability to express emotions adaptively may internalize and prolong physiological distress.
Hierarchical Framework: The findings support a model where broad personality traits (like Negative Affectivity) provide a baseline vulnerability, while specific EMSs refine the cognitive processing of stimuli, explaining an additional 7% of the variance in misophonia severity.

4. Clinical Implications

Targeted Interventions: The authors suggest that therapeutic approaches like Schema Therapy or Metacognitive Interpersonal Therapy could be highly effective for misophonia.
Refining Treatment: By addressing specific schemas—specifically reducing rigid expectations of others (Entitlement) and improving emotional expression (Emotional Inhibition)—clinicians may help patients decrease their internal reactivity to triggers and improve their overall functional capacity.

In summary, this research highlights that misophonia is not merely a reaction to sound but is deeply influenced by ingrained cognitive schemas. By identifying these schemas as distinct vulnerability factors, the study paves the way for more personalized and effective psychological interventions that target the cognitive-emotional appraisals driving the disorder.