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Year 2025

Abstract Misophonia is a poorly understood condition in which intense distress is experienced in response to mostly orofacial stimuli. To better understand why specifically anger and disgust seem to characterize this distress, we investigated meanings conveyed by misophonic trigger stimuli in two studies. Study 1 explored these meanings and emotions in two small focus groups ( n  = 3, n  = 5) of misophonia sufferers. Four meaning—themes were generated based using reflexive thematic analysis: “intrusion,” “violation,” “offense,” and “lack of autonomy.” Also, four emotional reaction themes were constructed: “anger/defensive rage,” “disgust,” “fear,” and “safety behaviors.” Study 2 aimed to corroborate the findings of Study 1 in a large, independent sample. To this end, misophonia symptom severity was assessed in 431 young adults using the Amsterdam Misophonia Scale (A-Miso-S). Participants rated the extent to which the meanings and reactions identified in Study 1 matched their experiences with prototypical misophonic trigger stimuli. The meanings showed a positive, moderate correlation with misophonia symptom severity and accounted for 35.15% of the variance in A-Miso-S scores. An exploratory factor analysis identified two factors explaining 50% of the variance in the meanings and reactions. Factor 1, “Avoidance of intrusive/disgusting stimuli” had high and unique loadings on avoidance, intrusion, and disgust. Factor 2, “Autonomy/Violation,” had high and unique loadings on violation, lack of autonomy, offense, and defensive rage. These findings suggest that the meanings of intrusion, violation, and lack of autonomy are inherent to the misophonic experience, with potential implications for treatment strategies.

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Aliases

Understanding the misophonic experience
(Ozuer et al., 2025)

Key Terms

Misophonia
theory of constructed emotion
defensive rage
referential learning
A-MISO-S-R
reflexive thematic analysis
safety behaviors

Import Date 10-04-2025

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Dv Authors Yesim Ozuer, Rilana Cima, Elke Kestens, Ilse Van Diest,

Dv Limitations • Small and homogenous focus group sample limits generalizability. • Possible social desirability bias in group settings. • Thematic interpretations may vary by analyst subjectivity. • using just college students, generalizability of findings may be limited given how theory of mind/perspective taking abilities evolve with age. • Focus group dynamics may have led to social conformity or overemphasis on certain themes. • Participants were specifically asked to recall distressing events, which may have biased responses toward more severe experiences. • The interpretive nature of reflexive thematic analysis introduces subjectivity—other researchers may derive different themes.

Dv Future Directions • Broader and more diverse qualitative studies, including interviews and diary studies • Further research into developmental antecedents, particularly around adolescence when autonomy needs are unmet. • Investigations into moral vs. visceral disgust distinctions. • Experimental designs to test cognitive reappraisal and attributional training interventions.

Dv Relevance • looks at core misophonia response of anger and disgust, concluding they result from the fact that the following meanings were conveyed to Misophonics by triggers: intrusion, violation, offense, and lack of autonomy • gives good overview of idea of emotion theories and frameworks and their relevance to Misophonia including : • as a meaning making process (theory of constructed emotions) • Lang’s bio-information theory that emotional experiences are stored in memory as associative networks • proposes referential learning (specifically the kind related to learning likes/dislikes) as the mechanism through which negative associations form in misophonia for the conditioning etiology hypothesis of misophonia • suggests looking into procedures to change the meaning of triggers as a way to treat misophonia • discusses the idea of defensive rage being at the center of the anger responses in Misophonia

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Misophonia MOC

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Understanding the misophonic experience: a mixed method study

Status:: #status/reviewed

Metadata

Item Type: #journalArticle
Authors:: Yesim Ozuer, Rilana Cima, Elke Kestens, Ilse Van Diest,
Date:
Date Added: 1739071546000
URL: https://www.frontiersin.org/articles/10.3389/fpsyg.2025.1493676/full
DOI: 10.3389/fpsyg.2025.1493676
Cite Key: ozuerUnderstandingMisophonicExperience2025
Topics: [object Object]
Tags:: #defensive-anger, #descriptive, #Emotion, #emotion-theory, #emotional-representations, #factor-analysis, #learning, #meaning-information, #Misophonia, #MisoQuest, #reviewed, #thematic-analysis,
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Abstract


Background/Purpose	Background- • Misophonia is not officially recognized in the DSM-5 but is increasingly researched due to its emotional, interpersonal, and functional impacts. • Trigger stimuli often involve human-produced sounds, especially from close relations, evoking intense anger/disgust more than fear. • Prior research has not systematically examined the subjective "meanings" associated with these triggers, which may inform emotional responses. Purpose- • To explore and validate the emotional meanings associated with misophonic trigger sounds. • Study 1: Identify key themes through focus group interviews. • Study 2: Quantitatively validate these themes in a larger sample and examine their relationship to symptom severity.
Participants/samples	Study 1 • N = 8 participants (2 focus groups: n = 3 and n = 5) • Inclusion: >17 years, fluent in Dutch, A-Miso-S score >10 • Age range: 23–65 years; 75% female Study 2:** • N = 431 university students • Age: 17–35 (Mean = 20.7) • Participants completed surveys including A-Miso-S and questions derived from Study 1 themes.
Measures	• Amsterdam Misophonia Scale (A-Miso-S): Assesses symptom severity. • Study 2 questionnaire: Custom items measuring alignment of participant experiences with themes identified in Study
Procedures	Study 1: • Focus group interviews using semi-structured guides. • Topics: recent misophonic events, emotional/physiological/behavioral responses, meaning assigned to triggers. • Reflexive thematic analysis applied to transcripts. Study 2 • Online questionnaire assessing resonance with Study 1 themes. • Exploratory Factor Analysis (EFA) conducted to identify underlying factor structure of meaning/reaction items.
Results	Study 1 – Qualitative Themes: - Associated Meanings-: • Intrusion/Violation: Sounds interpreted as intentional boundary-crossing. • Offense: Distress without perceived intention to harm. • Lack of Autonomy: Feeling powerless, trapped, or emotionally dysregulated. - Primary Emotional Reactions-: • Anger/Defensive Rage: Impulsive, protective anger linked to perceived invasion. • Disgust: Immediate, visceral aversion directed at people producing sounds. - Secondary Responses-: • Safety Behaviors: Avoidance, use of headphones, withdrawal from social contexts. • Fear: Anticipatory fear of encountering triggers or of one’s own uncontrollable reaction. Study 2 – Quantitative Findings: • All 7 themes moderately positively correlated with misophonia severity. • Meanings accounted for 35.15% of variance in A-Miso-S scores. • EFA revealed two factors explaining 50% of the variance: • Factor 1: Avoidance of Intrusive/Disgusting Stimuli (loadings on avoidance, intrusion, disgust) • Factor 2: Autonomy/Violation (loadings on violation, lack of autonomy, offense, defensive rage)
Discussion/Limits	Conclusion- • Misophonic reactions are shaped not just by sound properties but by perceived social/emotional meanings (e.g., violation, disrespect). • Key emotional responses (anger, disgust) are aligned with these interpretations, particularly when triggers come from close social figures. • Emotions resemble defensive rage, not just moral disgust or irritation.
Limitations::	• Small and homogenous focus group sample limits generalizability. • Possible social desirability bias in group settings. • Thematic interpretations may vary by analyst subjectivity. • using just college students, generalizability of findings may be limited given how theory of mind/perspective taking abilities evolve with age. (page 13) • Focus group dynamics may have led to social conformity or overemphasis on certain themes. • Participants were specifically asked to recall distressing events, which may have biased responses toward more severe experiences. • The interpretive nature of reflexive thematic analysis introduces subjectivity—other researchers may derive different themes.
Future Directions::	• Broader and more diverse qualitative studies, including interviews and diary studies • Further research into developmental antecedents, particularly around adolescence when autonomy needs are unmet. • Investigations into moral vs. visceral disgust distinctions. • Experimental designs to test cognitive reappraisal and attributional training interventions.
Relevance::	• looks at core misophonia response of anger and disgust, concluding they result from the fact that the following meanings were conveyed to Misophonics by triggers: intrusion, violation, offense, and lack of autonomy • gives good overview of idea of emotion theories and frameworks and their relevance to Misophonia including : • as a meaning making process (theory of constructed emotions) • Lang’s bio-information theory that emotional experiences are stored in memory as associative networks • proposes referential learning (specifically the kind related to learning likes/dislikes) as the mechanism through which negative associations form in misophonia for the conditioning etiology hypothesis of misophonia • suggests looking into procedures to change the meaning of triggers as a way to treat misophonia • discusses the idea of defensive rage being at the center of the anger responses in Misophonia

Notes

key terms and concepts

Theory of Constructed Emotion (TCE)- developed by Lisa Feldman Barrett, is a contemporary framework for understanding how emotions are generated in the brain. It challenges classical views that emotions are innate, hardwired, and universal, and instead proposes that emotions are constructed by the brain based on context, prior experience, and learned concepts. (page 3)
Defensive rage- is a form of reactive, impulsive aggression that arises in response to perceived intrusion or violation. It is different from goal-oriented or planned aggression (like predatory rage). This type of rage is tied to a need for immediate self-protection and often involves a sudden increase in sympathetic nervous system activity (e.g., increased heart rate, heightened arousal). (page 7)
Referential learning- is a form of associative learning where emotional meaning is linked to stimuli through learned associations with past experiences, particularly in emotionally salient contexts.
- It involves constructing a network between:
      - the stimulus (e.g., chewing sound),
      - the response (e.g., anger or disgust), and
      - the meaning attributed to that stimulus (e.g., violation, disrespect). (page 15)
Misophonia – A condition characterized by strong negative emotional reactions (typically anger or disgust) to specific human-generated sounds, especially orofacial ones (e.g., chewing, breathing).
A-Miso-S (Amsterdam Misophonia Scale) – A 6-item questionnaire adapted from the Y-BOCS, used to measure misophonia symptom severity.
Reflexive Thematic Analysis – A qualitative analytic method used to identify, analyze, and report themes within data, emphasizing researchers' active role in theme generation.
Defensive Rage – An impulsive, emotionally charged response to perceived intrusion or threat, linked to increased sympathetic nervous system activity.
Safety Behaviors – Deliberate strategies (e.g., wearing earplugs, avoidance) used to reduce exposure to misophonic triggers or manage distress.

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Bookmarks

bookmark for talking about the theory of constructed emotion (page 3)
bookmark for talk about Lang’s bio-informational theory of emotion (page 3)
bookmark for talking about the associative meaning they found (page 5)
bookmark for talking about defensive rage (page 7)

reading notes

Core Principles of the Theory of Constructed Emotion

Emotions are not biologically hardwired Emotions (like anger, fear, sadness) are not fixed "modules" in the brain. Instead, the brain creates emotional experiences using more general-purpose brain systems (e.g., interoception, attention, memory). 2.
The brain is a predictive organ The brain constantly tries to predict what will happen next using past experience. These predictions are used to guide perception, action, and experience, including emotion. Emotions are part of these predictions, constructed to make sense of incoming sensory data.

Concepts shape emotional experience We learn emotional concepts through language, culture, and experience (e.g., what “anger” feels like, how it should be expressed). These concepts are applied in real time by the brain to interpret bodily sensations and environmental cues, resulting in a labeled emotion.
Interoception is central The brain tracks and predicts the body’s internal state (called interoception). Sensations like a racing heart, tense muscles, or stomach flutter are interpreted using context and past learning, shaping how we label those sensations (e.g., as fear or excitement).

Lang’s Emotional Framework in the Paper

The authors cite Lang (1979) and Lang et al. (1980) to support the idea that emotional experiences are stored in memory as associative networks. According to this framework, an emotional memory contains three interlinked components:
- Stimulus information – what was perceived (e.g., a chewing sound),
- Response information – what the body did (e.g., heart racing, muscle tension),
- Meaning information – the subjective appraisal or interpretation (e.g., "this is disrespectful", "I’m being violated").
In misophonia, these networks are thought to be tightly integrated. When a trigger sound is encountered, it activates the whole network, resulting in a full-blown emotional and physiological reaction. The paper uses this framework to argue that meanings are not peripheral but central to the misophonic experience. That is, the emotional response is not just about the sound, but about what that sound represents, which can include personal history, social norms, and boundary violations.

referential learning in the context of misophonia

Misophonic individuals may have repeatedly experienced certain sounds (like chewing, sniffing, etc.) in situations where they felt powerless, disrespected, or emotionally overwhelmed.
Over time, these meanings become encoded into the emotional memory associated with those sounds.
Once learned, hearing the sound alone can trigger the entire network, including:

    - physiological arousal,

    - emotional distress (like rage or disgust),

    - safety behaviors or avoidance.

Interpretation of Core Emotional Responses

Anger as Defensive Rage:
    - The study emphasizes that the anger observed in misophonia is not simply annoyance but aligns with defensive rage, a form of impulsive and protective emotional reaction.
    - This form of anger is tied to perceived intrusion or violation—especially when the source is someone close (e.g., family or friends who “should know better”).
    - It involves high sympathetic arousal and often emerges in contexts where the individual feels trapped or unable to escape.
Disgust:
    - Disgust was reported as immediate and visceral, often directed at the person producing the sound rather than the sound itself.
    - Unlike anger, participants did not try to rationalize or explain their disgust, aligning with the "unreasoning disgust" hypothesis (Russell & Giner-Sorolla, 2011).
    - This reaction raises the question of whether misophonic disgust is moral (relating to judgment) or sensory (linked to physical revulsion), though the current study could not conclusively distinguish between the two.
Fear:
    - Unlike anger and disgust, fear was not a primary emotional response but appeared in anticipatory contexts, such as:
        - Fear of encountering triggers in unavoidable environments (e.g., public transport).
        - Fear of ones own uncontrolled reaction to triggers.
    - It was often linked with avoidance and safety behaviors, suggesting a secondary, anticipatory function rather than an immediate response to stimuli.

Meaning and Attribution in Misophonic Experiences

A central argument of the paper is that emotional meanings, not the acoustic properties of triggers, drive the misophonic experience.
These meanings (e.g., violation, offense, loss of autonomy) influence whether the reaction is anger, disgust, or fear.
The source of the sound (e.g., someone known vs. a stranger vs. an animal) alters emotional interpretation:
    - Human sources elicit stronger reactions due to perceived agency or intent.
    - Animal or baby sounds are less likely to trigger strong reactions, possibly due to perceived innocence or lack of control.

Implications for Theory and Treatment

The findings align with the Theory of Constructed Emotion (Barrett, 2017), suggesting that emotions are constructed via meaning-making based on past experiences and predictions.
Recognizing the interpretative and social components of misophonia opens new avenues for cognitive-behavioral interventions, potentially targeting:
    - Appraisals of intent or control in sound-producing individuals.
    - Reattribution training to reduce moralistic interpretations.
    - Strategies to enhance perceived autonomy and emotion regulation. (page 15)