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Id 564aa126-fd9f-4199-8384-c659fcb45c90
Year 2026
Abstract Background: Misophonia is a newly conceptualized disorder. Although its onset is usually in childhood and early adolescence, the current knowledge about etiology or treatment options for children and adolescents is still limited. This is the first study investigating treatment-seeking children and adolescents in routine mental health care with regard to misophonia symptomatology and co-occurring symptoms.
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- (Pfeiffer et al., 2026)
Import Date 04-05-2026
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Dv Authors Elisa Pfeiffer, Fabienne Krech, Marc Allroggen, Ulrike M.E. Schulze, Paul L. Plener, Uschi Braun, Deniz Ercengiz, Valentin Wollenek, Nina Heinrichs, Anne Möllmann,
Dv Initial Source Misophonia MOC
Dv Status #status/Bare-bones-review
Dv Limitations • Non-population-based sample; results reflect proportions within this specific clinical context, not general population prevalence. • Two of four sites offered misophonia-specific consultations, introducing potential referral bias and possible modest overestimation of probable misophonia rates. • Exclusive reliance on self-report; no clinical interviews; firm diagnostic conclusions cannot be drawn. • German translation of SMS-A has not been validated. • SMS-A sound checklist may not cover all potential misophonic triggers. • Coping strategy data collected via open question without examples; trigger-person item allowed multiple answers and assessed worst-symptom contexts rather than all potential trigger persons. • SCARED internal consistency was below the accepted threshold (α = .664); anxiety findings should be interpreted with caution. • Clinical diagnoses and symptom severity from participants' routine mental health records were not available due to anonymization. • Participation response rate and solicitation wording were not systematically recorded; self-selection bias cannot be ruled out.
Dv Future Directions • Examine whether higher misophonic symptom severity is present in treatment-seeking youth regardless of whether misophonia is their primary presenting concern. • Investigate whether misophonia symptoms decrease during treatment of co-occurring mental health conditions. • Examine how other symptoms are affected by misophonia-specific treatment. • Use network analysis to clarify the interplay among co-occurring symptom domains and the temporal ordering of misophonia relative to other conditions. • Systematically investigate the role of social context in symptom activation, including relationship to the sound source and whether symptoms persist in socially neutral contexts. • Examine the impact of peer relationships, including cyberbullying and social-cognitive functioning, on misophonia in youth. • Further validate, translate, and disseminate misophonia assessment tools suitable for young children. • Develop and evaluate misophonia-specific treatment approaches for children and adolescents.
Dv Relevance • study looked at prevalence and comorbidity across clinics in Germany and Austria, finding significant comorbidities. • a good source for info on comorbidities, and the Misophonic experience,
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Misophonia in a large treatment-seeking child and adolescent sample in mental health care in Germany and Austria
Status:: #status/Bare-bones-review
Metadata
- Item Type: #journalArticle
- Authors:: Elisa Pfeiffer, Fabienne Krech, Marc Allroggen, Ulrike M.E. Schulze, Paul L. Plener, Uschi Braun, Deniz Ercengiz, Valentin Wollenek, Nina Heinrichs, Anne Möllmann,
- Date:
- Date Added: 1775422725000
- URL: https://link.springer.com/10.1186/s12888-026-07979-1
- DOI: 10.1186/s12888-026-07979-1
- Cite Key: pfeifferMisophoniaLargeTreatmentseeking2026
- Topics: [object Object]
- Tags:: #Misophonia, #Bare-bones-review-🦴, #clinical, #article-in-press-copy,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia is a newly conceptualized disorder not yet included as a distinct diagnosis in DSM-5 or ICD-11. • A Delphi consensus stated misophonia symptoms should not be better explained by auditory, psychological, or psychiatric disorders. • Prevalence estimates in adults from population-based studies range from 4.6–18%, with variability attributable to heterogeneous measurement approaches. • Research in treatment-seeking populations consistently links misophonia to internalizing symptom domains including anxiety, depression, somatization, and OCD. • Most people with misophonia report onset in childhood or early adolescence, yet clinical characteristics in youth populations are poorly understood. • Prior pediatric studies (Guzick et al., Siepsiak et al., Lewin et al.) used single-site designs, online/community recruitment, and heterogeneous or only partially validated measures. • No prior study has examined probable misophonia in a routine, multi-center mental health care sample of children and adolescents. • PTSD has been found to be a highly prevalent comorbid condition in adults with misophonia; its association in youth is understudied. Purpose- • Determine the proportion of treatment-seeking youth meeting the SMS-A cut-off for probable misophonia. • Examine whether clinical characteristics (anxiety, depression, PTSD, OCD) are associated with misophonia symptom severity. • Describe clinical and phenomenological features of the probable misophonia subsample, including onset age, trigger sounds, coping strategies, social contexts, co-occurring symptoms, quality of life, and functional impairment. • Investigate differences between youth with and without probable misophonia on co-occurring symptom severity, quality of life, and functional impairment. |
| Participants/samples | • N = 214 children and adolescents; reduced to N = 211 for some analyses after exclusions. • Probable misophonia subsample: n = 66; non-misophonia subsample: n = 145. • Age range 10–21 years; mean age approximately 14.73 years across total sample; groups did not differ meaningfully in age. • Gender: 56.54% female, 32.71% male, remainder non-binary/genderqueer/unspecified/other; probable misophonia group had higher proportion of female-identified participants. • Inclusion criteria: age 10–21, currently seeking/receiving treatment for any mental health problem at a participating site, German language proficiency, written informed consent from participant and legal guardian (if under 16). • No exclusion criteria specified. • Recruited from four multi-center sites in Germany (Ulm University, Bielefeld University, Centre for Psychiatry Calw) and Austria (Medical University Vienna); both inpatient and outpatient settings; recruitment November 2022–January 2024. • Two of four sites offered specific outpatient consultations for misophonia, introducing potential referral bias. |
| Measures | • SMS-A (Sussex Misophonia Scale for Adolescents): Part 1 = 48 yes/no items across 8 sound categories; Part 2 = 39 items, 5-point Likert scale; cut-off ≥49 = probable misophonia; German translation used (not yet validated); α = .97. • SMFQ (Mood and Feelings Questionnaire–Short Version): 13-item depression screen, 3-point Likert; cut-off ≥8 = clinically relevant depression; α = .934. • CATS-2 (Child and Adolescent Trauma Screen 2–Short Version): traumatic experience screen + 6-item PTSD symptom scale, 4-point Likert; cut-off ≥7 = increased PTSD, ≥9 = clinically relevant PTSD; α = .854. • SCARED (Screen for Child Anxiety Related Disorders–Short Version): anxiety symptoms, 3-point Likert; cut-off ≥3 = clinically relevant anxiety; α = .664 (below acceptable threshold). • ZWIK-S (Obsessive-Compulsive Inventory for Children and Adolescents–Self-Report): 36 OCD items, 5-point Likert; cut-off ≥36 = clinically relevant OCD; α = .956. • ARI (Affective Reactivity Index): 7-item chronic irritability measure, 3-point Likert; no diagnostic cut-off applied; α = .887. • KIDSCREEN-10: 10-item quality of life measure, 5-point Likert; scores transformed to T-scores; higher = better quality of life; α = .802. • WSAS-Y (Work and Social Adjustment Scale–Youth): 5-item functional impairment measure, 9-point Likert; higher = greater impairment; α = .849. • Self-generated open questions: age of misophonia onset, coping strategies (open format), and social context of symptom occurrence (multiple-answer). |
| Procedures | • Paper-pencil questionnaire battery administered at clinical sites before, during, or after regular treatment appointments by trained project staff. • Completion time approximately 20–40 minutes. • SMS-A Part 2 and supplementary misophonia questions completed only if at least one repetitive sound was endorsed in Part 1. • Coping strategies reported via open-ended question; responses coded into 10 categories. • Missing data imputed using subscale mean when ≤20% of items were missing; one participant excluded for >20% missing; n = 2 excluded as outliers on SMS-A (+3SD) for regression analysis; n = 3 excluded from subsample analysis for non-completion of SMS-A Part 2. • Statistical analyses: descriptive statistics and chi-squared tests (RQ1, RQ3); Pearson correlations and multiple linear regression with depression, anxiety, PTSD, and OCD as predictors of misophonia severity (RQ2); independent samples t-tests (Welch correction when needed) with False Discovery Rate correction for group comparisons (RQ4). |
| Results | Prevalence of repetitive sounds and probable misophonia • The large majority of the total sample endorsed at least one misophonia-relevant repetitive sound. • Approximately one-third of the total sample met the SMS-A cut-off for probable misophonia. • The most common sound categories reported across the total sample were mouth/nose sounds and eating sounds; all sound categories except rustling were endorsed by more than half of participants. • Probable misophonia group endorsed significantly higher rates of every sound category compared to the non-misophonia group. Association between clinical characteristics and misophonia severity • All clinical characteristics (depression, anxiety, PTSD, OCD) were significantly and positively correlated with misophonia symptom scores. • In the multiple regression, depression and OCD were significant independent predictors of misophonia severity; anxiety and PTSD were not significant predictors when controlling for the other variables. • The overall regression model accounted for a substantial proportion of variance but left a significant portion unexplained. Description of probable misophonia subsample • Mean age of misophonia onset was approximately 9.4 years. • Most problems occurred when with other people; classmates were the most frequently named trigger persons, followed by mothers, fathers, other children/adolescents, and friends. • A small minority reported trigger activation when alone. • Most common coping strategies were listening to music and leaving the room; avoidance/withdrawal and headphone use were also reported. • Nearly all participants in the probable misophonia group reported clinically significant co-occurring symptoms in at least one other domain; anxiety was most prevalent, followed by depression, PTSD, and OCD. Group differences (probable vs. non-probable misophonia) • Probable misophonia group reported significantly higher severity on all co-occurring symptom measures: depression, PTSD, anxiety, OCD, and irritability. • Probable misophonia group reported significantly lower quality of life and significantly greater functional impairment compared to the non-misophonia group. • The largest between-group difference was observed for OCD symptoms. |
| Discussion/Limits | Conclusion- • The authors conclude that the high rate of disliked repetitive sounds across the full treatment-seeking sample supports the conceptualization of sound sensitivity as a dimensional construct, while the clinical cut-off distinguishes common aversion from clinically significant misophonia. • The findings indicate that the prevalence of probable misophonia in routine mental health care substantially exceeds rates documented in non-clinical populations, consistent with the conservative threshold set by the SMS-A developers. • The authors conclude that misophonia is closely embedded within the spectrum of internalizing psychopathology; unexplained variance in the regression model supports the notion that misophonia may represent a distinct construct beyond established diagnoses. • The data support a stronger association between OCD symptoms and misophonia in youth compared to adults, which the authors propose may reflect developmental differences in regulatory capacity or sensory modulation rather than diagnostic misclassification. • The findings indicate that avoidance and withdrawal coping strategies, while resourceful, may reduce opportunities for healthy socio-emotional development. • The authors conclude that the mean onset age of approximately 9.4 years supports emerging evidence that misophonia may begin even earlier than previously documented. • The findings indicate that peer contexts (especially classmates) are prominent trigger settings for youth, extending prior evidence focused primarily on family members. • The authors conclude that a transdiagnostic stress-related process (perceived stress and hyperarousal) may partially explain the high co-occurrence of misophonia with internalizing disorders. |
| Limitations:: | • Non-population-based sample; results reflect proportions within this specific clinical context, not general population prevalence. • Two of four sites offered misophonia-specific consultations, introducing potential referral bias and possible modest overestimation of probable misophonia rates. • Exclusive reliance on self-report; no clinical interviews; firm diagnostic conclusions cannot be drawn. • German translation of SMS-A has not been validated. • SMS-A sound checklist may not cover all potential misophonic triggers. • Coping strategy data collected via open question without examples; trigger-person item allowed multiple answers and assessed worst-symptom contexts rather than all potential trigger persons. • SCARED internal consistency was below the accepted threshold (α = .664); anxiety findings should be interpreted with caution. • Clinical diagnoses and symptom severity from participants' routine mental health records were not available due to anonymization. • Participation response rate and solicitation wording were not systematically recorded; self-selection bias cannot be ruled out. |
| Future Directions:: | • Examine whether higher misophonic symptom severity is present in treatment-seeking youth regardless of whether misophonia is their primary presenting concern. • Investigate whether misophonia symptoms decrease during treatment of co-occurring mental health conditions. • Examine how other symptoms are affected by misophonia-specific treatment. • Use network analysis to clarify the interplay among co-occurring symptom domains and the temporal ordering of misophonia relative to other conditions. • Systematically investigate the role of social context in symptom activation, including relationship to the sound source and whether symptoms persist in socially neutral contexts. • Examine the impact of peer relationships, including cyberbullying and social-cognitive functioning, on misophonia in youth. • Further validate, translate, and disseminate misophonia assessment tools suitable for young children. • Develop and evaluate misophonia-specific treatment approaches for children and adolescents. |
| Relevance:: | • study looked at prevalence and comorbidity across clinics in Germany and Austria, finding significant comorbidities. • a good source for info on comorbidities, and the Misophonic experience, |
Notes
key terms and concepts
- misophonia – a proposed disorder characterized by strong negative emotional and behavioral responses to specific audiological or visual triggers produced by another human.
- probable misophonia – designation for participants scoring above the SMS-A clinical cut-off of >49, indicating clinically significant misophonic symptomatology.
- Sussex Misophonia Scale for Adolescents (SMS-A) – a self-report measure comprising 48 yes/no items assessing misophonia-relevant repetitive sounds (Part 1) and 39 Likert-rated items assessing misophonic symptom severity (Part 2); cut-off score of ≥49 indicates probable misophonia.
- internalizing symptoms – a cluster of co-occurring psychiatric symptoms including anxiety, depression, PTSD, and OCD that have been consistently linked to misophonia in the literature.
- functional impairment – reduced ability to perform in school/work, everyday activities, social activities, leisure, and family relationships, as measured by the WSAS-Y.
- treatment-seeking sample – children and adolescents currently receiving inpatient or outpatient mental health care at one of four participating clinical sites in Germany and Austria.
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contextual statement
In a 2026 study, Pfeiffer et al. attempted to characterize the prevalence and clinical phenomenology of probable misophonia in treatment-seeking youth by administering a multi-domain self-report battery (SMS-A, SMFQ, CATS-2, SCARED, ZWIK-S, ARI, KIDSCREEN-10, WSAS-Y) to N = 214 children and adolescents (ages 10–21) across four inpatient and outpatient mental health care facilities in Germany and Austria.
summary statement
In a 2026 study, Pfeiffer et al. investigated the prevalence, clinical correlates, and phenomenology of probable misophonia in a routine treatment-seeking child and adolescent mental health sample by using a multi-center cross-sectional questionnaire design with N = 214 participants assessed on misophonia, internalizing symptoms, quality of life, and functional impairment. They found that approximately one-third of the sample met the clinical cut-off for probable misophonia, nearly all of whom reported co-occurring clinically significant internalizing symptoms, and that depression and OCD were the strongest predictors of misophonia severity, with the probable misophonia group showing greater symptom burden, lower quality of life, and greater functional impairment than those without probable misophonia. From this they concluded that misophonia is common in routine mental health care for youth, is closely associated with internalizing psychopathology while retaining features of a distinct construct, and warrants early detection, validated assessment tools appropriate for young children, and development of tailored treatment approaches.