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Altered Cognitive Control and Default Mode Network Engagement During Inhibition in Misophonia

Eijskers 2019 stop signal study revealed that misophonia patients showed distinct activation patterns during the Stop Signal Task compared to controls. Specifically, they lacked inhibition-related activation in the left dorsolateral prefrontal cortex (DLPFC) seen in controls and instead activated this region more during go trials, suggesting a shift in cognitive control toward response preparation rather than inhibition. Patients also failed to activate the posterior cingulate cortex (PCC) during successful inhibition a region associated with detecting changes and adjusting behavioral strategies—and showed reduced engagement of the superior medial frontal gyrus (SMFG), a default mode network region linked to self-reflection and attentional focus. These patterns suggest that misophonia involves altered recruitment of cognitive and attentional control networks, consistent with increased effort to manage responses and a potential overreliance on accuracy-driven strategies. (Eijsker et al., 2019)