Unofficial Literature Review: Current Research on Misophonia
Misophonia is characterized by decreased tolerance to particular sounds or associated sensory stimuli, producing emotional, physiological, and behavioral responses that are substantially stronger than those experienced by most individuals. Although commonly associated with sounds such as chewing, breathing, sniffing, and repetitive tapping, contemporary research increasingly suggests that misophonia cannot be explained simply as an aversion to particular sound categories. Instead, findings indicate an interaction among acoustic characteristics, sensory processing, contextual interpretation, autonomic arousal, attention, and individual learning histories. The 2022 consensus definition developed by Swedo et al. represented an important step toward standardizing the field, defining misophonia as a disorder of decreased tolerance to specific sounds or associated stimuli and emphasizing that reactions depend more upon the pattern or meaning of stimuli than their loudness. Misophonia nevertheless remains absent as a distinct diagnosis from major psychiatric diagnostic manuals.
Early neurobiological research provided evidence that misophonic responses involve measurable differences in physiological and neural processing. Kumar et al. (2017) found that individuals with misophonia demonstrated increased anterior insular cortex activation when exposed to trigger sounds, accompanied by increased heart rate and galvanic skin response. Differences in functional connectivity were also observed between the anterior insula and regions implicated in emotion, memory, and regulation. These findings challenged interpretations of misophonia as merely an exaggerated conscious dislike of sound and suggested involvement of neural systems responsible for salience and internal bodily states. Subsequent neuroimaging research has reported structural and functional differences involving regions such as the amygdala and attentional networks, although sample sizes remain relatively small and replication is necessary.
Measurement has improved substantially alongside theoretical development. Rosenthal et al. (2021) developed the Duke Misophonia Questionnaire (DMQ), providing a multidimensional measure encompassing trigger frequency, affective and physiological responses, coping behavior, impairment, and related beliefs. The availability of better validated measures is particularly important because earlier studies used inconsistent definitions and assessment instruments, making comparison between samples difficult. The DMQ and subsequent work therefore represent movement toward greater methodological consistency within misophonia research.
Research also demonstrates substantial heterogeneity in the presentation of misophonia. Rosenthal et al. (2022), whose phenotyping study is included in the current literature collection, examined psychiatric and medical correlates in 207 adults. Anxiety disorders were common, while obsessive-compulsive disorder, panic disorder, and borderline personality disorder characteristics showed associations with misophonia severity in adjusted analyses. These findings do not establish misophonia as a manifestation of another psychiatric disorder. Rather, they demonstrate that psychiatric comorbidity is common and clinically relevant. More recent population-level research strengthens this conclusion. Freshley et al. (2026) found that approximately two-thirds of individuals meeting criteria for misophonia in a U.S. population-based sample reported at least one psychological disorder, with anxiety and depression particularly common.
At the same time, evidence increasingly indicates that misophonia should not be conceptualized exclusively within psychiatric models. Andermane et al. (2023) examined patterns of sound intolerance and found that misophonia could be differentiated from other forms of sound sensitivity through participants’ sound-response profiles. Importantly, misophonia was associated with broader sound intolerance beyond a narrow list of canonical trigger sounds, while presenting differently from hyperacusis and sound intolerance associated with autism. More recent work has expanded attention beyond audition altogether. Woolley et al. (2026) reported that approximately 80% of participants with misophonia described some form of non-auditory sensory sensitivity, particularly tactile and olfactory sensitivity. However, non-auditory sensitivities generally produced less functional impairment than misophonic auditory symptoms. This suggests a potentially broader sensory-processing phenotype in at least a subgroup of affected individuals without reducing misophonia to generalized sensory sensitivity.
One of the most important emerging themes concerns the interaction between the physical properties of trigger sounds and their perceived meaning or source. Experimental evidence indicates that identical or similar acoustic information may be experienced differently depending upon how the listener interprets its origin. Siepsiak et al. (2023) investigated reactions to human eating, animal eating, and mouth-related stimuli, demonstrating that contextual information influences aspects of the misophonic response. Müfreze et al. (2025) similarly examined whether the presumed person producing a human-generated trigger affected discomfort, providing further evidence that social source information contributes to trigger severity. Heller et al. (2025) demonstrated that changing the apparent source of sounds through visual and semantic information could alter ratings of unpleasantness. Collectively, these studies demonstrate that misophonia cannot be understood solely through physical acoustics; top-down interpretation and contextual information can modify the response.
However, evidence for contextual effects does not imply that the acoustic structure of trigger sounds is irrelevant. Recent research has begun examining whether commonly aversive sounds possess identifiable spectrotemporal properties. Clonan, Stevenson, and Escabí (2026) used the Free Open-Access Misophonia Stimuli (FOAMS) dataset and a computational model of auditory processing to investigate whether acoustic statistics predict discomfort. Their models successfully predicted tolerance ratings and identified individualized spectrotemporal sensitivities contributing to aversion. Importantly, the authors found that different listeners could show distinct acoustic sensitivity profiles even when responding to sounds within similar categories. This provides evidence for a bottom-up contribution to misophonic triggering while simultaneously explaining some of the substantial individual variability observed clinically.
This work is compatible with newer cognitive models that conceptualize misophonia as the product of interacting processes rather than a single abnormal mechanism. Savard and Coffey (2025) argue that existing models must accommodate the heterogeneity of misophonia and incorporate cognitive, perceptual, emotional, and neurobiological processes. Likewise, Rosenthal, Shan, and Hanna (2026) question whether misophonia is appropriately understood as an anxiety disorder, highlighting features that overlap with anxiety while also distinguishing misophonic responses from conventional fear-based psychopathology. These theoretical developments move the field away from attempts to place misophonia entirely within either audiology or psychiatry and toward multidimensional models.
Treatment research remains considerably less developed than descriptive research. A 2025 scoping review identified only 15 peer-reviewed behavioral or audiological intervention studies meeting inclusion criteria, with substantial differences in assessment procedures, samples, and intervention approaches. Consequently, claims that any single treatment constitutes an established or universally effective intervention remain premature. Current evidence instead supports individualized assessment of functional impairment, sensory and contextual triggers, comorbid conditions, coping behaviors, and environmental needs.
Overall, contemporary research supports conceptualizing misophonia as a heterogeneous disorder involving interactions between auditory stimulus characteristics and higher-level processes such as source identification, contextual interpretation, salience, autonomic reactivity, and learning. An important unresolved question is how these mechanisms interact. In particular, the emerging evidence that spectrotemporal characteristics can predict discomfort creates a rationale for systematically comparing the acoustic features of commonly identified trigger and non-trigger sounds. Such research may help determine whether trigger sounds share measurable acoustic characteristics, whether distinct acoustic clusters exist, and how these bottom-up properties interact with the contextual and person-specific processes already demonstrated in the literature.
References
Andermane, N., Bauer, M., Sohoglu, E., Simner, J., & Ward, J. (2023). A phenomenological cartography of misophonia and other forms of sound intolerance. iScience, 26(4), 106299. https://doi.org/10.1016/j.isci.2023.106299
Clonan, A. C., Stevenson, I. H., & Escabí, M. A. (2026). Identifying the acoustic fingerprints of trigger sounds and predicting discomfort for misophonia. Hearing Research, 470, 109478. https://doi.org/10.1016/j.heares.2025.109478
Freshley, A., Clark, H. L., Schadegg, M. J., & Dixon, L. J. (2026). Clinical correlates of individuals with and without misophonia in the U.S.: Results from a population-based study. Psychiatry Research, 357, 116941. https://doi.org/10.1016/j.psychres.2026.116941
Heller, L. M., Oszczapinska, U., Smith, J. M., & Julien, M. M. (2025). Reassigning sources of misophonic trigger sounds to change their unpleasantness: Testing alternative mechanisms with a new set of movies, paintings, and words. PLOS ONE, 20(4), e0321594. https://doi.org/10.1371/journal.pone.0321594
Kumar, S., Tansley-Hancock, O., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., Cope, T. E., Gander, P. E., Bamiou, D.-E., & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology, 27(4), 527–533. https://doi.org/10.1016/j.cub.2016.12.048
Müfreze, P., Avcil, C., & Herdi, O. (2025). Beyond the sound: The role of the source of human-made trigger sounds in misophonia. Noro Psikiyatr Arsivi, 62(1), 48–53. https://doi.org/10.29399/npa.28744
Rosenthal, M. Z., Anand, D., Cassiello-Robbins, C., Williams, Z. J., Guetta, R. E., Trumbull, J., & Kelley, L. D. (2021). Development and initial validation of the Duke Misophonia Questionnaire. Frontiers in Psychology, 12, 709928. https://doi.org/10.3389/fpsyg.2021.709928
Rosenthal, M. Z., McMahon, K., Greenleaf, A. S., Cassiello-Robbins, C., Guetta, R., Trumbull, J., Anand, D., Frazer-Abel, E. S., & Kelley, L. (2022). Phenotyping misophonia: Psychiatric disorders and medical health correlates. Frontiers in Psychology, 13, 941898. https://doi.org/10.3389/fpsyg.2022.941898
Rosenthal, M. Z., Shan, Y., & Hanna, M. (2026). Misophonia is a newly defined disorder, but is it an anxiety disorder? Annual Review of Clinical Psychology, 22, 243–262. https://doi.org/10.1146/annurev-clinpsy-061324-071140
Savard, M.-A., & Coffey, E. B. J. (2025). Toward cognitive models of misophonia. Hearing Research, 458, 109184. https://doi.org/10.1016/j.heares.2025.109184
Siepsiak, M., Vrana, S. R., Rynkiewicz, A., Rosenthal, M. Z., & Dragan, W. Ł. (2023). Does context matter in misophonia? A multi-method experimental investigation. Frontiers in Neuroscience, 16, 880853. https://doi.org/10.3389/fnins.2022.880853
Swedo, S. E., Baguley, D. M., Denys, D., Dixon, L. J., Erfanian, M., Fioretti, A., Jastreboff, P. J., Kumar, S., Rosenthal, M. Z., Rouw, R., Schiller, D., Simner, J., Storch, E. A., Taylor, S., Vander Werff, K. R., Altimus, C. M., & Raver, S. M. (2022). Consensus definition of misophonia: A Delphi study. Frontiers in Neuroscience, 16, 841816. https://doi.org/10.3389/fnins.2022.841816
Woolley, M. G., Johnson, H. E., Knight, S. J. E., Bowers, E. M., Petersen, J. M., Muñoz, K., & Twohig, M. P. (2026). Sensory processing differences in misophonia: Assessing sensory sensitivities beyond auditory triggers. Journal of Psychiatric Research, 193, 278–282. https://doi.org/10.1016/j.jpsychires.2025.11.026