A Symptom Network Model of Misophonia: From Heightened Sensory Sensitivity to Clinical Comorbidity

Misophonia – an unusually strong aversion to certain sounds – can cause significant distress and disruption to those who have it but is an enigma in terms of our scientific understanding. A key challenge for explaining misophonia is that, as with other disorders, it is likely to emerge from an interaction of traits that also occur in the general population (e.g., sensory sensitivity, anxiety) and that are transdiagnostic in nature (i.e., shared with other disorders). With a large sample of participants (N=1430), we performed a cluster analysis (based on responses to questions relating to misophonia) and identified two misophonia subgroups differing in severity, as well as a third group without misophonia. A subset of this sample (N=403) then completed a battery of measures designed to assess sensory sensitivity and clinical co-morbidities. Clinical symptoms were limited to the most severe group of misophonics (including autistic traits, migraine with visual aura, anxiety sensitivity, obsessive-compulsive traits). Both the moderate and severe groups showed elevated attention-to-detail and hypersensitivity (across multiple senses). A novel symptom network model of the data shows the presence of a central hub linking misophonia to sensory sensitivity which, in turn, connects to other symptoms in the network (relating to autism, anxiety, etc.). In this way, the severity of misophonia can be understood as a propagation from core features, which are sensory-attentional in nature, to peripheral clinical symptoms.