A Consensus Definition of Misophonia: Using a Delphi Process to Reach Expert Agreement

by May 12, 2021Research3 comments

Susan Swedo, David M. Baguley, Damiaan Denys, Laura J. Dixon, Mercede Erfanian, Alessandra Fioretti, Pawel J. Jastreboff, Sukhbinder Kumar, M. Zachary Rosenthal, Romke Rouw, Daniela Schiller, Julia Simner, Eric A. Storch, Steven Talylor, Kathy R. Vander Werff, View ORCID ProfileSylvina M. Raver

The Brief:

“Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, a project was conducted to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia… The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.”


“The purpose of this project was to determine whether the current body of published literature supported the development of a consensus definition of misophonia. Through the efforts of a Misophonia Consensus Committee using a modified Delphi process, a consensus definition of misophonia was developed from previously published definitional statements that each had at least 80% agreement from Committee members. This definition represents an important first step for researchers and clinicians to progressively build-upon and revise as the body of knowledge in the published scientific literature grows over time. We hope that this consensus definition can bring necessary clarity for individuals experiencing misophonia, the growing community of clinicians who support them, and researchers who seek to better understand this disorder.”

Consensus Definition of Misophonia:


“Misophonia is a disorder of decreased tolerance to specific sounds or stimuli associated with such sounds. These stimuli, known as “triggers,” are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people. Misophonic responses do not seem to be elicited by the loudness of auditory stimuli, but rather by the specific pattern or meaning to an individual. Trigger stimuli are often repetitive and primarily, but not exclusively, include stimuli generated by another individual, especially those produced by the human body. Once a trigger stimulus is detected, individuals with misophonia may have difficulty distracting themselves from the stimulus and may experience suffering, distress, and/or impairment in social, occupational, or academic functioning. The expression of misophonic symptoms varies, as does the severity, which ranges from mild to severe impairments. Some individuals with misophonia are aware that their reactions to misophonic trigger stimuli are disproportionate to the circumstances. Misophonia symptoms are typically first observed in childhood or early adolescence.


In response to specific trigger stimuli, individuals with misophonia may experience a range of negative affective reactions. Anger, irritation, disgust, and anxiety are most common, though some individuals may experience rage. Misophonic triggers may evoke increased autonomic arousal such as increased muscular tension, increased heart rate, and sweating.

Trigger stimuli may also evoke strong behavioral reactions such as agitation or aggression directed towards the individual producing the stimulus. On rare occasions, aggression may be expressed as verbal or physical outbursts although these responses are seen more in children with misophonia than in adults. Individuals with misophonia often engage in behaviors to mitigate their reactions to triggers such as: avoiding or escaping from situations in which they encounter trigger stimuli; seeking to discontinue the triggering stimuli; mimicking or reproducing the triggers.


The strength of an individual’s reaction to a misophonic trigger stimulus may be influenced by multiple factors including but not limited to: the context in which the stimulus is encountered; the individual’s perceived degree of control over the stimulus source; and the interpersonal relationship between the individual with misophonia and the source of the trigger. Self-generated stimuli typically do not evoke the same aversive responses as stimuli produced by other people.


Individuals’ reactions to misophonia triggers may cause significant distress, interfere with day-to-day life, and may contribute to mental health problems. Individuals with misophonia may experience functional impairments that range from mild to severe including but not limited to impaired occupational and/or academic functioning, concentration difficulties, and an inability to perform important work tasks. Individuals may also experience impaired social functioning, strained social relationships, and social isolation resulting from their misophonia symptoms.


Misophonia can be present in people with or without normal hearing thresholds, and can occur alone or with the auditory conditions of tinnitus and hyperacusis. Misophonia can also occur with neurological or psychiatric conditions or disorders including but not limited to: anxiety disorders, mood disorders, personality disorders, obsessive compulsive related disorders, post-traumatic stress disorder, autism spectrum disorder, and attention deficit hyperactivity disorder. For any given individual, the symptoms of misophonia should not be better explained by any co-occurring disorders.


Although each person may have their own pattern of triggers, some stimuli serve as common misophonic triggers. Auditory triggers are most common, although individuals with misophonia may also identify distress in response to visual triggers.

Sounds associated with oral functions are among the most often reported misophonic trigger stimuli, such as chewing, eating, smacking lips, slurping, coughing, throat clearing, and swallowing. Nasal sounds, such as breathing and sniffing, often serve as triggers as well. Auditory triggers may also include non-oral/nasal sounds produced by people such as pen clicking, keyboard typing, finger or foot tapping and shuffling footsteps, as well as sounds produced by objects, such as a clock ticking, or sounds generated by animals. Visual triggers have been reported to include stimuli such as cracking knuckles and jiggling or swinging legs, as well as visual stimuli associated with an auditory trigger, such as watching someone eat.”

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(Please note: the text above and as well as the link to the full text relate to a pre-print that has not yet been peer reviewed. As the authors point out, “It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.”)

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  1. Nancy Gatta

    Seriously? No mention of t his as neurological.

    • Allergic to Sound

      I noticed that too. I wonder if maybe it wasn’t in their remit to categorise it as such

  2. Gina

    I would have thought under the section about linking to other mental disorders, depression would have been there. I know my misophonia has been the basis for my depression for decades. At least we’re finally getting some real recognition.


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