Sensory Processing, Dissociation, and Affective Symptoms in Misophonia: A Cross-Sectional Study of 35 Adults

Introduction

Misophonia is a recently identified sensory condition causing intense negative reactions to specific sounds [1,2]. In daily life, ordinary sounds such as chewing, breathing, or pen clicking can trigger intense reactions such as anger, disgust, and anxiety in individuals with misophonia [3,4]. Diagnostic systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) do not yet officially recognize this condition as a disorder [2]. However, an increasing number of studies point to underlying psychiatric comorbidities and neurobehavioral dimensions in misophonia [5,6]. Prevalence studies indicate that misophonia affects approximately 12.8–20% of the general population [7,8]. A population-based study from the United States included 4005 participants (51.5% women; 62.5% White). Sensitivity to misophonia trigger sounds was reported by 78.5% of participants, and 4.6% met the clinical threshold for misophonia [9]. Comorbidity is substantial: up to 79% of individuals with misophonia have at least 1 co-occurring psychiatric disorder [10]. In particular, comorbidity with depression, generalized anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), suicidal behaviors, and borderline personality disorder are frequently observed in individuals with misophonia [5,6]. Emotion regulation difficulties and atypical sensory processing likely contribute to misophonia’s clinical presentation [11,12]. Misophonia is associated with poorer quality of life across emotional, social, and general health domains [13], yet standardized diagnostic criteria and comprehensive treatment protocols are lacking. Preliminary evidence suggests that cognitive-behavioral therapy – and, in selected cases, risperidone – are potential interventions [10,14].

Sensory processing disorder (SPD) is a condition characterized by difficulties in perceiving, modulating, and interpreting sensory stimuli, which negatively affects daily functioning [12]. Individuals with SPD may exhibit hyper- or hypo-sensitivity to various sensory inputs such as sounds, visuals, tactile stimuli, or movement [12]. Similarly, individuals with misophonia have been reported to show heightened sensory reactivity across multiple modalities, particularly auditory [15]. Indeed, findings by Kaufman and colleagues (2022) suggest that people with misophonia react intensely not only to specific sounds but also to other sensory cues such as odors [15]. This suggests that misophonia may be conceptualized as a form of sensory processing difference. Indeed, a recent comprehensive study found that the core features of misophonia are sensory-attentional in nature, and that the severity of misophonia is closely associated with the level of sensory sensitivity [11]. A recent study in youth demonstrated that adolescents with misophonia frequently exhibit psychiatric comorbidities and that misophonia severity is positively associated with sensory sensitivity [16]. In a large 3-group study (non-misophonic, moderate, severe), adults with severe misophonia showed broadly elevated exteroceptive sensitivities on the Glasgow Sensory Questionnaire across visual, auditory, olfactory, gustatory, tactile, and vestibular modalities, as well as greater visual stress on the Pattern Glare task, whereas interoceptive awareness on the MAIA did not differ by group. These findings indicate that misophonia involves heightened multisensory reactivity rather than isolated auditory responding [11].

Individuals with misophonia exhibit not only strong emotional reactions but also significant physiological arousal when exposed to environmental stimuli [17]. For example, compared to healthy controls, individuals with misophonia show marked increases in heart rate and skin conductance when exposed to trigger sounds [18]. These responses suggest that misophonia involves heightened physiological sensitivity to environmental stimuli. Despite their strong physiological responses to stress, individuals with misophonia have difficulty regulating their emotions and struggle to control reactions such as anger and restlessness [17]. In summary, although misophonia is not yet recognized as an official diagnostic category, it presents a complex clinical picture characterized by the co-occurrence of sensory hypersensitivity and emotional regulation difficulties [2,5,6,11,12].

Dissociative symptoms – particularly depersonalization (a sense of detachment from oneself) and derealization (a sense of detachment from the external environment) – are characterized by a temporary disruption or alteration in the connection between internal experience and the outside world [19]. When these symptoms occur, individuals often feel as though they are distant from themselves and from reality; it may seem as if their body or surroundings are unreal, dreamlike, or behind a foggy veil [20,21]. Dissociative experiences frequently emerge in the course of anxiety-related conditions such as PTSD, panic disorder, and generalized anxiety disorder, as well as in other dissociative disorders [22,23]. In fact, in PTSD, depersonalization and derealization are commonly observed as intense detachment responses triggered by overwhelming sensory input [24,25]. In such cases, individuals may exhibit both heightened physiological arousal (hyperarousal) and, simultaneously, emotional numbing and a sense of disconnection from the self [21,26]. The classic study by Sierra and colleagues (2002) demonstrated that patients with depersonalization disorder responded more rapidly than healthy individuals to sudden intense stimuli (eg, loud noises), yet showed suppressed skin conductance responses to emotionally charged stimuli [21]. This finding has been interpreted as indicating that, in the face of overwhelming sensory input, the brain may unconsciously “shut down” emotional responses as a protective detachment mechanism [21]. Recent theoretical perspectives similarly suggest that intense sensory overload can trigger a dissociative response in some individuals as a defensive mechanism [26]. For example, in trauma-exposed individuals, disruptions in the integration of vestibular input (inner-ear sense) with the brain have been shown to contribute to dissociative symptoms such as disconnection from the external world and alterations in body perception [26,27]. Within this theoretical framework, it is proposed that exposure to overwhelming sensory stimuli can cause a kind of “perceptual overflow” in the nervous system, resulting in a state of depersonalization or derealization, wherein the individual feels detached from their environment at the level of conscious awareness. In light of these findings, it is conceivable that there is a notable overlap between misophonia and dissociative symptoms.

Most individuals with misophonia exhibit avoidance behaviors in response to triggering stimuli and attempt to reduce sensory overload through strategies such as avoiding social environments or constantly wearing headphones [28,29]. This strong tendency toward avoidance is, in fact, an indication that these individuals find environmental stimuli overwhelmingly distressing [18]. From this perspective, the commonly observed sensory hypersensitivity and avoidance of stimuli in individuals with misophonia can, similar to traumatic situations, trigger a type of dissociative mechanism and lead to symptoms such as depersonalization and derealization. Moreover, anxiety and depressive symptoms – known to co-occur with misophonia – may also play a significant role in this relationship [30]. Studies have shown that anxiety frequently coexists with misophonia and negatively impacts quality of life [30], and that depressive symptoms are also commonly observed in individuals with misophonia [31]. These psychiatric symptoms can both interact with sensory processing differences to increase the severity of misophonia and pave the way for the emergence of dissociative symptoms. For example, hypervigilance – a constant state of alertness – is common in misophonia and can elevate anxiety levels [32]; in the long term, this state of chronic arousal may lead individuals to emotional exhaustion and a “shutdown” response.

To date, few studies have directly examined the relationship between misophonia and dissociative symptoms [33]. However, the theoretical and indirect findings summarized above suggest a potential link between these 2 phenomena. In this context, the present study aimed to evaluate sensory processing characteristics in individuals with high levels of misophonia, determine the prevalence of dissociative symptoms in this population, and explore the role of accompanying psychiatric factors such as anxiety and depression in the relationship between misophonia and dissociation. The findings obtained from this research will help illuminate the clinical profile of misophonia – which has not yet been formally recognized as a diagnostic category – from a holistic perspective. Accordingly, we sought to characterize sensory processing and psychiatric symptom burden in adults with misophonia (n=35) versus healthy controls (n=51) and to test whether misophonia severity relates to dissociative experiences and to depression, anxiety, and stress symptoms as assessed by validated instruments.

Materıal and Methods

ETHICS APPROVAL AND CONSENT TO PARTICIPATE:

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethics approval was obtained from the University Non-Interventional Clinical Research Ethics Committee (Approval No: 2025/2378, Date No: 25/07/2025). All participants were informed about the study and provided informed consent online on a voluntary basis before participation.

PARTICIPANTS:

This was a cross-sectional study conducted through an online survey. Between 26 July and 30 August 2025, announcements were disseminated via social media platforms inviting literate participants aged 18–65 years with internet access to take part. Participation was voluntary, and the application link directed respondents via a unique URL. Two reminders were issued at 2-week intervals. An automated prescreening form applied the exclusion criteria (eg, active substance use, known inflammatory/neurological diseases), after which eligible individuals were routed to the survey. Sampling followed an accessibility-based, voluntary approach (convenience sampling) (n=86). Participants completed a demographic form and standardized questionnaires. Inclusion criteria. Participants were eligible if they were 18–65 years of age; self-reported at least a moderate level of misophonia symptoms; were literate and had sufficient cognitive capacity to complete the online survey independently; had internet access to reach the online data collection form; and voluntarily agreed to participate by providing informed consent. Exclusion criteria were restricted to conditions that compromise valid self-report or confound auditory processing: moderate–severe hearing loss, current psychosis/mania, neurological disorders (eg, epilepsy, dementia, multiple sclerosis), current substance use disorder, and incomplete consent/forms.

DATA COLLECTION AND SURVEY ADMINISTRATION:

Data were collected via Google Forms between 26 July and 30 August 2025 using validated self-report questionnaires. Participation was voluntary and anonymous; no names or email addresses were collected, and electronic informed consent was required before proceeding. The survey was administered in a pre-specified order; all items were set as required, and simple page/branch logic was used to minimize skipping. Consequently, there were no item-level missing data. Incomplete questionnaires were excluded listwise per protocol, and no imputation was applied.

GROUP CLASSIFICATION (MISOPHONIA VS CONTROL):

Misophonia status was determined using MisQuest. Based on prior work [25,26] we used the 3 impairment items (not included in the total score) to index clinically significant impact; a score ≥7 classified participants into the misophonia group (n=35), whereas scores <7 defined controls (n=51). Comparative analyses were conducted between these 2 groups in terms of sensory processing characteristics, dissociative symptoms, and psychiatric symptoms (anxiety, depression, and stress).

SOCIODEMOGRAPHIC DATA FORM:

This form, developed by the researchers, includes questions aimed at identifying the participants’ basic demographic characteristics, such as age, gender, marital status, and education level. It was structured to assess the sociodemographic profiles of the individuals participating in the study.

MISOPHONIA QUESTIONNAIRE (MISQUEST): To assess misophonia symptoms, the MisQuest developed by Wu et al (2014) was used [25]. The Turkish adaptation, validity, and reliability study of the scale was conducted by Sakarya and Çakmak (2022) [26].

The MisQuest comprises 17 items with a 2-factor structure. Factor 1 (Misophonia Symptoms; 7 items) assesses responses to common trigger sounds (eg, chewing, tapping, nasal sounds) and is rated on a 5-point Likert scale from 0=“Not at all true” to 4=“Always true.” Factor 2 (Emotions and Behaviors Related to Misophonia; 10 items) evaluates emotional reactions (eg, anger, distress) and behavioral responses (eg, leaving the environment) to trigger sounds, using a 5-point scale from 0=“Never” to 4=“Always”.

There are no reverse-coded items in the scale. The total score ranges from 0 to 68, with higher scores indicating greater frequency and severity of misophonia symptoms and accompanying emotional or behavioral reactions. In addition, 3 supplementary items at the end of the scale, which are not included in the total score, are used to evaluate the impact of sound sensitivity on daily functioning. A score of 7 or higher in this section is considered to indicate clinically significant levels of misophonia [8,34]. In analyses, the MisQuest-total was used as a continuous indicator of symptom severity, and the ≥7 criterion defined the case group in between-group comparisons. Scale internal consistency for the present sample is reported in the Results section.

ADOLESCENT/ADULT SENSORY PROFILE (A/ASP):

In this study, the A/ASP was used to assess individuals’ sensory processing characteristics. This self-report instrument consists of 60 items designed to evaluate responses to sensory stimuli across 5 sensory modalities: taste/smell, visual, auditory, tactile, and vestibular. All items are rated on a 5-point Likert scale ranging from “almost never” to “almost always.” Participants indicate how frequently they respond to the sensory situations described in each item.

The scale categorizes sensory responses into 4 sensory-processing patterns: Sensory Avoiding, Sensory Sensitivity, Low Registration, and Sensation Seeking. Each subscale yields scores ranging from 15 to 75. The results are interpreted based on normative data developed for different age groups to identify the individual’s sensory processing profile. Separate norm ranges are defined for adolescents (ages 11–18), adults (ages 18–64), and older adults (65+). Participants’ scores are categorized and interpreted as “much more than most people,” “more than most people,” “similar to most people,” “less than most people,” or “much less than most people” [35]. In this study, we analyzed the 4 pattern scores as continuous variables. Internal consistency coefficients for these pattern scores in our sample are reported in the Results section.

DISSOCIATIVE EXPERIENCES SCALE (DES):

This scale was developed to assess the frequency with which individuals experience dissociative phenomena such as disruptions in self-awareness, distortions in time and reality perception, depersonalization (feeling detached from oneself), and derealization (feeling detached from the environment).

Originally developed by Bernstein and Putnam (1986), the scale consists of 28 items. Respondents are asked to indicate the frequency with which they experience each described phenomenon as a percentage between 0 and 100. Each item reflects the subjective frequency of a specific dissociative experience. The overall DES score is calculated by averaging the item scores, with higher scores indicating more frequent and intense dissociative experiences [36].

The Turkish adaptation, validity, and reliability study of the scale was conducted by Yargıç, Karancı, and Tutkun [37]. The psychometric analysis of the Turkish version showed a high internal consistency, with a reported Cronbach’s alpha of 0.93, indicating that the Turkish version is a highly reliable measurement tool [37]. We used the DES total as a continuous variable in correlation and regression analyses and did not apply categorical cut-offs for hypothesis testing.

DEPRESSION ANXIETY STRESS SCALES – SHORT FORM (DASS-21): The DASS-21 is a self-report instrument designed to assess symptoms of depression, anxiety, and stress experienced over the past week. Developed by Lovibond and Lovibond (1995), the scale consists of 21 items rated on a 4-point Likert scale (0=did not apply to me at all, 3=applied to me very much or most of the time). The scale comprises 3 subscales, each containing 7 items, corresponding to depression, anxiety, and stress symptom clusters. Subscale scores are calculated separately, and a total symptom burden score can also be computed if needed [38].

The Turkish adaptation, validity, and reliability study was conducted by Yılmaz et al (2017). The analyses demonstrated high internal consistency and confirmed the structural validity of the scale, indicating that the Turkish version of the DASS-21 is a reliable and valid tool for assessing psychological symptoms [39]. In this study, the 3 subscales were analyzed as continuous variables in correlation and regression models. Internal consistency for each subscale in the present sample is reported in the Results section.

SAMPLE SIZE AND POWER ANALYSIS:

An a priori power analysis for our association tests (two-tailed), targeting a medium effect size for correlation (r=.30) with α=.05 and power (1-β)=.80, indicated a required sample of n=84. Our final sample of n=86 meets this criterion.

STATISTICAL ANALYSIS:

Analyses were conducted in IBM SPSS Statistics 25.0 (two-tailed, α=0.05). We reported descriptive statistics (mean±SD, median [IQR], min–max). Distributional assumptions were evaluated with Shapiro-Wilk/Kolmogorov-Smirnov and visual diagnostics (histograms, Q-Q plots). For group comparisons, independent-samples t tests were used when normality and homogeneity of variances (Levene’s test) were satisfied; otherwise, the Mann-Whitney U test was applied.

Associations were examined with Pearson’s r for approximately normal, linearly related variables and with Spearman’s ρ otherwise (linearity and outliers were inspected via scatterplots/residuals). A hierarchical multiple regression tested the relationship between misophonia symptoms and sensory-processing patterns while adjusting for covariates; model assumptions were checked (linearity, normality and homoskedasticity of residuals, independence, and multicollinearity via VIF). For categorical variables, we used Pearson’s chi-square; when >20% of expected counts were <5, we estimated exact P values via Monte Carlo simulation (10 000 iterations).

Results

DEMOGRAPHICS:

Comparing the misophonia group (MisQuest score ≥7) with the healthy control group (MisQuest score <7), no statistically significant differences were observed in age, gender, marital status, education, psychiatric history, or misophonia awareness (all P>.05). The absence of between-group differences reduces the risk of demographic confounding in subsequent analyses. Participants’ demographic characteristics are presented in Table 1.

GROUP COMPARISONS: MISOPHONIA SYMPTOMS, SENSORY PROCESSING, DISSOCIATION, AND PSYCHOLOGICAL SYMPTOMS:

Significant differences were found between individuals with misophonia and the healthy control group in terms of misophonia symptoms, sensory processing, dissociative experiences, and psychological symptoms. The misophonia group had significantly higher scores on the MisQuest Symptom subscale (MisQuest-SYM; median=14) and the MisQuest Emotions and Behaviors subscale (MisQuest-EB; median=12) compared to the control group (both P<.001). Similarly, the mean MisQuest-Total score (MisQuest -Total) was significantly higher in the misophonia group (M=29.40±12.50) than in the control group (M=15.18±8.70) (P<.001).

Scores on the A/ASP subscales of Low Registration, Sensory Avoiding, and Sensory Sensitivity were significantly higher in the misophonia group compared to the control group (P=.001, P<.001, and P<.001, respectively), whereas no significant difference was found between the groups in Sensation Seeking scores (P=.606).

Additionally, the total percentage score on the Dissociative Experiences Scale (DES) was higher in the misophonia group (Median=10, Min–Max=0.71–58.21), and this difference was statistically significant (P<.001). Regarding psychological symptoms, the misophonia group had significantly higher scores in depression, anxiety, and stress (Median=8, 7, and 7, respectively) compared to the control group (all P<.001). Data on the comparison of scale scores between the Misophonia and Control groups are presented in Table 2.

RELATIONSHIPS BETWEEN MISQUEST-TOTAL AND SENSORY/DISSOCIATIVE/PSYCHOLOGICAL MEASURES:

According to the Spearman correlation analysis examining the relationship between total misophonia scores and other scale scores, significant positive correlations were found between MisQuest-Total score and low registration (r=0.565, P<0.01), sensory sensitivity (r=0.717, P<0.01), sensory avoiding (r=0.700, P<0.01), dissociative experiences (r=0.348, P<0.01), depression (r=0.421, P<0.01), anxiety (r=0.406, P<0.01), and stress (r=0.440, P<0.01).

These findings indicate that misophonia symptoms are not only associated with sensory processing differences but also with dissociative symptoms and levels of psychological distress. The data are presented in Table 3.

HIERARCHICAL REGRESSION PREDICTING MISOPHONIA SEVERITY:

According to the hierarchical regression analysis, Model 1, which included only the subscales of the A/ASP, was found to be significant (R²=0.542, F(4, 81)=23.984, P<.001). In this model, sensory seeking (β=0.218, P=.005), sensory sensitivity (β=0.301, P=.012), and sensory avoiding (β=0.333, P=.004) significantly predicted misophonia scores, whereas low registration was not a significant predictor (β=0.135, P=.175).

In Model 2, additional variables including age, gender, education level, psychiatric history, and DASS-21 subscales (depression, anxiety, stress) were entered. The extended model was also significant (R²=0.567, F(11, 74)=8.811, P<.001); however, none of the added variables significantly predicted misophonia scores (all t values, p>.05).

These findings suggest that misophonia symptoms are particularly associated with sensory processing styles such as sensory sensitivity, avoidance, and seeking, while demographic characteristics, psychiatric history, and psychological distress symptoms do not provide additional explanatory power. The analysis results are presented in Table 4.

Discussion

In this study, adults classified as having misophonia based on a MisQuest score ≥7 (n=35) were compared with healthy controls. Relative to controls, the misophonia group exhibited significantly higher scores on the A/ASP, DES, and the DASS-21. Misophonia symptom severity was positively correlated with A/ASP’nin Low Registration, Sensation Seeking, and Sensory Avoiding patterns, as well as with DES and with depression, anxiety, and stress. In hierarchical models that adjusted for covariates, Sensation Seeking, Sensory Sensitivity, and Sensory Avoiding remained significant predictors of misophonia symptoms.

Previous studies have also shown that individuals with misophonia exhibit hypersensitivity not only in the auditory domain but also across other sensory profiles [40]. Sensory sensitivity and avoidance are characterized by low sensory thresholds and active avoidance of stimuli [41]. In this context, the overlap between higher levels of misophonia symptoms and low-threshold sensory profiles observed in our participants is consistent with previous findings [11]. Recent studies in people with autism spectrum disorder further reinforce the sensory component of misophonia: Aldakhil et al (2025) reported significant comorbid sensory sensitivity among misophonia cases, and Katikar et al (2025) observed a high prevalence of misophonia in children on the autism spectrum, together suggesting that atypical sensory processing is an important pathway to misophonia in neurodiverse populations [10,42]. Against this background, the overlap between higher misophonia symptoms and elevated Sensory Sensitivity in our sample aligns with the literature and supports the view that multisensory hyperreactivity is a core feature rather than a simple byproduct of environmental disturbance.

Moreover, our results revealed that the sensory seeking score was also significantly positively correlated with misophonia (r=0.348, P=.005) and emerged as a significant predictor in the regression analysis. Although this finding may appear contradictory at first glance, it is known that some individuals simultaneously show sensitivity to certain sensory inputs while actively seeking others [43]. This suggests that perhaps increased responsiveness to unpredictable social sounds can coexist with a search for stable, high-intensity, and controllable stimulation. Such patterns likely reflect adaptive attempts to regulate sensory load and may function as compensatory, rather than contradictory, features of the phenotype. From a clinical standpoint, profiling not only sensory hypersensitivity but also selective sensory seeking may be an effective approach to inform treatment for misophonia. Interventions can be structured by combining stimulus management (eg, structured sound regulation/masking strategies in trigger-prone contexts) with graded exposure protocols, and by incorporating controlled, preference-aligned sensory activities (eg, continuous and predictable auditory input, rhythmic/kinesthetic–proprioceptive activities, deep-pressure–based regulation). This approach aims to stabilize arousal in the face of unpredictable triggers, narrow attentional focus, and enhance everyday functioning. In practice, we recommend clarifying goals and progressing in small steps, using trigger hierarchies, and strengthening patients’ self-regulation repertoires through safe, controllable forms of sensory input.

According to Model 1 of the hierarchical regression, Sensory Sensitivity (β=0.301, P=.012), Sensory Avoidance (β=0.333, P=.004), and Sensation Seeking (β=0.218, P=.005) significantly predicted misophonia scores, whereas Low Registration did not. This pattern suggests that misophonia is particularly associated with heightened reactivity and avoidance in response to sensory stimuli, while under-responsiveness or low awareness is only weakly related. Consistent with this interpretation, prior work has shown that individuals with severe misophonia exhibit hypersensitivity not only in the auditory domain but also across other modalities such as light, sound, and smell [11]. In Model 2, after adding age, gender, education, psychiatric history, and psychological symptoms, the sensory predictors remained significant and none of the added variables emerged as significant predictors. Taken together, these results indicate that, within this dataset, misophonia symptoms are determined by sensory processing styles rather than demographic or broad psychological factors, aligning with proposals that sensory sensitivity can play a fundamental role in misophonia [11,44].

This supports the heterogeneity of sensory modulation disorders and suggests that the sensory sensitivity associated with misophonia can coexist with different sensory processing styles in some individuals. In this regard, focusing not only on hypersensitivity but also on potentially co-occurring sensory profiles may provide a more comprehensive understanding of misophonia.

When the associations between psychological symptoms (depression, anxiety, and stress) and misophonia were examined, moderate positive correlations were observed with all variables. Notably, the strongest correlation was found with stress. This finding suggests that misophonia symptoms may be related to daily life stressors and may also be associated with difficulties in emotional regulation. Previous studies have similarly reported that misophonia is closely linked to problems in emotional regulation [17]. Additionally, comorbidity of misophonia with disorders such as anxiety and depression has been documented [8]. In this regard, the finding that individuals with misophonia exhibit higher levels of stress, depression, and anxiety symptoms is consistent with the existing literature.

A second key finding of the study is the significant positive correlation between dissociative experiences and misophonia scores (r=0.348, P=.001). Our finding is consistent with the limited literature examining the association between misophonia and dissociative experiences [33]. Our observed positive association between misophonia and dissociative experiences is consistent with prior interpretations suggesting that, under the expectation of uncontrollable and unpredictable triggers, heightened stress and interoceptive/threat reactivity may render dissociative responses part of the phenotype [33]. Nonetheless, the cross-sectional design limits causal inference. This suggests that misophonia may also be associated with psychological dissociation. Dissociative experiences often develop in response to early-life stressors, traumatic events, or inadequate emotional regulation abilities [45,46]. Considering that misophonia symptoms are characterized by perceiving environmental sounds as threatening and exhibiting exaggerated physiological or emotional reactions to these stimuli [47], and that individuals with misophonia experience difficulties in emotion regulation [17], it can be suggested that these symptoms may be related to sensory hypervigilance and avoidance tendencies. Furthermore, common features observed in individuals with dissociation—such as attentional splitting, excessive focus on internal experiences, and impairments in perceptual filtering [48], may further exacerbate misophonic reactions. This relationship suggests that misophonia might also be linked to psychological integrity. However, there are currently no studies in the literature directly investigating the association between misophonia and dissociative symptoms. This points to a significant gap in the field and highlights the need for future research to explore this issue in greater depth to better understand and interpret the findings.

One of the major strengths of this study is that it approaches misophonia not solely from the perspective of auditory hypersensitivity, but also in conjunction with multidimensional psychological variables such as sensory processing styles, psychological symptoms (depression, anxiety, and stress), and dissociative experiences. This holistic perspective supports a more comprehensive conceptualization of misophonia and offers an original contribution to the literature. Moreover, the use of psychometrically valid and reliable assessment tools that have been adapted to Turkish enhances the quality and credibility of the collected data. The two-group design, which compared individuals with misophonia to healthy controls, further strengthens the ability to detect group differences. Importantly, the finding of a significant association between misophonia and dissociative experiences provides a novel and original perspective on an area that has not yet been directly addressed in the existing literature.

This study has several limitations. The cross-sectional design precludes causal inference. The convenience, online sample was relatively small and skewed toward university graduates and female participants in Turkey, limiting generalizability beyond similar community samples; extrapolation to clinical, older, or cross-cultural populations should be made with caution. All data were self-reported, which may introduce response biases (eg, social desirability, recall); we sought to mitigate these via validated measures, anonymity, required items, attention checks/duplicate-response prevention, and predefined exclusion rules, yet residual self-report/common-method bias may remain. Dissociative experiences were assessed at a global level rather than by subdimensions (eg, depersonalization, derealization). Misophonia case status was defined using the MisQuest criterion (≥7). Although this approach aligns with prior studies, the threshold is not universally standardized and may lead to some misclassification. The A/ASP yields norm-referenced interpretations; however, in the present study we analyzed pattern scores as continuous variables without incorporating laboratory-based sensory or auditory physiological measures, which limits mechanistic inference. Likewise, the Dissociative Experiences Scale (DES) and the DASS-21 are screening instruments rather than diagnostic tools, so elevated scores indicate symptom burden but do not establish psychiatric diagnoses. Finally, we examined multiple associations in an exploratory framework; despite checking model assumptions and adjusting for covariates, residual confounding and an increased risk of type I error remain possible. Future work should use larger, probability-based or stratified samples, incorporate longitudinal and cross-cultural designs, and include structured diagnostic assessments to evaluate external validity and the stability of effect sizes across settings.

Conclusions

This study aimed to clarify how misophonia relates to sensory processing and dissociative/psychological symptoms. Consistent with our hypotheses, misophonia severity was most strongly associated with heightened sensory sensitivity and avoidance, and showed positive links with dissociative experiences and depressive/anxious distress. Hierarchical regression indicated that sensory processing styles accounted for unique variance in misophonia beyond demographic and clinical covariates, supporting a sensory–emotional framework of the condition.

Clinically, these findings point to integrated interventions that jointly target sensory modulation and emotion regulation (eg, graded sensory exposure with skills for arousal/affect regulation). Conceptually, they inform models that situate misophonia at the intersection of sensory reactivity and dissociative phenomena.

We note that the cross-sectional design and reliance on self-report limit causal inference and may leave residual response bias; thus, replication in larger, longitudinal, and clinically verified samples (including structured diagnostic assessments and cross-cultural cohorts) is warranted.

Take-home message: Misophonia aligns with a sensory–emotional profile – marked by sensory sensitivity/avoidance and elevated dissociation/distress – suggesting theory and treatment should address both sensory processing and emotional regulation.