Misophonia: Independent Evidence on Diagnosis, CBT & Who Funds It

Table of contents

• Evidence summary
• What misophonia is
• Symptoms, diagnosis and red flags
• Causes and risk factors
• Treatments that work
• Medicines
• Supplements, apps, devices and lifestyle claims
• Risks of common treatments
• Who to see
• Follow the money: who funds the research and who sells treatment
• Related research
• Frequently asked questions
• Sources and funding notes

Evidence summary

Independent evidence and credibility scorecard

Independence tiers: 1 = regulator or government body; 2 = academic team with public, university or general-charity funding and no declared stake in the result; 3 = funded by a condition-specific philanthropy with a stated mission to advance recognition and treatment, or minor declared ties; 4 = funded or authored by people who sell the treatment being described. Credibility runs from A (highest) to D.

Note on clustering: the trial evidence comes mainly from the Netherlands and the US, and most US work since 2019 is funded by the same philanthropy. The prevalence evidence is more spread out (UK, US, Germany). The UK sources are publicly or charity funded. No regulator or national guideline body has reviewed misophonia treatment.

What misophonia is

The word means "hatred of sound". Audiologists Pawel and Margaret Jastreboff coined it in 2001 (Jastreboff & Jastreboff 2023). For two decades, researchers in audiology, psychology and psychiatry defined it in different ways. That made studies hard to compare (Swedo 2022).

The 2022 consensus definition

An international expert committee, with Susan Swedo as first author of the resulting paper, used a modified Delphi method. Statements taken from a systematic review of the literature were voted on over four rounds. A statement was kept only if at least 80% of the committee agreed (Swedo 2022). The definition it agreed says:

• Misophonia is "a disorder of decreased tolerance to specific sounds or their associated stimuli".
• Reactions depend on the pattern or meaning of a sound, not how loud it is. This is the main difference from hyperacusis, where ordinary sounds feel too loud or painful.
• Triggers are often repetitive and usually made by other people, especially by the body: chewing, slurping, swallowing, throat clearing, breathing and sniffing. Pen clicking, typing, tapping and some animal or object sounds can also trigger it. Some people react to sights, such as leg jiggling or watching someone eat.
• The same sounds made by the person themselves usually do not trigger a reaction. Context, sense of control and the relationship with the person making the sound all change how strong the reaction is.
• Symptoms usually start in childhood or early adolescence.
• It can occur with normal hearing, with tinnitus or hyperacusis, and alongside anxiety, mood, obsessive-compulsive-related, personality and post-traumatic stress disorders, autism and ADHD. The symptoms should not be better explained by one of those conditions.

The consensus was funded by the REAM Foundation, working through the Milken Institute Center for Strategic Philanthropy. The SPARC philanthropy programme says it played a key role in developing the definition (SPARC). The paper gives grant number 7894 and states that the funder was not involved in the study design, analysis, writing or submission (Swedo 2022, full text).

Is it an official diagnosis?

Not yet. Misophonia is not listed in the DSM-5-TR or ICD-11 (Frontiers in Psychiatry 2023). In the UK, the NHS lists it only as a type of hearing sensitivity on its hyperacusis page (NHS). In practice, clinicians can describe and treat it, but there is no formal code, which can affect insurance cover and access to services.

How common is it?

Estimates vary more than tenfold, because studies use different questionnaires and cut-offs.

Our reading: annoyance at chewing and breathing sounds is very common. Misophonia severe enough to disrupt daily life is probably in the low single figures as a percentage of adults. The UK 18% figure counts people whose symptoms cause "significant burden", which is a broader group. The German authors suggest treating misophonia as a spectrum, from subthreshold to severe (Pfeiffer 2024).

Symptoms, diagnosis and red flags

Symptoms

According to the consensus, the most common reactions are anger, irritation, disgust and anxiety; some people feel rage. The body reacts too, with muscle tension, a faster heart rate and sweating. People may escape or avoid situations, ask others to stop, or copy the sound back. Verbal or physical outbursts are rare and are seen more in children than adults. Many adults know their reaction is out of proportion (Swedo 2022).

In the largest clinical series, from the Amsterdam University Medical Center, 575 patients were confirmed to have misophonia. 69% were women (Jager et al. 2020). The impact can include strained family relationships, avoiding shared meals, trouble concentrating at work or school, and social isolation (Swedo 2022).

How it is assessed

There is no blood test or scan. Diagnosis rests on a clinical interview, often with a questionnaire. The main ones are:

• A-MISO-S and AMISOS-R (Amsterdam Misophonia Scale and its revision). Clinician-rated severity; the AMISOS-R was the main outcome in the Dutch CBT trial (Jager 2021).
• S-Five. A five-factor self-report tool covering appraisals, threat, avoidance, outbursts and impact, with UK population norms (Vitoratou 2023).
• Duke Misophonia Questionnaire (DMQ). 86 items in nine subscales, from trigger frequency to beliefs and impairment, developed with input from patients and families (Rosenthal 2021).
• Misophonia Questionnaire (MQ) and MisoQuest. Self-report scales; the MQ was a main outcome in the US ACT trial (Twohig 2026).

A 2025 systematic review of 25 psychometric studies found the evidence on these questionnaires "limited", especially across languages and cultures (Maleki 2025). Different scales give different prevalence figures, so results from one study cannot simply be compared with another.

Getting the diagnosis right

Misdiagnosis is a real risk. In the Amsterdam series, 779 people were referred but misophonia was confirmed in 575 (74%). One in four did not have it. The authors note that misophonia-like symptoms can come from obsessive-compulsive personality traits, mood disorders, ADHD or autism (Jager 2020). A good assessment should therefore include:

• a hearing history and, where appropriate, a hearing test, to separate misophonia from hyperacusis, tinnitus or hearing loss (NHS);
• screening for anxiety, depression, OCD, PTSD, ADHD and autism (Swedo 2022);
• questions about anger, aggression and safety at home, especially for children.

Red flags

• Sudden hearing loss, hearing that worsens over days or weeks, or hearing loss with earache or discharge. The NHS says get an urgent GP appointment or call 111 (NHS).
• Sounds that are painful or seem too loud, rather than emotionally triggering, point to hyperacusis. See a GP (NHS).
• Aggression, threats or thoughts of self-harm. Treat these as urgent; see the crisis lines above and our guide to mental health crisis warning signs.

Causes and risk factors

The cause is unknown. The consensus panel judged that the mechanisms and genetic links remain inconclusive (Swedo 2022). The leading lines of evidence are:

• Brain responses (small human studies). In a UK brain-scan study, trigger sounds produced much larger responses in the anterior insular cortex of people with misophonia than in controls. This area helps judge what is important and process emotions. The study also found higher heart rate and skin conductance (Kumar 2017). A follow-up study in 33 and 42 people found no difference in hearing areas of the brain. Instead, it found stronger links to the area that controls mouth and face movements. The authors call this "hyper-mirroring" of other people's actions (Kumar 2021). Both studies were small, and neither has led to a treatment yet.
• Genetics (indirect). A Dutch team analysed an unpublished genome-wide study from the consumer genetics company 23andMe. It was based on a single self-report question about feeling rage at eating sounds. That trait was genetically correlated with tinnitus, major depression, PTSD and generalised anxiety disorder (Smit et al.). One question is not a diagnosis, so this is a weak signal.
• Co-occurring conditions. In the Amsterdam series, 26% had obsessive-compulsive personality traits, 10% mood disorders, 5% ADHD and 3% autism. Only 2% reported tinnitus and 1% hyperacusis (Jager 2020). A 2025 systematic review found reported rates of mood disorders ranging from 1.1% to 37.3%, and anxiety disorders from 0.2% to 69%. Most studies did not check for the full range of conditions (Rodrigues & Aazh 2025).
• Overlap with OCD. A 2026 meta-analysis of 17 studies (N = 1,193) estimated that 9.2% of people with misophonia have OCD, with a moderate correlation between the two (r = 0.39). The studies are small and varied, so treat the figure as provisional (Spallarossa 2026).
• Age and sex. Onset is usually in childhood or early adolescence (Swedo 2022). Clinic samples are mostly women (Jager 2020), but the representative UK survey explored sex and age differences (Vitoratou 2023).

Treatments that work

There is no NICE guideline or other national guideline on misophonia; we found none. The evidence base is small. A 2023 systematic review found 33 treatment studies: one randomised controlled trial, one open-label trial and 31 case studies. CBT was the approach used most often, and the review found it effective in the one RCT and in several case studies, but flagged an "overall lack of rigor", little replication and small samples (Mattson 2023). Several more trials have been published since.

Group CBT: the Amsterdam trial

This is the trial most often cited. Between May 2017 and December 2018, 54 of 71 recruited adults at Amsterdam UMC were randomly assigned to weekly group CBT for three months or to a waiting list. The trial was designed so the assessor would not know who was in which group, but the authors report that the assessor sometimes guessed allocations from how much people had improved. The therapy combined attention-shifting and arousal-reduction exercises, positive affect labelling and changing how trigger sounds were experienced. Of the 54, 46 (85%) completed the study (Jager 2021).

Results: AMISOS-R scores fell by 9.7 points in the CBT group and by a much smaller amount on the waiting list (full text). A standardised effect of d = 1.97 is very large, but waiting-list trials usually overstate effects, because people on a waiting list expect nothing to change. Just over a third (37%) were rated much or very much improved, so most people were not. Disability scores for work, social and family life improved, but a general quality-of-life score (EQ-5D) did not change, which the authors put down to the scale being a poor fit for this group. They say future work "should include an active control group" (Jager 2021).

Therapy against an active control

Two newer US trials compared a structured therapy with psychoeducation plus relaxation training. That is a fairer test, because both groups get attention and an explanation of their symptoms.

• Adults, ACT (n = 60). Each person had 12 one-hour sessions. Both groups improved substantially on assessor ratings, with no difference between groups on misophonia, overall severity, well-being or psychological flexibility. On the self-rated MQ, response rates were low: 7% to 27% with ACT and 3% to 20% with relaxation, depending on the subscale. On the assessor-rated measure they were 20% to 70% with ACT and 6% to 50% with relaxation (Twohig 2026).
• Children and teenagers, Unified Protocol (n = 43). Ten telehealth sessions; 54% responded to the CBT programme and 25% to relaxation. The CBT group did better on some, but not all, symptom and functioning measures (Lewin 2026).

Our reading: talking therapies with a CBT core help many people, but it is not yet clear how much of the benefit comes from the specific technique rather than from understanding the condition, learning to relax and having a supportive therapist. For broader context, see our reviews of CBT and ACT.

Trials still under way

A Dutch randomised trial of CBT plus psychomotor therapy for 82 children and adolescents has published its design (Rappoldt 2023); we did not find its results. A UK sham-controlled trial of non-invasive ear nerve stimulation (transcutaneous auricular vagus nerve stimulation) in 60 people is planned. It is funded by the Misophonia Research Fund (Rinaldi 2026). Until results are published, stimulation devices sold for misophonia are untested.

Medicines

We found no medicine licensed for misophonia in the sources we checked, and no randomised trial of any medicine. The 2023 systematic review lists 31 of its 33 studies as case studies; we could not confirm what its one randomised and one open-label trial tested (Mattson 2023). Published single cases include:

• Propranolol (a beta-blocker): a single patient's trigger symptoms were eliminated on 60 mg, in the author's report (Webb 2022). See our review of propranolol for anxiety for its general risks.
• Risperidone (an antipsychotic): one autistic man improved during an inpatient stay. At follow-up the authors said it was "not curative" (Pan 2022).
• Prednisone (a steroid): one person's symptoms eased while taking it for an unrelated injury (Webb & Williamson 2024). Long-term steroids carry well-known harms.
• Other reports and proposals include fluoxetine with olanzapine in one adolescent (Herdi 2024) and a paper proposing MDMA (Webb & Keane 2022). Neither contains trial data.

Single cases are the weakest kind of evidence. They are usually published because something worked, and the failures go unreported. Where a person has a co-occurring condition with its own evidence-based medicines, such as OCD, depression or an anxiety disorder, those conditions should be treated on their own merits. See our guides to OCD and generalised anxiety disorder.

Supplements, apps, devices and lifestyle claims

We found no trials of magnesium, CBD, GABA or other "calm" supplements for misophonia. For what is known about these products in anxiety, see our supplements evidence review and our review of oral lavender (Silexan).

Risks of common treatments

• Talking therapy. The trials did not report serious harms. Therapy takes time and money, and in the Dutch trial about two in three people were not "much improved" (Jager 2021). Exposure-based work can feel distressing at first and should be paced by a trained therapist.
• Avoidance and ear protection. Avoiding meals, rooms or people may ease distress in the short term but can isolate people (Swedo 2022). For hyperacusis, the NHS warns against constant earplug use and total avoidance of noise (NHS). Whether the same applies to misophonia has not been tested.
• Misattribution. Treating "misophonia" alone can miss an underlying anxiety disorder, OCD, depression, ADHD or autism. One in four people referred to a specialist clinic turned out not to have misophonia (Jager 2020).
• Paid programmes and devices. Clinics, apps and devices may be marketed with claims that run ahead of the evidence. Ask for the published controlled trial behind any claim.

Who to see

• GP or family doctor first. They can check hearing and general health and refer you on. The NHS says a GP may refer people with sound sensitivity to a hearing specialist (NHS).
• Audiologist. To rule out hearing loss, hyperacusis and tinnitus, which need different management (Swedo 2022).
• Psychologist or CBT therapist. Ideally one familiar with misophonia, since CBT-based therapy has the best evidence (Mattson 2023).
• Psychiatrist. If there is a co-occurring condition that may need medicine, or a risk of harm. See our guide to mental health assessment and diagnosis.
• Specialist clinics. A few academic centres run dedicated clinics, such as Amsterdam UMC, where the CBT trial took place (Jager 2021), and the Duke Center for Misophonia and Emotion Regulation in the US (Duke). Access varies by country and insurance.

Follow the money: who funds the research and who sells treatment

Who pays for misophonia research

One funder dominates. The Misophonia Research Fund (MRF) is an initiative of the REAM Foundation, which the MRF describes as "a private family foundation". Its founders are named as Diane and Steve Miller (MRF: about). The MRF site gives 2018 as its founding year and 2019 as its launch year. It was set up with guidance from the Milken Institute Center for Strategic Philanthropy. The Milken programme, now called SPARC, says the partnership was "motivated by lived experience" and has deployed "over $12 million" (SPARC).

From the papers we checked, funding was confirmed for:

• the 2022 consensus definition (Swedo 2022);
• the UK and German prevalence studies, funded by the NIHR Maudsley BRC and Wellcome Trust, and by the University of Ulm;
• the US prevalence study (Dixon 2024) and the youth trial (Lewin 2026), funded by the Misophonia Research Fund (the youth trial also by the REAM Foundation);
• the adult ACT trial (Twohig 2026), which lists Misophonia Research Fund and Cambridge Eye Trust grants.

What this means: the MRF sells no therapy, drug or device, so it has no commercial reason to favour a particular treatment. Its stated vision is "to end suffering from misophonia" (MRF). That gives it a mission-driven interest in misophonia being seen as a distinct, common and treatable disorder. Funded studies have reported results that cut against easy answers, including a low US prevalence (4.6%) and a null ACT-vs-relaxation result. When one funder shapes the definition, the measures and the trials, the field's assumptions can converge quickly. That is why independent replication matters.

Outside the MRF, the studies we found were mostly university or public-body work. The funders of the brain-imaging work could not be verified in the record accessed (Kumar 2017; Kumar 2021), and the UK prevalence study was funded by the NIHR Maudsley BRC and Wellcome Trust (Vitoratou 2023). The German prevalence study was funded by the University of Ulm (Pfeiffer 2024). We did not find a funding statement for the Dutch CBT trial, and the Amsterdam case-series record shows none (Jager 2020).

Guideline and consensus panels

There is no NICE or other national treatment guideline, so there are no guideline-panel conflicts to examine. The nearest equivalent is the consensus definition panel. Its funding came from REAM via Milken; the paper states the funder was not involved in the study design, analysis, writing or submission (Swedo 2022). We could not confirm the panel list from the text we accessed, so we do not name individual members (Swedo 2022; Mattson 2023). Overlap between those who define a condition and those who test treatments for it is common in young fields, so independent replication matters.

Who sells treatment

• Clinician-developers. The Jastreboffs' 2023 paper describing their neurophysiological model and treatment states that both authors are employed by JHDF, Inc. (Jastreboff 2023, full text). It is a description of a clinical approach, not a controlled trial.
• Apps. A commercial app site, ocd.app, presents the 2025 app trial on its research pages alongside a pricing page (ocd.app). The site's footer names GGTUDE LTD as the company behind it. The trial's conflict statement says lead author Guy Doron is a cofounder of GGtude Ltd and has a financial interest in the evaluated module (Podoly 2025). The site is seller-run, so we grade this source tier 4.
• Consumer genetics. The only genome-wide data came from 23andMe's unpublished analysis of one survey item, reanalysed by a Dutch academic team; the paper was funded by the UK Medical Research Council (Smit et al.).
• Private therapists and courses. Many private clinics offer misophonia programmes. We found no market-size figure from a citable source, and we did not assess individual providers.

Documented integrity events

We found no regulatory warnings, product recalls or enforcement actions specific to misophonia treatments. That reflects how little the market is regulated, not proof that every product is sound.

Related research

For wider, evidence-graded context, see these Pure City Research guides:

• Cognitive behavioural therapy (CBT)
• Acceptance and commitment therapy (ACT)
• Exposure and response prevention
• Obsessive-compulsive disorder
• Generalised anxiety disorder
• Post-traumatic stress disorder
• Digital CBT and mental health apps
• Mindfulness-based therapy
• Propranolol for anxiety
• Mental health assessment and diagnosis
• Mental health crisis warning signs

Frequently asked questions

Sources and funding notes

What we could not verify: the full funding and conflict statements of the Spallarossa 2026 meta-analysis (not in the full-text record we accessed); the UK prevalence sample size; the consensus panel list (we do not name members); funding of the Webb and Herdi case reports; the Dutch children's trial results; and which GGtude app version is sold on ocd.app. The 96% eating-sound figure we first reported is not supported by its source and has been removed. Europe PMC grant records were checked this round for Lewin 2026, Twohig 2026, Dixon 2024, Vitoratou 2023, Mattson 2023, Rinaldi 2026, Smit 2022 and Pfeiffer 2024, and the tables now state those funders. Europe PMC lists no grants for the Podoly 2025 app trial, the lavender tea trial or the Rodrigues & Aazh 2025 review; their conflict statements are as described above.

1. Swedo SE et al. Consensus definition of misophonia: a Delphi study. Front Neurosci 2022; full text — definition; REAM Foundation funding via the Milken Institute Center for Strategic Philanthropy; grant 7894; the funder was not involved in the study.
2. Jager IJ et al. Cognitive behavioral therapy for misophonia: a randomized clinical trial. Depress Anxiety 2021; full text — main RCT; Amsterdam UMC; no funding statement found; no conflicts declared.
3. Jager I et al. Misophonia: phenomenology, comorbidity and demographics in a large sample. PLoS One 2020 — 575-patient clinic series; "no specific funding".
4. Vitoratou S et al. Misophonia in the UK: prevalence and norms from the S-Five. PLoS One 2023; full text — UK prevalence; funded by the NIHR Maudsley BRC and Wellcome Trust; no competing interests declared.
5. Dixon LJ et al. Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of U.S. adults. J Psychopathol Clin Sci 2024 — US prevalence; funded by the Misophonia Research Fund (Europe PMC).
6. Pfeiffer E et al. The prevalence of misophonia in a representative population-based survey in Germany. Soc Psychiatry Psychiatr Epidemiol 2025 (online 2024) — German prevalence; Ulm University.
7. — student prevalence; University of Nottingham.
8. Spallarossa C et al. Relationship between misophonia and OCD: systematic review and meta-analysis. Eur Psychiatry 2026 — OCD overlap; University of Pavia; funding and conflict statements not found in the full-text record accessed.
9. Rodrigues ALM, Aazh H. Psychiatric comorbidities in hyperacusis and misophonia: a systematic review. Audiol Res 2025 — comorbidity ranges; authors declare no conflict of interest; funder not stated.
10. Mattson SA et al. A systematic review of treatments for misophonia. Pers Med Psychiatry 2023 — treatment review; funded by NIH (NICHD), the International OCD Foundation, the REAM Foundation and others; no known competing financial interests declared.
11. Twohig MP et al. ACT versus progressive relaxation training for misophonia: RCT. J Affect Disord 2026 — adult active-control RCT; Funded by the Misophonia Research Fund and the Cambridge Eye Trust (Europe PMC); the first author declares royalties from New Harbinger, Oxford University Press and Praxis CET.
12. Lewin AB et al. Treatment of youth misophonia: RCT of transdiagnostic CBT vs psychoeducation and relaxation. Behav Ther 2026 — youth RCT; funded by the Misophonia Research Fund and the REAM Foundation (Europe PMC).
13. McMahon K et al. The Unified Protocol for misophonia: a pilot trial. Front Psychol 2023; full text — adult pilot; funder not verified in the record accessed.
14. Spencer SD et al. Pilot trial of exposure and stress management therapy for misophonia. J Psychiatr Pract 2025 — uncontrolled telehealth pilot;
15. Podoly TY et al. RCT of an mHealth intervention for anger-related cognitions in misophonia. J Affect Disord 2025 — app trial; Guy Doron is an author (Reichman University affiliation) and declares that he is a cofounder of GGtude Ltd with a financial interest.
16. Koroglu Gokbel S, Durat G. Lavender herbal tea in misophonia: RCT. J Psychiatr Res 2026 — single-blind; Sakarya University authors; declares no competing financial interests.
17. Rappoldt LR et al. CBT plus psychomotor therapy for youth misophonia: RCT design. Contemp Clin Trials Commun 2023 — protocol; Amsterdam team.
18. Rinaldi LJ et al. taVNS for misophonia: protocol for a sham-controlled RCT. BMJ Open 2026 — protocol; funded by the Misophonia Research Fund (Europe PMC).
19. Kumar S et al. The brain basis for misophonia. Curr Biol 2017 — imaging; funder not verified in the record accessed.
20. Kumar S et al. The motor basis for misophonia. J Neurosci 2021 — imaging; funder not verified in the record accessed.
21. Smit DJA et al. A genome-wide association study of a rage-related misophonia symptom. Front Neurosci 2022 — genetics using unpublished 23andMe data; funded by the UK Medical Research Council.
22. Rosenthal MZ et al. Development and initial validation of the Duke Misophonia Questionnaire. Front Psychol 2021 — questionnaire;
23. Maleki M et al. Psychometric properties of misophonia questionnaires: systematic review. J Audiol Otol 2025 — measures; Tabriz University of Medical Sciences.
24. Jastreboff PJ, Jastreboff MM. The neurophysiological approach to misophonia: theory and treatment. Front Neurosci 2023; full text — originators' model; both authors are employed by JHDF, Inc. (conflict statement).
25. Webb J. β-blockers for the treatment of misophonia and misokinesia. Clin Neuropharmacol 2022; Pan EJ et al. Risperidone, case report, 2022; Webb J, Williamson A. Steroids, case report, 2024; Herdi O. Fluoxetine and olanzapine, case report. Dusunen Adam 2024; Webb J, Keane S. MDMA proposal, 2022 — single cases and proposals; no funding listed. Jadon Webb, author of three of these papers, lists an affiliation with Bloom Mental Health LLC on one 2022 paper; the other case-report authors declare no conflicts.
26. NHS: Hyperacusis (reviewed 11 May 2026) and NHS: Hearing loss — UK government health advice.
27. Misophonia Research Fund: about and home page; SPARC (formerly Milken Institute Center for Strategic Philanthropy): misophonia — funder self-descriptions.
28. Duke Center for Misophonia and Emotion Regulation — academic clinic and research centre.
29. ocd.app: Podoly 2025 misophonia RCT summary — commercial app website.

Educational research reviewed 6 October 2026. This article is not medical advice; talk to a qualified clinician or pharmacist before starting, stopping or combining treatments.