Scholars@Duke publication: Examining the relationship between difficulties with emotion regulation and misophonia and hyperacusis symptom severity in adults with clinically significant misophonia

Examining the relationship between difficulties with emotion regulation and misophonia and hyperacusis symptom severity in adults with clinically significant misophonia

Publication , Journal Article

Aryal, S; Moskovich, A; Prabhu, P; Rosenthal, MZ

Published in: Hearing Research

December 1, 2025

Misophonia is a prevalent and impairing sound intolerance condition that shares symptom overlap and high rates of co-morbidity with hyperacusis. Research demarcating these sound intolerance conditions is critical for the development of accurate diagnostic tools and treatment matching. Previous research suggests difficulties with emotion regulation may be a core feature of misophonia, but its relationship to hyperacusis is unknown. As a first step in exploring whether emotion regulation may be a clinical feature that differentiates misophonia from hyperacusis, the current study examined the relationship between difficulties with emotion regulation and both misophonia and hyperacusis symptom severity in a sample of adults with clinically significant misophonia. Participants (N=143) completed the Misophonia Questionnaire, the Hyperacusis Questionnaire, and the Difficulties in Emotion Regulation Scale. Stepwise hierarchical regression analyses were conducted to examine whether difficulties with emotion regulation predicted misophonia (Model 1) and hyperacusis (Model 2) symptom severity, after controlling for age and hyperacusis severity or misophonia severity respectively. Partial correlation and Fisher's Z analyses were subsequently conducted to examine whether domains of emotion regulation were differentially related to symptom severity. Results indicated that greater difficulties with emotion regulation were significantly associated with misophonia but not hyperacusis severity. Additionally, misophonia symptom severity was specifically related to difficulties with goal-directed behavior, impulse control, access to strategies and nonacceptance. Findings provide preliminary evidence that difficulties with emotion regulation may be a clinical feature that differentiates misophonia from hyperacusis that should be further tested in samples of individuals with hyperacusis without misophonia.