Social-Cognitive Dysregulation Model of Misophonia: Perspective from a Behavioural Study

Misophonia is increasingly conceptualized as more than a disorder of sound tolerance, with trigger over-reactivity shaped by the social meaning of sounds, inferred intentions, and representations of others’ actions. We tested a social-cognitive dysregulation model of misophonia in (N = 341) adults using behavioural measures of Theory of Mind and emotion recognition, alongside measures of reflective functioning, empathy, alexithymia, and mimicry. Dimensional associations with misophonia severity and its five different dimensions were examined while accounting for age, sex, sound sensitivity, and anxiety/depressive symptoms. Increased misophonia severity was associated with less accurate and slower mental-state inference and emotion recognition. ToM accuracy effects were evident for more complex, cognitive, and affective mentalizing, but not for simpler mentalizing or physical control judgments, while emotion-recognition accuracy differences emerged for positive but not negative stimuli. Greater severity was also characterized by reduced certainty and greater uncertainty about mental states, greater difficulty identifying one’s own feelings, and elevated alexithymia, whereas global self-reported empathy was largely preserved. Misophonia severity further predicted a greater propensity to mimic trigger-producing actions or sounds; 41% of participants exceeding the S-Five clinical cutoff (≥87) endorsed mimicry, which was particularly associated with a subjective restoration of control. Findings remained robust following influential-case sensitivity analyses. These results reveal a selective disturbance in self–other representation spanning mentalizing, emotion decoding, emotional self-representation, and embodied regulatory processes. They position misophonia within a broader social-cognitive framework in which auditory-affective reactivity may intersect with altered inferential and sensorimotor processing, while stopping short of causal inference.