Evaluation of the relationship between misophonia, difficulties in emotion regulation, and metacognition in adolescents

SUMMARY Evaluation of the Relationship Between Misophonia, Difficulties in Emotion Regulation, and Metacognition in Adolescents Dr. Zeynep Işılay ORMANCI Misophonia is a recently defined phenomenon characterized by intense anger, disgust, anxiety, and avoidance reactions to specific sounds. Individuals with the condition often report experiencing hypervigilance toward environmental sound triggers, along with internal tension and pronounced distress. Current evidence suggests that rather than being a mere auditory sensitivity, misophonia is a multidimensional construct that impairs cognitive, emotional, and social functioning. While it has not yet been incorporated into official psychiatric diagnostic manuals, recent research indicates it could be evaluated as a distinct psychiatric disorder, one that is highly associated with various psychiatric comorbidities. Because the onset typically occurs during childhood or adolescence, early detection—along with understanding the underlying cognitive and emotional mechanisms and planning appropriate interventions—is key to preventing psychopathologies that may develop in later life. Previous reports suggest that misophonia presents more severely in individuals with high emotional reactivity and might be linked to difficulties in regulating negative emotions. Additionally, the ways individuals interpret sounds and assign meaning to these experiences are thought to be tied to metacognitive processes. Therefore, investigating how emotion regulation difficulties and metacognitive beliefs relate to misophonia is important for clarifying the mechanisms behind its onset and maintenance. The present study examined the prevalence of misophonia symptoms among adolescents aged 15–18, exploring their links to clinical and familial variables, as well as the interplay between misophonia symptoms, emotion regulation difficulties, and metacognitive beliefs. Data were collected online from 320 participants across different provinces in Turkey. The adolescents completed the Amsterdam Misophonia Scale (A-MISO-S), the Brief Form of the Difficulties in Emotion Regulation Scale (DERS-16), and the Metacognitions Questionnaire for Children and Adolescents (MCQ-C), while their parents filled out a sociodemographic data form. Within the sample, the prevalence of misophonia was 9.7%, with most participants (71.9%) reporting symptoms at a subclinical level. Misophonia scores were significantly higher in adolescents who had a history of misophonia in their first-degree relatives. Similarly, those presenting with auditory or vestibular complaints showed a significant increase in misophonia levels. Analyses revealed no significant correlation between the severity of misophonia and either emotion regulation difficulties or metacognitive beliefs. However, the anticipated positive correlation between emotion regulation difficulties and metacognitive beliefs was present. Ultimately, the lack of a significant association between misophonia, emotion regulation, and metacognition may be attributed to developmental variations specific to middle adolescence. Considering that existing literature mostly highlights the link between misophonia and emotion regulation in adult samples—and that metacognitive processes have rarely been addressed directly in this context—it is crucial to evaluate these findings through a developmental lens. Moving forward, future research utilizing multi-method approaches across diverse age groups will be instrumental in mapping the developmental trajectory of misophonia more comprehensively. Keywords: misophonia, difficulties in emotion regulation, metacognition, adolescence, mediation analysis