Misophonia in Adolescents: The Interplay of Parental Emotional Expression, Family Functioning, and Childhood Trauma—A Cross‐Sectional Control Study

OBJECTIVE: Misophonia is an underrecognized condition characterized by intense emotional responses to specific auditory stimuli. Beyond its sensory basis, growing evidence suggests that relational experiences and difficulties in emotional processes may play a critical role in its development and severity. This study aimed to explore the roles of family functioning, adolescent-reported parental emotional expression, and childhood trauma in adolescents with misophonia, using a clinical comparison group with anxiety disorders. METHODS: A total of 128 adolescents aged 12-18 were assessed in a child and adolescent psychiatry outpatient clinic. The misophonia group (n = 78) was identified using the Misophonia Questionnaire (cutoff ≥ 7) and structured clinical interviews. The control group (n = 50) included adolescents with primary anxiety disorders but no clinically significant misophonia symptoms. Validated self-report measures were used to assess family dynamics, perceptions of parental emotional expression, trauma history, and functional impact, along with parent-reported behavioral difficulties that provide indirect information about adolescents' emotion regulation-related challenges. RESULTS: Adolescents with misophonia reported significantly higher levels of emotional and physical neglect and abuse, along with more dysfunctional family dynamics and heightened emotional intrusiveness and irritability. These youth also showed greater difficulties in emotion regulation-related domains, as reflected in parental emotional expression patterns and parent-reported behavioral difficulties, as well as higher levels of functional impairment in home and social settings. Misophonia severity was associated with trauma exposure and maladaptive familial emotional climates. CONCLUSION: Findings suggest that misophonia in adolescence may be shaped by early adverse experiences and relational patterns that contribute to difficulties in emotional functioning. Family-based and trauma-informed approaches should be considered when assessing and treating adolescents presenting with misophonia symptoms.