Misophonia in autism: A systematic review of prevalence, clinical features, and comorbidities

Misophonia, characterized by intense emotional reactions to specific sounds, is increasingly studied in autism spectrum disorder (ASD) and related mental health conditions such as obsessive-compulsive disorder (OCD), anxiety, and depression. Autistic individuals often have sensory sensitivities, which may predispose them to misophonia. However, the relationship between misophonia, sensory sensitivities, and psychiatric comorbidities in autism remains underexplored.

This systematic review examines the prevalence, clinical characteristics, comorbidities, and treatment outcomes of misophonia in autistic individuals and related conditions. It also explores the neurobiological links between misophonia and sensory sensitivities and their impact on quality of life, aiming to inform diagnostic and intervention strategies.

A systematic search was conducted across seven databases following PRISMA guidelines. Studies assessing misophonia in autism, using established diagnostic criteria, were included. The risk of bias was evaluated using ROBINS-I, AXIS, Venice criteria, and JBI tools.

Fourteen studies (n = 89,889 participants) met inclusion criteria. Misophonia prevalence in autism ranged from 12.8 % to 35.5 %, with 79 % of autistic individuals with misophonia also experiencing psychiatric comorbidities such as anxiety, OCD, and depression. Clinical characteristics included intense emotional reactions to specific sound triggers (e.g., eating, breathing) and significant disruptions in daily functioning. Sensory sensitivities were reported in 21.4 % of cases, highlighting the overlap between misophonia and broader sensory processing challenges in autism. There were only two intervention studies: one demonstrating the efficacy of risperidone in reducing misophonia severity, and another suggesting cognitive-behavioral therapy (CBT) and tinnitus retraining therapy (TRT) as potential management strategies. Quality assessment revealed varying levels of bias, particularly in observational studies, which often lacked robust randomization and blinding.

Misophonia is prevalent in autism and frequently co-occurs with psychiatric conditions and sensory hypersensitivities. Standardized diagnostic tools and tailored interventions are needed to improve clinical outcomes. Future research should explore longitudinal trajectories, genetic and environmental influences, and effective management strategies to address the complex interplay between misophonia, sensory sensitivities, and autism.