Developmental plasticity and network-level mechanisms in misophonia: A theory-building review

Misophonia is a decreased sound tolerance (DST) condition characterized by disproportionate emotional, autonomic, and behavioral responses to specific, typically low-intensity sounds. Despite increasing recognition, its neurobiological basis remains incompletely understood, particularly with respect to its typical onset during late childhood and adolescence. Existing models emphasize auditory-limbic conditioning but may not fully account for developmental vulnerability or stimulus specificity. This theory-building review proposes a developmental neurobiological framework in which misophonia is conceptualized as a disorder of perception-emotion coupling, potentially shaped by maladaptive plasticity across interacting auditory, salience, limbic, and prefrontal networks during sensitive periods of maturation.

A theory-driven narrative review was conducted, integrating evidence from neuroimaging, electrophysiological, autonomic, and clinical studies. Relevant literature was identified through PubMed, Scopus, and Web of Science databases, covering the period up to early 2026. Search terms included "misophonia," "auditory processing," "salience network," and "development." Jastreboff's conditioned reflex model was considered alongside contemporary frameworks from network neuroscience. This review is selective and hypothesis-generating rather than systematic.

Available evidence suggests that exaggerated, stimulus-specific salience attribution to auditory stimuli-potentially mediated by anterior insula-centered networks-may interact with relatively immature prefrontal regulatory mechanisms during development. This interaction may contribute to the strengthening of auditory-limbic associations and the emergence of persistent, context-dependent misophonic responses.

Reframing misophonia within a developmental network framework may help situate the condition within disorders involving altered sensory appraisal and emotional regulation, while preserving its stimulus-specific profile. This perspective generates testable hypotheses and may provide a basis for future empirical research and the development of mechanism-informed intervention strategies.