Physiological Responses to Auditory, Visual, and Auditory Imagery Triggers in Misophonia

Misophonia is characterized by decreased tolerance to specific trigger sounds, yet the underlying physiological mechanisms remain poorly understood. Misophonic responses are also often reported to be elicited not only by the auditory triggers themselves, but also by visual cues associated with those sounds. However, direct empirical evidence for visual cues associated with auditory triggers remains limited. Moreover, it is not known if misophonic responses can be elicited in the absence of any sensory input, such as during auditory mental imagery. The present study systematically examined physiological responses to misophonic trigger stimuli across auditory and visual sensory modalities, as well as auditory imagery, using multi-channel psychophysiological measures and both trial-wise and time-resolved approaches. Individuals with misophonia and matched control participants were exposed to trigger, generally aversive, and non-aversive stimuli presented in auditory, visual (silent video), and auditory imagery conditions. Physiological responses were recorded across five channels, including electromyographic activity over corrugator supercilii (EMGc) and zygomaticus major (EMGz) muscles, electrodermal activity (EDA), heart rate (HR), and fingertip skin temperature. Compared with generally aversive stimuli, auditory trigger sounds elicited significantly greater physiological responses in individuals with misophonia than in control participants, characterized by increased EMGc, EMGz, EDA, and HR, indicating heightened affective and autonomic engagement beyond general aversiveness. Silent visual trigger cues also evoked greater trigger-specific physiological responses, although these effects were observed in fewer physiological channels (primarily EMGc and HR). Auditory mental imagery produced weaker group-level physiological effects, with significant differentiation limited to EDA. Across all three modalities, greater trial-wise subjective distress was consistently associated with greater EMGc, EMGz, and EDA responses, as well as greater HR responses in the auditory and visual modalities, indicating a close correspondence between physiological activation and the subjective experience of misophonic distress. In contrast, physiological overactivation was not significantly associated with overall misophonia severity or auditory imagery ability. Together, these findings provide the most comprehensive characterization to date of peripheral physiological responses in misophonia across auditory and visual perception, as well as auditory imagery. They demonstrate that misophonia is characterized by exaggerated affective and autonomic physiological responses to trigger sounds, extend this response profile to silent visual cues associated with trigger sounds, and provide initial evidence that auditory mental imagery can engage selected components of the misophonic response.