Patterns of Reactivity in Misophonia: Profiles of Behavioral and Self-Reported Symptoms

Individuals with misophonia experience intense affective reactions to trigger sounds and often cope through avoidance. Avoidance may be anticipatory (preventing exposure) or reactive (escaping exposure), but individual patterns remain poorly understood. In a sample of individuals with misophonia (N = 370), we used Gaussian mixture modeling to identify profiles based on anticipatory avoidance, reactive escape, and emotional responses. We compared profiles derived from behavioral assessments and self-reports and examined their associations with clinical outcomes. Behavioral data revealed three qualitatively distinct profiles: high affective reactivity, anticipatory-dominant reactivity, and reactive-dominant reactivity. Self-reports instead yielded four profiles that mainly reflected severity differences. Agreement between methods was modest, suggesting that they capture partly different aspects of misophonic responding. Behavioral profiles also differed in clinically relevant outcomes. These findings highlight the value of behavioral assessment for identifying distinct response styles and advancing understanding of misophonia beyond symptom severity.