Amsterdam Misophonia Scale

The Amsterdam Misophonia Scale (A-MISO-S) is a 6-item assessment tool developed to measure the severity of misophonia and its impact on daily functioning.

Questions: 6
Duration: 5 min
Original title: Amsterdam Misophonia Scale
Adaptation: Amsterdam Misophonia Scale
Authors: Schröder, A., Vulink, N., & Denys, D.
Created: 2013

The Amsterdam Misophonia Scale (A-MISO-S) is a 6-item assessment tool developed to measure the severity of misophonia and its impact on daily functioning. Adapted from the well-established Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), it provides a structured way to quantify the time spent anticipating or reacting to trigger sounds, the degree of interference in social or occupational roles, and the level of distress—typically manifesting as anger, disgust, or irritation—that these triggers provoke.

Designed to be used over the past week, the scale helps clinicians capture a snapshot of a patient's current symptom burden. It evaluates both the internal experience of misophonia, such as the perceived control over thoughts and the effort made to resist fixating on triggers, as well as the external behavioral adaptations like the extent of deliberate avoidance behaviors. By offering a standardized severity score, the A-MISO-S supports clinical formulation and provides a repeatable metric to monitor treatment progress and help patients evaluate coping strategies more effectively.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

10/ 24

The A-MISO-S is a brief self-report scale (6 items) assessing the severity of misophonia—a condition characterized by intense aversive emotional reactions (anger, disgust, aggressive impulses) triggered by specific human sounds (chewing, breathing, etc.). Adapted from the Yale-Brown Obsessive Compulsive Scale, it assesses time occupied by misophonia, interference with social functioning, level of anger, resistance to impulse, control over thoughts and anger, and avoidance.

0–4

Subclinical misophonic symptoms

5–9

Mild misophonia

10–14

Moderate misophonia

15–19

Severe misophonia

20–24

Extreme misophonia

Severity bands defined a priori by the scale authors, not empirically derived.

généralemixed · community sample · no or mild functional impairment (WSAS 0–8, subclinical) · 18–77 years · Germany · n = 1042 · 2023 · Möllmann et al. (2023)

024

M = 7.66 ± 3.95

cliniquemixed · pathology: misophonic disorder · significant functional impairment (WSAS ≥ 9) · 18–77 years · Germany · n = 839 · 2023 · Möllmann et al. (2023)

024

M = 13.22 ± 3.39

Scoring

Sum of the 6 items, total score ranging from 0 to 24, with each item scored on a 5-point scale (from 0 to 4).

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What the test measures

The A-MISO-S assesses the overall severity of misophonia by evaluating six distinct domains of the patient's experience over the preceding week.

Time occupied: The frequency and duration of time spent experiencing or thinking about misophonic triggers.
Interference: The extent to which misophonic reactions disrupt the patient's social, occupational, or role functioning.
Distress: The intensity of the negative emotional response, specifically focusing on anger, irritation, and disgust triggered by the sounds.
Resistance: The active effort the patient makes to ignore the triggers or redirect their attention, regardless of success.
Control: The patient's actual ability to stop, dismiss, or divert their thoughts away from the misophonic stimuli.
Avoidance: The degree of deliberate avoidance of situations, places, or people, including compensatory behaviors like using masking sounds.

This instrument is primarily used with adults and adolescents presenting with pronounced sensitivity to specific, typically human-made, sounds.

When and why to use it

Clinicians utilize the A-MISO-S to establish a severity baseline and guide treatment planning for patients reporting an overwhelming fight-flight-freeze response to specific sounds.

Intake and assessment: To quantify the functional impairment and distress caused by misophonia, moving beyond a simple presence/absence of symptoms to better understand the anxiety experience.
Monitoring change: To track the evolution of symptom severity and avoidance across the course of treatment, particularly when introducing nervous system regulation skills.
Treatment planning: To identify which specific domains—such as lack of control versus extreme avoidance—require the most immediate clinical attention to help the patient navigate their comfort, stretch, and panic zones.
Structuring the clinical interview: To facilitate a detailed conversation about the exact nature of the patient's protective habits, shifting from automatic behaviors toward adaptive vs maladaptive coping.

Obtaining a validated score adds objective weight to the clinical impression, ensuring that the subtle but debilitating impacts of resistance and avoidance are consistently quantified rather than underestimated.

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The questions

Rate the characteristics of each item during the prior week up until and including the time you fill out this survey. Scores should reflect the average (mean) occurrence of each item for the entire week.
1. What proportion of your time is occupied by misophonic triggers? How often do misophonic triggers (or thoughts about them) occur?
Assesses the cognitive load and frequency of exposure to the misophonic triggers.
- None
- Mild — less than 1 hr/day, or occasional triggers (no more than 5 times a day)
- Moderate — 1 to 3 hrs/day, or frequent triggers (no more than 8 times a day, most hours are unaffected)
- Severe — more than 3 and up to 8 hrs/day, or very frequent triggers
- Extreme — more than 8 hrs/day, or nearly constant triggers
2. To what extent do misophonic triggers interfere with your social or professional life? Is there anything you don't do because of them?
Evaluates the functional impairment and behavioral restriction caused by the condition.
- No interference
- Slight interference with social or professional activities, but overall performance is not impaired
- Noticeable interference with social or professional functioning, but still manageable
- Causes significant impairment in social or professional functioning
- Incapacitating
3. What level of anger (or distress) do you feel when confronted with misophonic triggers?
Measures the intensity of the specific emotional response triggered by the sounds.
- No anger / distress
- Mild, slightly disruptive anger
- Moderate, disruptive but still manageable anger
- Severe and very disruptive anger
- Extreme anger, nearly constant and disabling distress
4. How much effort do you make to resist misophonic triggers (or thoughts about them)? How often do you try to divert your attention from these triggers or ignore them? (Rate only the effort to resist, not the success or failure of actual control.)
Quantifies the deliberate cognitive and behavioral effort exerted to ignore the triggers.
- Always make an effort to resist, or symptoms are so minimal that active resistance is not necessary
- Try to resist most of the time
- Make some effort to resist
- Give in to all urges/obsessions reluctantly, without trying to control them, but with some hesitation
- Completely and willingly give in to all misophonia-related urges/obsessions
5. How well do you manage to control your thoughts about misophonic triggers and your anger? How successfully can you interrupt or divert your thoughts and anger?
Assesses the actual degree of subjective control the patient has over their fixation on the triggers.
- Complete control
- Good control: able to interrupt or divert thoughts and anger with some effort and concentration
- Moderate control: sometimes manage to interrupt or divert thoughts and anger
- Little control: rarely succeed in interrupting or dismissing thoughts; can only divert attention with difficulty
- No control: experienced as completely involuntary; rarely able, even momentarily, to change thoughts or anger
6. Have you avoided situations, people, or places because of your misophonic triggers? How much time do you spend avoiding misophonic situations?
Examines the extent to which the patient alters their life or uses compensatory mechanisms to escape triggers.
- No deliberate avoidance
- Mild avoidance, less than 1 hr/day or occasional avoidance
- Moderate avoidance, 1 to 3 hrs/day or frequent but still manageable avoidance
- Severe avoidance, more than 3 and up to 8 hrs/day, very frequent and extensive avoidance
- Extreme avoidance, more than 8 hrs/day, avoids almost all activities