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Misophonia Measurement Mess

The Lack of Validity & Reliability in Misophonia Scales

used with permission of tookapic/Pexels
Source: used with permission of tookapic/Pexels

Psychologists and researchers know that developing a scale to diagnose a newly proposed disorder is not an easy task! Rather, it is an arduous process that includes extensive validation and reliability studies. At the most rudimentary level a diagnostic test should have validity (i.e. it should test what it purports to test) and reliability (i.e. it should produce consistent and stable results over time).Yet,developing a test in order to diagnose any new disorder is paradoxical. One needs tests in order to diagnose, yet one needs to know what they are diagnosing in order to develop a test! In the past, test development and research have moved together somewhat reciprocally. Scales were updated along with new research findings and with new conceptualizations of disorders.

However, in the age of the Internet and in the case of newly termed disorders, the cart is most definitely moving before the horse.

Misophonia has fallen victim to this phenomenon, and misophonia scales of all kinds can be found with a push of a few buttons. Tests devised by misophonia sufferers, advocates, researchers and clinicians are muddled on the Internet. Ideally, researchers, clinicians and sufferers alike would utilize each others’ resources to develop misophonia measures. Yet, that is not what is happening. Despite good intentions, we are in a misophonia measurement mess.

I am not a test developer. However, I offer a brief review of what is “out there” so that you can further evaluate these issues. Note, I am using only three examples (the most widely used scales).

Misophonia Activation Scale (MAS-1): This was devised by advocates of the nonprofit group Misophonia UK. The scale was developed in 2010, but on the website the scale is appropriately referred to as a “work in progress” and offers many disclaimers about its development. The test measures both physical sensation as well as emotional responses. A level of 0 describes a person with misophonia who hears a trigger but experiences no discomfort. A level of 10 describes “actual use of physical violence on a person or animal, or self-harm.”

Thoughts: Even though the test developer makes all of the appropriate disclaimers, this test has been widely used by sufferers and researchers alike. In addition to the need for validation, the widespread use of this scale correlates physical violence with misophonia. While the feeling of “rage” is often associated with misophonia, studies have not explored to what degree, if any, trigger sounds actually produce violence in people with misophonia. In addition, the test may not discriminate misophonia from other disorders. Therefore, for example, some of the violent activity associated with misophonia may be due to confounding with other disorders such as Intermittent Explosive Disorder, or Conduct Disorder as some examples.

The Amsterdam Misophonia Scale (A-MISO-S): This scale was developed at the Amsterdam Medical Center in order to measure the severity of misophonia symptoms. It is a 6-item scale (with a range of 0–24). The scale addresses the time an individual spends occupied by misophonia, how much the misophonia sounds interfere with the individual’s social and work functioning, the individual’s level of anger in response to sounds, level of resistance against the impulse, how much control the individual has over thoughts and anger, and how much time an individual spends avoiding misophonia situations. Scores range from 0–4 are considered subclinical misophonic symptoms, 5–9 mild, 10–14 moderate, 15–19 severe, 20–24 extreme.

Thoughts: The scale developers adapted a version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The scale’s authors’ state the rationale for using the adapted Y-BOCS is that “Similar adaptations of the Y-BOCS have appeared to be reliable and valid measures of symptom severity in other obsessive-compulsive and impulse control disorders.” Possibly the authors are hinting at convergent validation in this case. When measuring a construct (e.g. ideas or levels of a disorder that cannot be easily quantified) it is common to compare a new test to an older test that has been extensively studied. If the new test correlates highly with the “tried and true” test, then this adds evidence that the new test is measuring the same construct, or disorder. However, OCD and Misophonia are not the same constructs, or disorder. Unless I am missing something, this is confusing. Regardless, as aforementioned, validating a scale is an arduous evidence gathering process. Perhaps comparing OCD and Misophonia is a piece of the puzzle. However, I’m still not clear as to why the Y-BOCS was adapted to measure a disorder of decreased sound tolerance. In addition, as far as I can see, no other studies for validity and reliability of the scale have been done, yet perhaps they are in process.

Misophonia Assessment Questionnaire ( MAQ): The MAQ was devised by a seasoned audiologist who has worked with tinnitus, hyperacusis and misophonia patients since the Jastreboffs’ termed the disorder in 2001. One can score between the “subclinical range” and the “extreme range”. The questionnaire includes 63 items presented within a likert-type rating scale.

Thoughts: The Questionnaire is simple, straightforward and makes no claims beyond what it is; a questionnaire that indicates how much the individual’s life is impacted by “sound issues”. Since all of the questions are phrased using this term the questionnaire may confound misophonia and other disorders of decreased sound tolerance. However, it is not “diagnostic” in nature, and is more in line with the kinds of measures one would expect to see relative to where the research for misophonia is at this point in time. As is true of all the other measures, there are no reports of validation or reliability studies.

In conclusion, it seems that there are no scales for misophonia that have proper validation and reliability studies. Clearly we need to develop scales, but they must be carefully developed so that conceptualization of the disorder is not further confused. While we all want to validate the disorder, it does not help to put the cart before the horse. for more information