TABLE 2.

Operational diagnostic criteria for misophonia and DVMSQ-based assessment.

Criterion	DVMSQ operationalization
A. Presence of one or more commonplace “trigger” soundsa that reliably elicit intense and inappropriate emotional responses, irrespective of sound intensity or perceived loudness.	Item S1 [Screening] = Yes
B. Trigger sounds reliablyb evoke feelings of extreme irritation, anger, rage and/or disgustc that are clearly excessive, unreasonable, or out of proportion to the circumstances (whether or not the individual recognizes them as such).	One or more of the following: Item 1 [Irritation] ≥ Often Item 2 [Anger/Rage] ≥ Often Item 4 [Disgust] ≥ Often
C. The individual actively avoidsd situations or activities that include trigger sounds, endures these situations with intense discomfort, or needs to block out potential trigger sounds (e.g., using earplugs, music, or white noise) to cope with these situations.	One or more of the following: Item 12 [Avoidance] ≥ Sometimes Item 5 [Urge to run away] ≥ Often Item 6 [Urge to cover ears] ≥ Often
D. If unable to avoid trigger sounds or stop them from occurring, the individual experiences a significant loss of self-control, potentially resulting in emotional outbursts or other extreme reactions (e.g., yelling/screaming, running out of the room, panic attacks, and rarely physical aggression).	One or more of the following: Item 8 [Lack of Control] ≥ Sometimes Item 7 [Urge to be violent] ≥ Sometimes
E. The emotional reactions to trigger sounds are persistent, typically lasting for 6 months or more. Specific triggers do not need to remain constant over this period, but at least one trigger sound must meet both criteria A and B at all times over the preceding 6-month period.	Not assessed by DVMSQ Assumed to be true if all other criteria are satisfied.
F. Emotional reactions to trigger sounds and/or avoidance of these sounds cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.	Two or more of the following: Item 13 [Social] ≥ Moderate Item 14 [Occupational] ≥ Moderate Item 15 [Household] ≥ Moderate Item 16 [Community] ≥ Moderate Item 18 [Mental Health] ≥ Moderate Item 19 [Global Problems] ≥ Moderate Item 20 [Life Affected] ≥ Moderate

To meet the duke-vanderbilt Misophonia Screening Questionnaire (DVMSQ) criteria for “clinically significant misophonia,” an individual must meet all criteria A–F (criteria E is not assessed by the DVMSQ and is assumed to be true if all others are satisfied). Individuals who meet criteria A–D but not criterion F are classified as having “sub-clinical misophonia.” Note that the item numbers in this algorithm refer to the original DVMSQ and not the revised version provided in the supplemental information.

^aIn accordance with the recent consensus definition of misophonia, these criteria do not require that the individual be triggered by chewing or other oro-nasal sounds.

^bThese emotional reactions may be dependent on the context in which the trigger is encountered (e.g., only occurring when the trigger is produced by a specific person), but the reaction should be easily reproducible within that specific context.

^cEmotional responses to trigger sounds may be accompanied by fear, anxiety, or physical symptoms of sympathetic arousal (e.g., heart pounding, muscle tension, sweating, and paresthesia), but in the absence of anger, irritation or disgust, these reactions are insufficient to meet criterion B.

^dIncludes both direct avoidance of the trigger stimulus and indirect avoidance (i.e., actions taken to stop the stimulus from occurring, such as telling another person to stop making a sound, removing triggering household items, etc.).