Misophonia Handicap Inventory Questionnaire

The purpose of this questionnaire is to identify difficulties that you may be experiencing because of your misophonia.

What are the most common Triggers?
• Gum Chewing.
• Eating Sounds.
• Lip Smacking.
• Speaking Sounds (s, p, k)
• Breathing Sounds.
• Repetitive softer sounds like pen clicking, pencil tapping.
• Nasal noises, throat clearing.
• Sucking through the teeth sounds.

Please answer every question, all fields are required.

First Name*
Last Name*
Email*
Phone*
How often you think that your responses to some sounds are difficult to understand and explain as they are based on emotions causing you to act?*
With the sudden presence of the triggers, how often you feel anger or panic?*
How often do you feel a physical sensation as a response to a trigger sound? (shoulder muscles tightens, jaw tightening, palpitations, nausea, stomach problems)*
How often you hear trigger sound with just a little of discomfort, but strong coping reaction of various kind – usually caused by the presence of the trigger sound?*
How often with the presence of the certain sounds do you feel like asking people making these sounds to stop, or you are covering your ears, or making humming or some other sounds yourself in order to feel more comfortable?*
How often you do you feel uncomfortable in some locations or while being involved in some specific activities such us having meals with your family members or in the lunch rooms, restaurants or various other places of this kind?*
How often are you not feeling secure and comfortable at school or work, knowing that you can expect to experience exposure to some triggers at any time or steady exposure to triggers at all times?*
How often do you feel like not going to school or work at all, because of fear of the exposure to triggers you know to be present all the time in those places?*
How often do you isolate yourself or are moving away from the other members of your family or friends in order to be able to feel comfortable and secure?*
How often are you not going to movie theaters, restaurants or fast food places because of the fear of being exposed to the sudden and unexpected triggers?*
How often are you using ear protection, ear plugs or listening to music using headphones in order to ensure your comfort and to feel secure?*
How often are you reacting to triggers with not only panic but also anger and severe irritation to the point of verbally assaulting the person making noise?*
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Name
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TREATMENT IS USUALLY RECOMMENDED WHEN MISOPHONIA IS ABOVE MILD LEVEL

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“Do you hear what I hear?”

Misophonia Handicap Inventory Questionnaire

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