Facial emotion recognition and disgust proneness in misophonia: findings from a clinical case-control study

INTRODUCTION: Misophonia is characterized by decreased tolerance to specific sounds, often occurring in interpersonal contexts and accompanied by intense emotional, physiological, and behavioral responses. Disgust and anger are among the most prominent emotional reactions in misophonia, yet it remains unclear whether these responses are accompanied by broader differences in socio-emotional processing, such as facial emotion recognition (FER). The present study aimed to examine FER performance and disgust-related dimensions in individuals with misophonia and to evaluate their associations with misophonia severity and emotional distress. METHOD: In this cross-sectional case-control study, fifty individuals diagnosed with misophonia and 48 matched healthy controls completed measures of misophonia symptoms, emotional distress, disgust propensity and sensitivity, and a FER task assessing recognition accuracy and reaction time across seven facial emotion categories. RESULTS: Compared with controls, individuals with misophonia showed higher disgust propensity, disgust sensitivity, total disgust scores, and emotional distress. After controlling for emotional distress, group differences remained significant for disgust propensity and total disgust scores, but not for disgust sensitivity. No significant overall group differences were observed in facial emotion recognition accuracy or reaction time. Exploratory analyses suggested higher accuracy for angry facial expressions in the misophonia group; however, this finding was not supported by a significant group by emotion interaction and appeared to be partly influenced by emotional distress. CONCLUSIONS: No significant overall group differences were observed in FER accuracy or reaction time between individuals with misophonia and healthy controls. FER performance was not significantly associated with clinical variables. Disgust propensity remained elevated in misophonia after controlling for emotional distress, highlighting the relevance of disgust-related emotional processes in this condition. These findings suggest that individuals with misophonia do not exhibit a generalized impairment in FER and that heightened disgust propensity may represent a relatively distinct emotional feature of misophonia beyond general emotional distress.