Phenomenology of Misophonia in the Iranian Population: A Grounded Theory Study

Abstract

The present study aimed to explore the lived experiences of individuals with misophonia in Iran and to develop a data-grounded theory of the phenomenon. This qualitative study employed grounded theory using the systematic approach of Strauss and Corbin. The participants comprised 14 individuals, including 12 individuals with misophonia, one clinical psychology specialist, and one family member of an individual with misophonia, who were selected from among students at universities in Zanjan through purposive and theoretical sampling. Data were collected through in-depth semi-structured interviews and analyzed using MAXQDA software through open, axial, and selective coding. The findings led to the identification of the core phenomenon of “internal explosion in response to violated expectations,” comprising three interrelated layers: sensory–physiological, cognitive, and meaning–identity. Causal conditions included conditioning in the context of chronic stress, including military service, irregular work shifts, and experiences of war; adverse early relationships and childhood trauma, including bullying; and personality predisposition and perfectionism. Contextual conditions included private versus public environments, close relationships versus interactions with strangers, and the sleep–wake boundary. Intervening conditions included the perceived justifiability of the sound, the natural entitlement associated with time, the emotional relationship with the sound-producing individual, and psychological state and stress. Coping strategies were identified at four levels: environmental control, situational management, internal management, and long-term attitudinal change. Consequences emerged across three dimensions: individual consequences, including persistent psychological distress, sleep disturbance, and changes in worldview; interpersonal consequences, including tension in close relationships and stigmatizing labels; and behavioral consequences, including avoidance and dependence on sound-blocking devices. In addition, nine novel concepts emerged from the data: acquired hypervigilance, the day/night sleep paradox, threefold sound justifiability, a triadic vicious cycle, compulsive sound checking, the association between misophonia and childhood bullying trauma, cognition–affect conflict or a quasi-delusional experience, the bipolarity of auditory experience, and the effects of loneliness and warm social interactions.