Misophonia Activation Scale

Misophonia Activation Scale (MAS-1)

Please select the level that best describes what you experience.

Level 0: Person with misophonia hears a known trigger sound but feels no discomfort.

Level 1: Person with misophonia is aware of the presence of a known trigger person but feels no, or minimal, anticipatory anxiety.

Level 2: Known trigger sound elicits minimal psychic discomfort, irritation or annoyance. No symptoms of panic or fight or flight response.

Level 3: Person with misophonia feels increasing levels of psychic discomfort but does not engage in any physical response. Sufferer may be hyper-vigilant to audio-visual stimuli.

Level 4: Person with misophonia engages in a minimal physical response – non-confrontational coping behaviors, such as asking the trigger person to stop making the noise, discreetly covering one ear, or by calmly moving away from the noise. No panic or flight or flight symptoms exhibited.

Level 5: Person with misophonia adopts more confrontational coping mechanisms, such as overtly covering their ears, mimicking the trigger person, engaging in other echolalia, or displaying overt irritation.

Level 6: Person with misophonia experiences substantial psychic discomfort. Symptoms of panic, and a fight or flight response, begin to engage.


Level 7: Person with misophonia experiences substantial psychic discomfort. Increasing use (louder, more frequent) of confrontational coping mechanisms. There may be unwanted sexual arousal. Sufferer may re-imagine the trigger sound and visual cues over and over again, sometimes for weeks, months or even years after the event.

Level 8: Person with misophonia experiences substantial psychic discomfort. Some violence ideation.

Level 9: Panic/rage reaction in full swing. Conscious decision not to use violence on trigger person. Actual flight from vicinity of noise and/or use of physical violence on an inanimate object. Panic, anger or severe irritation may be manifest in sufferer’s demeanor.

Level 10: Actual use of physical violence on a person or animal (e.g., a household pet). Violence may be inflicted on self (self-harming).

Unwanted sexual arousal can occur with an intense misophonic response, as listed at level seven, but only one of my clients has ever mentioned this. I had several clients who reported an unpleasant sexual response reflex occurring at all levels of misophonia severity. This is explained later, but for now, I suggest you do not consider sexual arousal as a primary factor in determining your misophonia severity. Virtually everyone with misophonia has wide variation in their response to triggers based on the situation, the trigger, and how long it continues. I suggest you rate yourself at the highest level you experience in a typical week.