Misophonia Impact Survey

Misophonia Impact Survey (MIS)

1. Rate how misophonia has interfered with family life in the past two weeks. (If you have avoided these activities because of misophonia, include that factor in your rating.)

2. Rate how misophonia has interfered with intimate relationships in the past 2 weeks. (If you have avoided this because of misophonia, include that factor in your rating.)

3. Rate how misophonia has interfered with your social life and leisure activities with others in the past 2 weeks. (If you avoid these activities because of misophonia include that factor in your rating.)

4. Rate how misophonia has interfered with your work / school work, including unpaid volunteer work, training, or similar activities in the past 2 weeks. (If you avoid these activities because of misophonia include that factor in your rating.)

5. Rate how misophonia has interfered with your individual activities and alone time in the past 2 weeks. (If you avoid certain activities because of misophonia include that factor in your rating.)

Add all the numbers on the Misophonia Impact Survey and that is your total misophonia impact score.

These assessments can be a valuable way to track the progress of your misophonia over time. Because change in misophonia symptoms is often slow (whether increasing or decreasing in severity) and treatment programs can take six months or more, it can be beneficial to fill out these forms regularly to track your progress when you are engaged in a treatment program.