Abstract
Hyperacusis is characterised by an increased sensitivity to everyday sounds, while
misophonia involves strong emotional, behavioural and physical reactions to specific trigger
sounds, such as chewing or tapping. Despite their significant impact, some questionnaires used
to assess these conditions exhibit varying psychometric robustness, and the psychological links
between these conditions and health outcomes—such as fatigue, stress, and sleep quality—
remain incompletely understood.
This thesis addressed these gaps through a systematic review and three empirical studies.
The systematic review assessed eight widely used questionnaires against COSMIN standards,
identifying gaps in reliability and validity, which provided the basis for the subsequent
empirical studies. The first study validated the English version of MisoQuest, a 14-item
misophonia questionnaire, demonstrating adequate model fit in CFA but finding that a
one-factor structure was not fully supported due to shared variance among some items. While it
showed good convergent and discriminant validity, moderate correlations with fatigue
indicated potential construct overlaps, requiring further investigation. The second study
explored this relationship between misophonia and fatigue, identifying stress and sleep quality
as partial mediators, highlighting the potential for targeted interventions. The final study
validated the 4C Hyperacusis and Misophonia Management Questionnaires in clinical
population, demonstrating a one-factor structure for the 4C Hyperacusis Management and two-
factor structure for the 4C Misophonia Management, both with acceptable model fit. The
questionnaires also showed strong reliability, along with good convergent and discriminant
validity. These tools assess patients' confidence in managing symptoms, particularly within the
context of cognitive-behavioural therapy.
To summarise, the results of this thesis provide novel evidence of the assessment of
hyperacusis and misophonia by validating questionnaires and examining the relationships
between psychological factors and health outcomes