What Your S-Five Misophonia Score Means: Severity, Impact, and What Comes Next

Last reviewed: 08/24/2026

Reviewed by: Dr. Kiesa Kelly

You took a misophonia questionnaire, you have a number, and you want to know what it says about you. That is fair. It is also where most pages fail you, because they interpret a score without first asking which scale produced it — and at least four misophonia questionnaires are in circulation, with completely different ranges.

This article is about the S-Five, the 25-statement scale that totals out of 250. If your number came from elsewhere, the next section helps you work that out first.

In this article, you'll learn:

• How to tell which misophonia scale your number came from

• How the S-Five is built, and what its five subscales measure

• What the validated threshold of 87 out of 250 does and does not mean

• Why your subscale profile usually tells you more than your total

• What helps, and when a formal evaluation is worth booking

The short answer — what an S-Five score actually means

The S-Five is a severity measure. It describes what sound sensitivity is costing you across five dimensions, and was never built to diagnose anything. If you have not been assessed yet, our guide to what a misophonia assessment actually involves covers that process; this article is about reading the number.

In a study of 772 people representative of the UK general population, researchers compared S-Five totals against a semi-structured clinical interview conducted by psychologists experienced in misophonia. A total of 87 or above out of 250 was the point where the scale best separated the people those clinicians judged to have significant misophonia from the people they did not — sensitivity 84 percent, specificity 72 percent, area under the curve 0.83 [1].

Eighty-seven is not the line where misophonia begins. It is the level at which experienced clinicians in one UK study tended to find significant burden, and roughly one in six people they considered cases scored below it.

🧭 Key takeaway: The S-Five measures severity, not diagnosis. The 87 threshold describes where clinicians tended to find significant burden — not a category you have entered.

First, which misophonia scale did you take?

This has to come before interpretation. Someone holding a score from a short interviewer-rated scale who reads a 0-to-250 interpretation will badly misread themselves, and the mistake usually runs in the frightening direction. Our mental health screening tools page shows how differently validated instruments can be built.

The misophonia scales in circulation

• S-Five (Selective Sound Sensitivity Syndrome Scale) — 25 statements, each rated from 0 ("not at all true") to 10 ("completely true"), producing a total out of 250 across five factors [1][2]. It is paired with a separate trigger checklist, the S-Five-T, currently listing 37 sounds. That checklist is scored on its own and is not part of the 0-to-250 total, so if you completed both you have two separate results [1].

• MisoQuest — a 14-item self-report scale designed to identify whether the misophonia pattern is present rather than to grade its severity [6].

• Duke-Vanderbilt Misophonia Screening Questionnaire (DVMSQ) — an 18-item screener built around functional impairment, producing a threshold rather than a severity band [7].

• Duke Misophonia Questionnaire (DMQ) — the long-form option at 86 items, mapping triggers, responses, coping, impairment, and beliefs about the sounds [8].

• Amsterdam Misophonia Scale (A-MISO-S) — adapted from the Yale-Brown Obsessive-Compulsive Scale, covering time occupied, impact on functioning, distress, resistance, perceived control, and avoidance. It was designed to be interviewer-rated using clinical judgement, though it has also been used as a self-report form [1][4].

• Misophonia Questionnaire (MQ) — three parts. Two cover symptoms and emotional or behavioural responses; the third is a single severity item rated from 1 ("minimal") to 15 ("very severe"), where 7 or more indicates clinically significant symptoms [1][5].

Why the same number means different things on different scales

A 12 is a near-ceiling result on the MQ severity item and a rounding error on the S-Five. None of these scales convert to each other. So find the instrument's name on the form, count the questions, and check the highest number you could have picked for one answer. Twenty-five statements on a 0-to-10 slider is the S-Five. Anything shorter, or anything a clinician filled in while talking to you, is not — and this article's threshold does not apply to it. If a clinician administered it, ask which one it was; our psychological assessment process page describes how measures get chosen and reported.

📏 Key takeaway: A misophonia score is meaningless without its scale. Count the items and check the answer range before you compare your number to anything.

Three things people get wrong about a score

"Crossing 87 means I have been diagnosed with misophonia." It does not. The authors described the interview the threshold was calibrated against as explicitly not a clinical diagnosis of misophonia at a disorder level — it identified people significantly burdened by misophonia at that moment [1]. Misophonia has no DSM-5-TR or ICD-10 code — its consensus definition exists precisely because no diagnostic category does [3] — so no scale can produce a formal diagnosis of it.

"A score below the threshold means it isn't real." This one does the most damage, and it is wrong on the study's own terms. At 87 the sensitivity was 84 percent, meaning about 16 percent of the people those clinicians considered cases were missed by the number. Impairment lives in your week, not in the cut-off.

"87 is the standard clinical cutoff." It is one threshold, from one UK representative sample, published in 2023 [1]. It is not a US norm and has not been adopted as a diagnostic standard. Treat it as the best available reference point, not an official line.

How the S-Five is scored

Twenty-five statements, a 0-to-10 slider, a total out of 250

Every S-Five item is a statement about your experience of sound, rated for how true it is on an eleven-point scale from 0 to 10. Add all 25 and the total runs from 0 to 250 [1][2]. There is no reverse scoring and no weighting — a 7 counts the same wherever it appears. Age and gender made almost no difference to how the scale behaved in the UK sample [1].

The five subscales

Each of the 25 statements belongs to exactly one of five factors, so the five subscale scores add up to your total [1][2]:

• Externalising appraisals — how much you blame the person making the sound.

• Internalising appraisals — how much the reaction turns inward, into shame, guilt, or thinking less of yourself.

• Impact on functioning — how much sound sensitivity is shrinking your life.

• Outbursts — how often you lose control of the response, or fear that you will.

• Threat — how much a trigger registers as danger rather than annoyance.

🧩 Key takeaway: Five subscales, one total. The total tells you how loud the whole picture is; the subscales tell you what shape it has.

What your total score suggests

At or above 87, your responses match the pattern those UK clinicians associated with significant burden. Below it, they match the pattern more typical of the wider population, where sound irritation is extremely common. In that sample, 142 of 772 met the threshold, which the authors used to estimate that around 18.4 percent of the UK population experiences misophonia to a degree causing significant burden [1]. Almost one in five cuts both ways: you are not unusual, and the threshold identifies a level of cost, not a rare condition.

Why a screening threshold is not a diagnosis

A screening threshold answers one question: at what score do we best sort a group into probable cases and probable non-cases? It says nothing about you specifically, and it carries the assumptions of its sample — UK general population, not US clinical [1].

Two more things it cannot do. It cannot tell you whether something other than misophonia is producing your reaction, given how easily hyperacusis, anxiety, and sensory sensitivity are mistaken for it [3]; our guide to why misophonia travels with autism, OCD, ADHD, and anxiety covers that overlap. And it cannot tell you what would help, because two people at the same total can need very different plans.

⚖️ Key takeaway: A screening threshold sorts groups. Diagnosis and treatment planning sort individuals, and only a clinician working from your history can do the second.

Why your subscale profile matters more than your total

The study supports this directly. When the researchers tested how well each S-Five score separated cases from controls, the impact subscale (AUC 0.87) and the threat subscale (AUC 0.88) both discriminated better than the total (0.83), while externalising discriminated worst [1]. That is a finding about telling cases from controls, not about choosing a treatment, so it should not be stretched further. But it points somewhere useful: the parts of the S-Five that ask what the sound is costing you carry more signal than the part that asks whose fault it is.

Two people, the same total, very different weeks

Consider someone who scores 96, almost all of it in externalising and outbursts. She is furious at her partner for chewing, she snaps, she apologises afterwards, and the argument is the worst part of the day. Her work is unaffected, she still eats out, she still goes to the cinema. What is costing her is the conflict and the guilt — not the sound, which she tolerates fine when nobody she loves is making it.

Now consider someone else who also scores 96, distributed almost entirely across impact and threat. He does not shout at anyone. He eats alone in his car, wears earplugs to family dinners and leaves early, and turned down a promotion because the role sits in an open-plan office. A colleague's pen-clicking two desks away can end his afternoon. He would describe himself as coping; in practice his life has been quietly shrinking for six years.

Same number, almost nothing else in common. Research on misophonia severity has similarly found that functional impairment tracks symptom burden rather than sitting on top of a single total [9] — and the second pattern is the one most often underestimated, by the person living it as much as by anyone else.

What each subscale points toward

A high impact score is the one to take most seriously. It is the direct measure of what sound takes from you, and what documentation for accommodations tends to rest on — our guide to whether misophonia counts as a disability covers how impairment gets evidenced.

A high threat score suggests the reaction is processed closer to danger than to irritation, which often responds to work aimed at the response rather than the sound. High outbursts alongside high externalising usually shows up in relationships first, and tends to bring shame with it.

A low total with one high subscale is not a contradiction. It is a profile, worth bringing to whoever assesses you rather than rounding off.

🔋 Key takeaway: Read the impact subscale first. It is the closest thing on the form to an answer about what this is costing you.

What actually helps

What the evidence supports

The strongest evidence in misophonia sits with cognitive behavioural approaches. In the first randomised controlled trial, group CBT significantly reduced misophonia symptoms compared with a waiting list, with gains maintained at follow-up [11]. That is one trial in a young field — the consensus definition of misophonia is only a few years old [3] — so read it as promising rather than settled.

Co-occurring conditions matter here too. In a clinical sample of 575 people meeting misophonia criteria, 26 percent had co-occurring obsessive-compulsive personality traits, 10 percent a mood disorder, 5 percent ADHD, and 3 percent an autism spectrum condition [10]. Where one of those is part of the picture, treating it often changes sound tolerance as well — our piece on how ADHD and sound sensitivity interact covers that pairing specifically.

What to be cautious about

Be cautious of anything sold as a misophonia cure, or promising a specific outcome from a set number of sessions. Be cautious of self-treatment plans built around a total, which does not tell you which part of the response to work on. And be cautious of retaking the questionnaire to check whether you have moved — repeated self-scoring becomes its own kind of monitoring, and a fortnight of honest notes will tell you more.

Published comorbidity figures also vary enormously. One 2025 systematic review found reported depression rates in misophonia ranging from 1.1 to 37.3 percent and anxiety from 0.2 to 69 percent, attributing much of that spread to reliance on self-report [12] — a good argument for having a person, rather than a form, sort out what is going on.

When to seek a formal evaluation

Here is a straightforward way to decide. If your impact subscale is high, or the cost is climbing year over year, an evaluation is worth booking regardless of your total. If your total cleared 87 but the cost sits mainly in conflict with one person, relationship-facing work may be the more direct route. And if attention, mood, or anxiety are also in the picture, evaluate those together rather than in sequence — sound tolerance drops when the nervous system is already stretched. Brief screeners help organise what you bring: the GAD-7 covers anxiety, and the AQ-10 is worth completing where an autistic profile is plausible.

Before you book anything, these five questions are worth asking:

1. Scope — does this evaluation assess misophonia specifically, or is it a general psychological evaluation that will mention it?

2. Instruments — which validated misophonia measures do you use, and will you report subscale scores or only a total?

3. Differential — how do you distinguish misophonia from hyperacusis, phonophobia, and sensory sensitivity, and what if the picture points to an auditory cause?

4. Co-occurring conditions — if the evaluation suggests ADHD, autism, OCD, or an anxiety disorder, can you diagnose it here, or is that a separate referral?

5. Output — what exactly do I receive at the end, and will it include impairment documentation I can use for accommodations?

An evaluation produces a characterisation rather than a diagnostic label: a measured severity profile, documented functional impact, any co-occurring condition named properly, and a plan. You are welcome to ask us any of those questions before you decide.

🚪 Key takeaway: The decision rule is impact and trajectory, not the total. If sound is taking more from you this year than last, that is the signal worth acting on.

Next step — getting support

Your S-Five total tells you how loud the picture is right now. The subscales tell you its shape, and the shape is what a plan is built from. Neither is a verdict about who you are — and if the number sent you looking for answers, the next move is usually not another questionnaire.

Not sure what your number means for you?

A score is a starting point rather than a conclusion — a clinician who works with sound-sensitivity presentations can help you read your profile, weigh whether a full evaluation is worth it, and decide what would help.

Explore specialized therapy →

Frequently Asked Questions

What kind of doctor can diagnose misophonia?

No clinician can give you a formal misophonia diagnosis, because misophonia has no DSM-5-TR or ICD-10 code yet. What a licensed clinical psychologist, psychiatrist, or trained therapist can do is document your trigger pattern against the published consensus definition, score it on validated measures like the S-Five, and diagnose any co-occurring anxiety, OCD, ADHD, or autism. If ordinary sounds feel physically painful or too loud, an audiologist should be your first call instead.

What can be mistaken for misophonia?

Hyperacusis and phonophobia are the two most common mix-ups, and both are sorted out by asking what the sound does rather than how loud it is. Hyperacusis makes ordinary sound feel physically painful; phonophobia is fear of a specific sound; misophonia is an intense emotional reaction to particular repeating sounds while hearing itself feels normal. Sensory sensitivity in autism, generalized anxiety, and post-traumatic hypervigilance can also produce sound-related distress that a self-report total will not tell apart.

Is misophonia a form of OCD or a separate condition?

It is a separate condition. Misophonia is not a subtype of OCD, though the two share features and can co-occur. In a clinical sample of 575 people meeting misophonia criteria, 26 percent had co-occurring obsessive-compulsive personality traits, and the first misophonia severity interview was itself adapted from an OCD scale. If your S-Five outburst and threat subscales are high and your triggers are followed by rituals or checking, that combination is worth assessing properly.

Is misophonia a symptom of ADHD?

No, misophonia is not an ADHD symptom, and neither condition causes the other. They do co-occur: 5 percent of one large misophonia clinical sample had ADHD. What matters more for reading your S-Five result is that ADHD changes how a sound lands rather than how you score. When attention regulation is already stretched, the same trigger costs more on a bad day than a good one, which is why a single-sitting total can misrepresent your usual week.

What if my S-Five score is just below 87?

A score just below 87 does not mean nothing is wrong. The 87 threshold was set to balance sensitivity and specificity across a whole UK sample rather than to describe any individual, and at that cut-off roughly one in six people the study's clinicians considered cases still scored below it. If your impact subscale is high, or you are reorganizing meals, work, or relationships around sound, an evaluation is reasonable regardless of the total.

About the Author

Dr. Kiesa Kelly, PhD, is a licensed clinical psychologist and the founder of ScienceWorks Behavioral Healthcare. She earned her PhD in Clinical Psychology with a concentration in Neuropsychology and has more than 20 years of experience in psychological assessment — the discipline that governs how a self-report score is interpreted, what a validated threshold can support, and where a questionnaire stops and clinical judgement begins.

Dr. Kelly's clinical work centres on the conditions that sit underneath and alongside sound sensitivity: anxiety, OCD-spectrum presentations, ADHD and autism in adults, and trauma. She provides assessment and evidence-based treatment by telehealth across Tennessee, with an in-person option at our Nashville office, and reviews every article on this site for clinical accuracy before publication.

References

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3. Swedo SE, Baguley DM, Denys D, et al. Consensus definition of misophonia: a Delphi study. Frontiers in Neuroscience. 2022;16:841816. https://doi.org/10.3389/fnins.2022.841816

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6. Siepsiak M, Śliwerski A, Dragan WŁ. Development and psychometric properties of MisoQuest — a new self-report questionnaire for misophonia. International Journal of Environmental Research and Public Health. 2020;17(5):1797. https://doi.org/10.3390/ijerph17051797

7. Williams ZJ, Cascio CJ, Woynaroski TG. Psychometric validation of a brief self-report measure of misophonia symptoms and functional impairment: the Duke-Vanderbilt Misophonia Screening Questionnaire. Frontiers in Psychology. 2022;13:897901. https://doi.org/10.3389/fpsyg.2022.897901

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9. Möllmann A, Heinrichs N, Illies L, Potthast N, Kley H. The central role of symptom severity and associated characteristics for functional impairment in misophonia. Frontiers in Psychiatry. 2023;14:1112472. https://doi.org/10.3389/fpsyt.2023.1112472

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12. Rodrigues ALM, Aazh H. Psychiatric comorbidities in hyperacusis and misophonia: a systematic review. Audiology Research. 2025;15(4):101. https://doi.org/10.3390/audiolres15040101

Disclaimer

This article is for informational and educational purposes only and is not a substitute for professional diagnosis, medical advice, or treatment. A questionnaire score cannot diagnose any condition. If sound sensitivity is affecting your work, sleep, relationships, or wellbeing, please consult a qualified, licensed clinician about your specific situation.