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Surveys
2012
March
M
Misophonia
Misophonia
0%
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How aggrivated are you with the following:
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Chewing food
Chewing gum
Snapping gum
Slurping soup
Gulping drinks
Jaw clicking
Dragging feet
Uggs
Cracking knuckles
Crying babies
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Baby sucking on pacifier
Baby sucking on a bottle
Birds chirping
Small dogs barking
Large dogs barking
Dog licking
Dog cleaning itself
Cat cleaning itself
Chewing ice
Talking on cell phone
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Someone else's loud iPod
Crinkling newspaper
Potato chip wrappers
Eating particular foods:
Popcorn
Chips
Ice cream cone
Chicken wings
Crunchy vegetables
Eating with fingers
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Hair flipping
Hair brushing
Blow dryer
Clicking of a curling iron
Overweight people eating
Smoking
Clipping nails
Cleaning under fingernails
Biting nails
Footsteps in adjoining hallway or apartment
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Clicking remote control
Channel surfing
Someone walking slow in front of you
Mints against teeth
Brushing teeth
Crouching
Sneezing
Sniffling
Blowing nose
Humming
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Whistling
Page flipping
Typing on cell phone
Slapping of a paintbrush
Mopping
Stuffed nose whistle
Silverware against teeth
Silverware against plates
Chalk on a board
Fingernails on a chalkboard
Not At All
Very Mild
Mild
Slightly Agitated
Moderately Agitated
Very Agitated
Severe
Very Severe
Most Severe - Violent
Tapping fingers/fingernails
Tapping feet
Cutting hair
Cutting paper
Filing nails
Listening to someone with a 'bubble' in their throat and they don't clear it
People speaking loudly (you can even hear them through ear plugs or noise canceling head phones)
When is the first time you can remember a particular noise really agitating you?
Age 5-10
Age 11-15
Age 16-20
Age 21 - 25
Age 26 - 30
Age 30 - 35
Age 36 - 40
Over age 40
What was that noise?
Chewing food
Chewing gum
Snapping gum
Slurping soup
Gulping drinks
Jaw clicking
Dragging feet
Uggs
Cracking knuckles
Crying babies
Baby sucking on pacifier
Baby sucking on a bottle
Birds chirping
Small dogs barking
Large dogs barking
Dog licking
Dog cleaning itself
Cat cleaning itself
Chewing ice
Talking on cell phone
Someone else's loud iPod
Crinkling newspaper
Potato chip wrappers
Eating particular foods:
Popcorn
Chips
Ice cream cone
Chicken wings
Crunchy vegetables
Eating with fingers
Hair flipping
Hair brushing
Blow dryer
Clicking of a curling iron
Overweight people eating
Smoking
Clipping nails
Cleaning under fingernails
Biting nails
Footsteps in adjoining hallway or apartment
Clicking remote control
Channel surfing
Someone walking slow in front of you
Mints against teeth
Brushing teeth
Crouching
Sneezing
Sniffling
Blowing nose
Humming
Whistling
Page flipping
Typing on cell phone
Slapping of a paintbrush
Mopping
Stuffed nose whistle
Silverware against teeth
Silverware against plates
Chalk on a board
Fingernails on a chalkboard
Tapping fingers/fingernails
Tapping feet
Cutting hair
Cutting paper
Filing nails
Other
Do you believe it's progressively gotten better or more severe over time?
It's getting better
It's been the same
It's getting progressively worse
Did your family accommodate your dislikes or dismiss it and have you just "deal with it"?
They were very accommodating
They were somewhat accommodating
They did not understand at all and I just learned to try to deal with it
Do you have other siblings?
Yes
No
If so, are they older or younger?
Older
Younger
Both
Does anyone else in your family suffer from Misophonia?
Yes
No
If you answered yes to the last question, please enter any relative of yours that suffers from Misophonia
Mom
Dad
Brother
Sister
Aunt
Uncle
Cousin
Grandmother
Grandfather
If more than one relative please list them all here
Did you ever feel like you had to alienate yourself from certain situations in the early stages?
Yes
No
Thank you for answering these questions. You are helping us learn more about Misophonia.
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