The mediating role of emotional empathy in the relationship between adverse childhood experiences and misophonia: a structural equation modeling

Background Misophonia is characterized by intense anger, disgust, and physiological arousal in response to specific everyday sounds. Recent studies suggest that this condition may be linked not only to sensory sensitivity but also to emotional processing and developmental experiences. Adverse childhood experiences have been found to be associated with lasting effects on emotional regulation, stress response, and empathic sensitivity. The aim of this study is to examine the mediating role of emotional empathy in the relationship between adverse childhood experiences and misophonia. Methods This cross-sectional online study was conducted in Türkiye between September and November 2025, and 369 adults who met the diagnostic criteria for misophonia were included in the study. Data were collected using the Adverse Childhood Experiences (ACE) Scale, the Cognitive and Emotional Empathy Scale (emotional empathy subscale), and the Misophonia Scale. Direct and indirect relationships between variables were analyzed using structural equation modeling (SEM), and indirect effects were tested using a bootstrap method with 5,000 resamples. Results The analysis results showed that adverse childhood experiences were positively associated with emotional empathy ( β = 0.272, p = 0.001). In addition, emotional empathy levels were found to be significantly associated with the severity of misophonia. Mediation analysis indicated that emotional empathy played a partial mediating role in the relationship between ACE and misophonia. The indirect effect accounted for approximately 25% of the total effect. The structural model demonstrated a good level of fit (χ 2 /df = 1.588, RMSEA = 0.040, SRMR = 0.051, CFI = 0.945). Conclusion The findings of this cross-sectional study suggest that developmental and emotional processes may be associated with misophonia. Emotional sensitivity associated with adverse experiences during childhood, alongside emotional empathy, may be linked to misophonic reactions. These findings suggest that focusing solely on trigger sounds in treatment may be limited; approaches targeting trauma processing, emotion regulation and empathic hypersensitivity may be beneficial.