Navigating the intersection of obsessive-compulsive disorder and sensory disorders like misophonia often feels like standing at a crossroads in clinical interpretation. For years, the psychiatric community has observed a significant overlap between these conditions, often leading researchers to suggest that misophonia might be a subset or a specific manifestation of OCD. This traditional view posits that the intense emotional reactions and repetitive behaviors seen in sensory disorders are simply variations of the obsessions and compulsions we have long categorized as mental illness. However, as our understanding of neurobiology and the neurodiversity paradigm evolves, we must ask if we have the direction of this relationship backwards. Instead of viewing sensory processing differences through the lens of OCD, there is a professional and empathetic argument for viewing OCD through the lens of neurodivergence, suggesting that the symptoms of OCD may actually be a byproduct of a highly sensitive, divergent nervous system trying to navigate a world it finds overwhelming.
The tendency to pull misophonia into the orbit of OCD is often based on the observation of shared characteristics, such as the intrusive nature of triggers and the urgent need for environmental control. Some researchers have categorized misophonia as an obsessive-compulsive related disorder because of the repetitive nature of the distress and the ritualistic avoidance behaviors that often follow (Schröder et al., 2013). Yet, recent neuroimaging studies suggest that the core of misophonia lies in the brain’s salience network and the anterior insular cortex, which are responsible for sensory processing and emotional regulation (Kumar et al., 2017). This suggests a physiological foundation that is distinct from the primary cognitive loops of OCD. If we start with the premise that these are sensory processing differences first, we begin to see that the obsessive qualities of the mind might be a secondary adaptation. When the world is too loud, too bright, or too tactile, the brain naturally develops rigid patterns and compulsions as a form of self-preservation.
By reframing OCD as a form of neurodivergence rather than a standalone pathology, we align our understanding with a growing body of evidence that links obsessive symptoms to broader sensory processing variations. Research has shown that individuals with OCD often exhibit significant sensory over-responsivity, a trait that is also a hallmark of autism and ADHD (Hazen et al., 2008). This suggests that the stuckness of the OCD brain may be a response to a nervous system that is perpetually in a state of high alert. We are often taught that resilience means forcing our brains to ignore these sensitivities to achieve a neurotypical standard of functioning, yet for many, true resilience lies in the quiet radical act of honoring these physiological needs. This involves moving away from the grief of what we think our cognitive stability should look like and toward a functional acceptance of what our unique nervous systems actually require to be sustainable.
If we consider that OCD and sensory disorders are both expressions of a divergent brain, the clinical goal shifts from the elimination of symptoms to the accommodation of needs. A systematic review of the neurodiversity framework highlights that many difficulties labeled as disorders are actually the result of a mismatch between an individual’s neurology and their environment (Pellicano & den Houting, 2022). When researchers attempt to shoehorn misophonia into OCD, they may be missing the foundational sensory root that makes these experiences so taxing. Acceptance in this context means recognizing that the need for order, the avoidance of triggers, and the reliance on routine are not failures of character or simple mental glitches but are necessary adjustments for neurophysiological health. It is okay to do things differently if it means maintaining the stability of your own nervous system.
Ultimately, the debate over whether misophonia belongs under the OCD umbrella may be settled by looking at the broader spectrum of neurodevelopment. Meta-analyses have confirmed high rates of co-occurrence between OCD and other neurodivergent conditions, suggesting that these are not separate silos but are part of an interconnected web of neurological diversity (Postorino et al., 2017). When we stop trying to force these complex sensory and cognitive experiences into rigid diagnostic categories, we create space for an authentic sense of self. We move from a state of constant defense against our own minds to a state of intentional and grounded living. Supporting individuals with these overlaps is not about fixing a broken system but about cultivating an environment that respects their unique boundaries. By accepting that our brains process the world with a different level of intensity, we can finally stop fighting our own biology and start living in a way that is honest, compassionate, and sustainable.
References
Hazen, E. P., Reichert, E. L., Piacentini, J. C., Vitulano, L. A., Scahill, L., Sukhodolsky, D. G., & Bloch, M. H. (2008). Sensory over-responsivity as a predictor of obsessive-compulsive symptoms in children with tic disorders. Journal of Child and Adolescent Psychopharmacology, 18(5), 505–511. https://doi.org/10.1089/cap.2007.0142
Kumar, S., Tansley-Hancock, O., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., Cope, T. E., Gander, P. E., Cushion-Richey, S., & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology, 27(4), 527–533. https://doi.org/10.1016/j.cub.2016.12.039
Pellicano, E., & den Houting, J. (2022). Annual Research Review: Shifting from ‘normal science’ to participatory neurodiversity research. Journal of Child Psychology and Psychiatry, 63(4), 381–396. https://doi.org/10.1111/jcpp.13534
Postorino, V., Kerns, C. M., Vivanti, G., Bradshaw, J., Siracusano, M., & Mazzone, L. (2017). Anxiety disorders and obsessive-compulsive disorder in individuals with autism spectrum disorder. Current Psychiatry Reports, 19(12), 92. https://doi.org/10.1007/s11920-017-0846-y
Schröder, A., Vulink, N., & Denys, D. (2013). Misophonia: Diagnostic criteria for a new psychiatric disorder. PLoS ONE, 8(1), e54706. https://doi.org/10.1371/journal.pone.0054706
