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1. What noises trigger you? (Required.)

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2. If the noise is being made by someone is your relationship with them affected by the sounds?

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3. Are you comfortable telling people about your sound sensitivity(misophonia)?

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4. What have the reactions been when you've told people?

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5. Do you have other sensory sensitivities (smell, touch, taste, sights?)

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6. Have you ever struggled with food issues?

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7. How long have you had misophonia?

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8. How many times a day do you get triggered?

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9. Do you feel guilty about your triggers or the way you respond to them?

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10. Have you been diagnosed with a mental or physical health disorder/issue and if so do you believe it's connected to your misophonia?

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11. Do you have a history of trauma (sexual, physical, emotional) or emotionally disinterested/unavailable parents?  Please elaborate

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12. Did you ever experience trauma to the ear, for instance a loud sound, prior to the onset of your misophonia?

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13. Have you tried any kind of therapy, medication or tools for your misophonia? Did it help?

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14. This survey is completely anonymous. Absolutely no personal information is being gathered about you - only your responses to these questions - not even the I.P. address of your computer.

My hope is this freedom will enable you to unload your shame and allow others to see they are not alone. Please come up with a nickname to hide your identity in the event I read your responses on the show. If you are feeling suicidal PLEASE call the Suicide Prevention Hotline 800-273-8255. (Required.)

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15. What sex/gender are you? (Required.)

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16. Are you gay, straight, bisexual or asexual (not interested in either sex)? (Required.)

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17. How old are you?

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18. Do you have any comments or suggestions to make the Mental Illness Happy Hour podcast better?

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