Validity and Reliability Testing Study of the Turkish Version of the Misophonia Scale
Merve Deniz Sakarya, Eda ÇakmakMisophonia is a disorder where individuals experience decreased tolerance to certain sounds that trigger intense emotional or physiological responses in them. People with misophonia can feel disgust, anger, anxiety, and they may experience anger outbursts when exposed to certain sounds that are insignificant to other people, such as chewing, lip-smacking, and breathing. There is no consensus on the prevalence, assessment, and management of misophonia. A major barrier to the research on misophonia is the lack of robust psychometric assessment tools. This study aims to meet the need for a measurement tool for clinical and population-based evaluations intended for misophonia by adapting the Misophonia Questionnaire (Wu et al., 2014) to Turkish. The research was carried out on 638 undergraduate students at Baskent University, from 18 to 26 years of age. Exploratory factor analysis was conducted on 420 participants (73% female, 27% male) and confirmatory factor analysis was conducted on 218 participants (62% female, 38% male). The statistical reliability was evaluated using the internal consistency coefficient, split half, and test-retest methods. In the Misophonia Questionnaire, misophonia was explained by the following three subscale factors: misophonia symptoms, misophonia emotions and behaviors-avoidance and internalization, and misophonia emotions and behaviors-aggression and externalization. These were used in the exploratory factor analysis. The confirmatory factor analysis found that the fit indexes were within acceptable limits. With the discriminant validity, the participants with clinical misophonia were observed to have a higher mean in all factors than those without. The internal consistency coefficient of the scale was calculated at .89, and for the three subscale factors mentioned earlier were .79, .85, and .83, respectively. The calculated test-retest reliability coefficient was .78, which applied to 75 participants. The split-half reliability coefficient was .83 (for each subscale factor, was .86, .87, and .81, respectively). With this study, the Misophonia Questionnaire, which can be used to evaluate misophonia in the general population, was adapted into Turkish. From the psychometric analysis, data supporting the validity and reliability of the Misophonia Scale were obtained.
Mizofoni Ölçeği’nin Türkçe Formunun Geçerlik ve Güvenirlik Sınama Çalışması
Merve Deniz Sakarya, Eda ÇakmakMizofoni, şiddetli duygusal veya fizyolojik tepkileri tetikleyen belirli seslere karşı azalmış bir ses tolerans bozukluğu durumudur. Mizofonisi olan bireyler yemek çiğneme, dudak şapırdatma, nefes alıp verme gibi diğer insanlar tarafından önemsiz olarak bulunan spesifik seslere karşı tiksinme, kaygı, kızgınlık hissedebilmekte ve bazen öfke nöbetleri yaşayabilmektedir. Mizofoninin prevalansı, değerlendirme ve yönetimi konusunda fikir birliği yoktur. Mizofoni araştırmalarının önündeki en büyük engellerden biri psikometrik açıdan güçlü değerlendirme araçlarının azlığıdır. Bu çalışmanın amacı Mizofoni Ölçeği’nin (Misophonia Questionnaire; Wu ve ark., 2014) Türkçe uyarlamasını yaparak mizofoniye yönelik klinik ve populasyon temelli değerlendirmeler için ölçüm aracı ihtiyacını gidermektir. Araştırma, yaşları 18- 26 arasında değişen Başkent Üniversitesinde lisans düzeyinde öğrenim gören 638 öğrenci ile gerçekleştirilmiştir. Yapı geçerliği kapsamında açımlayıcı (N = 420) ve doğrulayıcı faktör analizi (N = 218) uygulanmış, içtutarlılık ve ayırt edici geçerlik sınamaları gerçekleştirilmiştir. Güvenirlik için ise iç tutarlılık, yarıya bölüm ve test-tekrar test yöntemleri kullanılmıştır. Açımlayıcı faktör analizinde ölçeğin mizofoni semptomları, mizofoni duygu ve davranışlar – kaçınma ve içselleştirme, mizofoni duygular ve davranışlar – saldırganlık ve dışsallaştırma olmak üzere üç faktörlü bir yapıya sahip olduğu gözlenmiştir. Doğrulayıcı faktör analizinde söz konusu üç faktörlü yapı için uyum indeksleri kabul edilebilir sınırlar içinde bulunmuştur. Ayırt edici geçerlik sonucunda, klinik olarak mizofonisi olanların olmayanlara göre tüm faktörlerde daha yüksek ortalamaya sahip olduğu görülmüştür. Ölçeğin bütünü için Cronbach Alfa iç tutarlılık katsayısının .89 (faktörler için sırasıyla .79, .85 ve .83), yarıya bölüm güvenirlik katsayısının .83 (faktörler için sırasıyla .86, .87 ve .81) ve test-tekrar test güvenirlik katsayısının .78 olduğu bulunmuştur. Bu çalışma ile genel örneklemde mizofoniyi değerlendirme amacı ile kullanılabilecek Mizofoni Ölçeği Türkçeye kazandırılmıştır. Yapılan psikometrik analizler sonucunda Mizofoni Ölçeği’nin geçerliğini ve güvenirliğini destekleyen verilere ulaşılmıştır.
Misophonia, defined as an abnormally strong reaction to a sound with a specific pattern and/or meaning to an individual (Jastreboff & Jastreboff, 2014), is a phenomenon that has not been given enough attention in the literature until recent years. Studies on misophonia consist mostly of case reports; thus, studies with large populations are necessary to understand this phenomenon. Measurement tools have been developed in the international literature in recent years to better understand the nature of misophonia. There are a variety of scales evaluating misophonia, such as the Amsterdam Misophonia Questionnaire (A-MISO-S; Schröder et al., 2013), Misophonia Questionnaire (MQ) (Wu et al., 2014) and MisoQuest (Siepsiak et al., 2020). However, there is no valid and reliable Turkish measurement tool to evaluate the symptoms and effects of misophonia. Therefore, the aim of the current study is to adapt the MQ (Wu et al., 2014) into Turkish.
Method
The items of the MQ were translated into Turkish by a native translator. Whether the items gave the same meaning in different cultures was checked by the researchers. Lastly, the translations were checked by two linguists. After the necessary adjustments were made, the final version of the scale was created. The research was carried out on 638 undergraduate students at Baskent University, from 18 to 26 years of age. Exploratory factor analysis was conducted on 420 participants (73% female, 27% male) and confirmatory factor analysis was conducted on 218 participants (62% female, 38% male).
The MQ contains 17 items. The original scale consists of three parts: “misophonia symptoms,” “misophonia emotions and behaviors,” and “misophonia severity.” The items are scored from 0 (not at all true) to 4 (always true). The misophonia symptom factor consists of seven specific sounds that often cause annoyance in individuals. The misophonia emotions and behaviors factor evaluates negative feelings and behaviors developing against misophonia symptoms. Misophonia severity, the last part of the scale, gives information about the severity of misophonia and is not included in the factor structure and scoring. In this section, the participant is asked to score sensitive sounds on a scale from 1 (minimal) to 15 (very severe), according to the degree that it affects their daily life. Scores of seven and above indicate clinically significant misophonia (Wu et al., 2014). The 17 items from section 1 and 2 are included in the scoring of the scale.
Results
While the original of the MQ was explained with two factors, based on the results of the exploratory factor analysis, the Turkish adaptation of the scale was explained with three factors—by the number of eigenvalues greater than 1, Horn’s (1965) parallel analysis and screen plot methods. The second original factor, misophonia emotions and behaviors is explained with two sub-factors. To discuss and confirm the accuracy of this factor, it was discussed with the author of the original scale, Dr. Wu. The final version of the scale was formed by renaming the factors. The first factor was named as “misophonia symptom,” the second factor “misophonia emotions and behaviors—avoidance and internalization,” the third factor “misophonia emotions and behaviors—aggression and externalization.” The principal component analysis and direct oblimin rotation methods were used to determine the structural validity of the MQ. According to the exploratory factor analysis results, the Bartlett’s test statistic for sphericity was obtained—(χ2 = 2948.28 df = 136 p < .001)—and the Kaiser-Meyer-Olkin coefficient was .89, so it was found to be sufficient (Alpar, 2017). The percentage of variance for the first, second and third factors were 37.13%, 10.83%, and 7.56%, respectively, with a total variance of 55.2%. According to the confirmatory factor analysis, it was observed that the fit indexes of the model were within acceptable limits: χ2 / df = 2.23, Root Mean Square Error of Approximation (RMSEA) = .07, Comparative Fit Index (CFI) = .91, Goodness of Fit Index (GFI) = .88, and Adjustment Goodness of Fit Index (AGFI) = .84 (Özdamar, 2017). Regarding the discriminant validity, clinical misophonia was observed to have a higher mean in all factors than those without.
Based on the results of the reliability analysis of the MQ, the internal consistency coefficient was calculated as .89, and for each of the three factors was .79, .85, and .83 respectively. The split-half reliability coefficient was calculated as .83 (for each subscale factor, it was .86, .87, and .81, respectively) and the test-retest correlation coefficient as .78.
Discussion
The factor structure of the Turkish version of the MQ is different from the original scale. After reaching a consensus with original scale’s author, it was deemed that the construct validity of the scale met the desired criteria in a three-factor structure—using explanatory and confirmatory factor analysis methods. The internal consistency coefficient of the scale was found to be high. Overall, the results of the study indicate that the Turkish version of the MQ has adequate reliability and validity values for a Turkish sample. It is presented as a practical, valid, and reliable measurement tool that can be used in large population studies on misophonia in the Turkish setting.
