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Pre-Menstrual Dysphoric Disorder

Updated: Nov 24, 2023

This post will briefly explain what it is, how it is diagnosed and what your next steps may be if you believe that you are affected by it.

PMDD, pre-menstrual dysphoric disorder, affects 1 in 20 women and 15-20% of those women will attempt suicide. This should highlight the severity of this condition and hence why it needs more attention.

To receive a diagnosis according to the DSM-V (diagnosis is currently more recognised in the USA), cycle track and mood track for 3 months at least before presenting your findings to your GP or gynaecologist. A) In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.

B) One or more of the following symptoms must be present:

1) Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection);

2) Marked irritability or anger or increased interpersonal conflicts;

3) Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts;

4) Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C) One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from criterion B above:

1) Decreased interest in usual activities

2) Subjective difficulty in concentration

3) Lethargy, easy fatigability, or marked lack of energy

4) Marked change in appetite; overeating or specific food cravings

5) Hypersomnia or insomnia

6) A sense of being overwhelmed or out of control

7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain.

D) The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.

E) Consider Other Psychiatric Disorders: disturbance isn't merely an exacerbation of the symptoms of another disorder, i.e. major depressive disorder, panic disorder, persistent depressive disorder (dysthymia) or a personality disorder (although it may co-occur with any of these disorders).

F) Exclude other Medical Explanations: symptoms aren't attributable to the physiological effects of a substance (e.g., drug abuse, medication or other treatment) or another medical condition (e.g., hyperthyroidism).

My symptoms include, anger, depression, a feeling of being on edge, difficulty concentrating, insomnia, feelings of overwhelm and often an out of control sense. Many women report that it feels like being possessed by a dark spirit, or Jekyll and Hyde situation. This is then followed by guilt and a deep sense of worthlessness and thoughts that others would be better off without you.

Once mensuration starts, or a few days into the period, relief will be felt and the mind gains clarity again and then the cycle of guilt and worthlessness and confusion can continue as you realise how horrible you've been. It is much more extreme than PMT. One can see things in a completely different light during the PMDD phase, so much so that it is as though they have a different personality. It affects relationships, especially intimate relationships.

The brain in those with PMDD is sensitive to hormones, yet it is not a condition that responds to hormonal control such as contraceptive pills. We do know that it is often triggered by an incident of acute and extreme stress or trauma (trauma big T or little t, simply means a stressful experience that one did not know how to process at the time). I know what my triggering event was but I am not ready to talk about it publicly so please respect my privacy here because it's not just my story.

It is possible to master the condition and I will share more about my journey with this in hopes that it can help others. As always, before contacting a psychotherapist, like myself, please ensure your physical health isn't exacerbating psychological symptoms. So ensure your nutrition is top notch, get a comprehensive blood test if you like to check your levels of key vitamins, minerals and hormones. Consider whether you get enough magnesium, whether your GABA is low, glutamate is high and if your liver is working efficiently enough to remove excess oesteogen. Ensure you're not exposing yourself to environmental oestrogen mimickers and anything else that could be worsening physical experiences of menstruation, such as cramps, headaches, and migraines.

As a therapist, these are things I would expect and encourage my Client to already have researched and investigated before working with me as these things need addressing regardless of whether there is psychological issues. We only get one vessel to experience our life in so we must respect and nurture it. Just as we tend the garden around the plant to ensure it is not overcrowded, has access to light and is sheltered from storms, we must tend the garden of ourselves, as well. Then we can begin polishing the leaves, trimming the branches and picking the dead petals off...

(I have an updated post on my personal PMDD journey here)

Much love,

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