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Should Severe Premenstrual Symptoms Be A Mental Disorder?

Posted by on Oct. 21, 2013 at 10:41 AM
  • 40 Replies

Should Severe Premenstrual Symptoms Be A Mental Disorder?

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8 min 22 sec



Women's moods can change based on the phases of their menstrual cycle. But does that mean they have a psychiatric disorder?

Women's moods can change based on the phases of their menstrual cycle. But does that mean they have a psychiatric disorder?

Katherine Streeter/ Katherine Streeter for NPR

The way Ronna Simmons of Philadelphia describes it, every two weeks a timer goes off.

Simmons, 24, will have been doing just fine, working, taking care of her daughter. And then suddenly everything changes. Normally cheerful, Simmons says she begins to hate herself.

"I tell everybody 'I'm not myself right now,' " she says. "'I'll call you back when I'm Ronna again.'"

Simmons has premenstrual dysphoric disorder, or PMDD. It's sometimes referred to as "PMS on steroids." PMDD is defined by psychiatrists as a fairly rare syndrome that prompts disabling emotional and sometimes physical reactions to the hormonal changes that come with a woman's period.

Psychiatrists have been slow to formally recognize PMDD as a disorder, but that's changed under the new Diagnostic and Statistical Manual, the DSM-5, which lists PMDD as a distinct mental disorder.

Doctors who treat say women typically begin experiencing symptoms around the start of the luteal phase of their menstrual cycle, a two-week span between ovulation and the first day of a woman's period. Symptoms can include severe depression, anxiety and tension.

And then just as quickly the symptoms disappear.

"Once your period starts," says Megan Olney, 29, from Warren, Ohio, "it's like a release. You feel OK, but then you have to deal with what you just went through."

Olney was a teenager when she realized that there seemed to be a link between her period and the extremely dark moods she was experiencing.

But when she tried getting help, she found doctors skeptical that her emotional problems could be connected to her period.

So Olney went online and diagnosed herself. She learned that PMDD is different from (PMS), different from depression or bipolar disorder. As many as 85 percent of menstruating women have at least one , according to the American College of Obstetricians and Gynecologists.

PMDD is much less common, affecting no more than 1 percent of menstruating women.

The PMDD diagnosis has three main criteria. First, the symptoms have to correspond with the menstrual cycle for a minimum of two successive months.

Second, the symptoms must be truly disruptive to a woman's ability to carry out her normal activities. That's different than in PMS, where most symptoms are mild.

Finally, to be diagnosed with PMDD women must report that they aren't depressed all the time, just in the days leading up to their periods.

In PMDD, says , who directs the Penn Center for Women's Behavioral Wellness, a woman clearly has "symptoms under a certain hormonal state that are not there under another hormonal state."

Epperson says the medical literature was until recently vague about what PMDD is and how to treat it, but that has changed.

Previous versions of the DSM lumped PMDD into a category called "not otherwise specified."

Last year, Epperson served on a in charge of updating the manual. They decided to give PMDD its own entry as a full diagnosis in the latest version of the manual, the DSM-5.

Epperson says it was a controversial decision.

"I think any time a disorder occurs more frequently in women or only in women, there's going to be a group of individuals who have concern that this will diminish women's role in society, their sense of being capable," Epperson says.

One person concerned about that is , who studies health disparities in the school of social work at Washington University in St. Louis. She has tried to find out how many women actually have PMDD, to see, as she puts it, if there was "any evidence for this disorder."

Gehlert's team randomly recruited 1,246 women from around St. Louis and Chicago. They asked the women to fill out a form every day for two months, answering basic questions about their mood and how they were feeling.

The form said nothing about menstruation. Instead, the women submitted daily urine samples, so Gehlert's team could see where each was in her monthly cycle.

"I wanted to go into it as scientifically and objectively as possible," she says.

This was especially important to Gehlert because PMDD struck her as a diagnosis that could be used against women.

"Say a poor woman was in court, trying to see whether she could keep custody of her child," Gehlert says. "Her partner's or spouse's attorney might say, 'Yes, your honor, but she has a mental disorder.' And she might not get custody of her children."

At the very least, Gehlert worries that PMDD could be overdiagnosed, pathologizing healthy women who were experiencing normal hormonal shifts. After all, she says, there's a lot of money to be made from it.

One textbook example is the prescription drug Sarafem, which was approved by the Food and Drug Administration in 2000 as a treatment for PMDD. In reality, Sarafem is identical to the widely prescribed SSRI antidepressant Prozac, or fluoxetine. The patent on Prozac was about to expire, and manufacturer Eli Lilly faced losing market share to generic versions.

YouTube

In this TV ad, no shopping cart was safe from a woman with PMDD.

So Lilly gave Prozac a new name, , and painted it pink. What had been a generic drug that cost 25 cents a pill was marketed as a PMDD-specific drug for $10 a pill.

The marketing of Sarafem raised eyebrows. In November 2010, after Lilly aired a TV commercial showing a frustrated woman wrestling with a shopping cart, the FDA sent Lilly a telling Lilly to "immediately cease using this broadcast advertisement and all other promotional materials for Sarafem that contain the same or similar issues."

The shopping-cart commercial never defined PMDD, the FDA said, and failed to distinguish it from PMS. "Consequently the overall message broadens the indication and trivializes the seriousness of PMDD," the letter continued. "For a diagnosis of PMDD, symptoms must markedly interfere with work, school, usual social activities, and relationships."

To Gehlert, the women in the Sarafem ads looked like normal women who were just having a tough day. That would attach any kind of normal frustration to the menstrual cycle, she says. And that could lead people to think "that women — over men — were predisposed toward that sort of behavior."

In the women Gehlert studied, just 1.3 percent fit the criteria for PMDD. The were published in 2009 in the journal Psychological Medicine.

It's a small number, smaller than what other researchers have found for PMDD. To Gehlert the jury is still out, especially when there is still so little hard evidence about how hormonal changes interact with a woman's emotions.

"I would feel much, much more comfortable if we understood the biology behind it," she says. "Even though we found evidence, the question remains: Is what we described real?"

Megan Olney says she understands their concerns. She knows how neatly PMDD can fit into harmful stereotypes about women. But getting formal recognition for PMDD has made a difference to her.

"There comes a point where you need to realize there is a name for what you're going through," she says. "It helps you to realize that you're not alone in your struggles."

Today, there's a big online community centered around PMDD, forums where Megan Olney and other women talk about what's worked for them – whether it's antidepressants, birth control pills or exercise and diet. They find each other on Twitter and other social media networks.

That community can be its own therapy, says Amanda Van Slyke, who is 23 and lives in Edmonton, Alberta.

The online communities have been a refuge for Van Slyke, a place where she "came out," as she puts it, as a woman with PMDD and found others willing to share their experiences with the disease.

Van Slyke and other women say the forums are also a place to be reminded that, unlike other mental disorders, PMDD always goes away, at least for a while.

National Woman's Party


by on Oct. 21, 2013 at 10:41 AM
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Replies (1-10):
AlekD
by Gold Member on Oct. 21, 2013 at 10:43 AM

My doctor and I have been discussing how my panic disorder may also be somewhat tied to PMDD since it gets very noticeably worse around that time. I am starting a new medication, Celexa, which is prescribed for both panic disorder and PMDD so we are hoping that it might do the trick for me. We'll see next month, lol.

AnnieGoolaheey
by Bronze Member on Oct. 21, 2013 at 10:47 AM

I suspect I have PMDD, it totally sucks.  It's like I am two different people.  There is the normal nice, happy, silly me.  And then mega bitch comes out a week before my period.  It affects my job, my marriage and my ability to be a good mom.  I hate it.  I try really hard to control my emotions, and I don't use it as an excuse to be bitchy either. 

Kfdmrw9312
by Member on Oct. 21, 2013 at 10:48 AM
1 mom liked this

Pms as a mental disorder......the person who came up with this idea is mental...BAHAHAHAHA

AnnieGoolaheey
by Bronze Member on Oct. 21, 2013 at 10:50 AM
1 mom liked this

Did you read the article?  They are talking about PMDD.  

Quoting Kfdmrw9312:

Pms as a mental disorder......the person who came up with this idea is mental...BAHAHAHAHA


AnnieGoolaheey
by Bronze Member on Oct. 21, 2013 at 10:53 AM
1 mom liked this

I do agree that classifying this as a mental disorder could lead to PMDD being highly over diagnosed...

candlegal
by Judy on Oct. 21, 2013 at 10:58 AM

I spent 30 years having severe migraines because of my period.   I didn't have cramps.  You learn to deal with it.

ReadWriteLuv
by Silver Member on Oct. 21, 2013 at 11:00 AM

I can relate to this. It's gotten worse every year, in my 20's I don't remember having anywhere near the problems I have in my 30's. Everything about my cycle is worse. I told my husband that I'm really down to two good weeks a month. One full week is spent mentally and emotionally miserable, then one full week I'm physically miserable with pain and bloating. I can't control the things that come out of my mouth the week before my period. I try, but I'm like a geyser. It just shoots out, I become irrationally angry and the dumbest things.

I tried to explain it to my husband once, and not only did he not understand, I think it made him want to commit me. I told him that I know I'm being irrational, but there is seriously nothing I can do to stop it. It's like the sane, rational me is still there, but the irrational she-beast side of me has her locked in a cage and has taken control. I know I'm being a ridiculous bitch, but I'm powerless to stop it.

Quoting AnnieGoolaheey:

I suspect I have PMDD, it totally sucks.  It's like I am two different people.  There is the normal nice, happy, silly me.  And then mega bitch comes out a week before my period.  It affects my job, my marriage and my ability to be a good mom.  I hate it.  I try really hard to control my emotions, and I don't use it as an excuse to be bitchy either. 


Sisteract
by Whoopie on Oct. 21, 2013 at 11:01 AM
1 mom liked this

Ok- what about peri- menopause or having fibroids that cause one to literally exsanguinate every 30 days (like having to stay home and keep the feet higher than the head for 24-36 hours)? EVERY women would have a viable, menses related medical dx-

AnnieGoolaheey
by Bronze Member on Oct. 21, 2013 at 11:03 AM

Exactly.  I cannot rationally explain anything when I am am "mega bitch".  The more rational I try to be, the more irrational I sound.  It's a totally different situation  when I am normal. 

Quoting ReadWriteLuv:

I can relate to this. It's gotten worse every year, in my 20's I don't remember having anywhere near the problems I have in my 30's. Everything about my cycle is worse. I told my husband that I'm really down to two good weeks a month. One full week is spent mentally and emotionally miserable, then one full week I'm physically miserable with pain and bloating. I can't control the things that come out of my mouth the week before my period. I try, but I'm like a geyser. It just shoots out, I become irrationally angry and the dumbest things.

I tried to explain it to my husband once, and not only did he not understand, I think it made him want to commit me. I told him that I know I'm being irrational, but there is seriously nothing I can do to stop it. It's like the sane, rational me is still there, but the irrational she-beast side of me has her locked in a cage and has taken control. I know I'm being a ridiculous bitch, but I'm powerless to stop it.

Quoting AnnieGoolaheey:

I suspect I have PMDD, it totally sucks.  It's like I am two different people.  There is the normal nice, happy, silly me.  And then mega bitch comes out a week before my period.  It affects my job, my marriage and my ability to be a good mom.  I hate it.  I try really hard to control my emotions, and I don't use it as an excuse to be bitchy either. 



tanyainmizzou
by on Oct. 21, 2013 at 11:03 AM
No
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