You may have seen Premenstrual Dysphoric Disorder (PMDD) used to describe the problems experienced by a small percentage of women whose monthly hormonal fluctuations cause massive and enduring disruption to their lives.
PMDD is estimated to affect around 5-7% of all women and I regularly hear from women (and sometimes their partners) who wonder whether they are suffering from PMDD rather than PMS.
In many ways, the symptoms of PMDD are very similar to the symptoms of PMS because PMDD is characterised by:
- Mood swings
- Anger, irritability and conflicts with people
- And often accompanied by physical symptoms such as sore breasts and bloating, and sometimes, also insomnia or joint or muscle pain
So, you may be asking, how is this different from a just a very bad case of PMS? One view is that PMS covers a broad spectrum of symptoms, ranging from mild to severe, and PMDD is really just a way of distinguishing very severe PMS. The other view which is gaining ground – is that PMDD is a whole other diagnosis. The main difference is the extent of PMDD symptoms, how extreme they are, and how long they last for. For example, unlike PMS, PMDD symptoms may well not disappear once a womans period starts.
What Distinguishes PMDD From PMS
Women with PMDD routinely report being affected by:
- Feelings of hopelessness
- Wanting to withdraw from normal activities
- Suicidal feelings.
- Panic attacks
- Feeling out of control
- Feeling like theyre going mad
PMDD symptoms can in fact look very much like a depressive disorder indeed many women with PMDD have been misdiagnosed with depression or manic depression / bi-polar. The difference is that if PMDD is a form of depressive illness, its a condition unique to women and the symptoms come round in a monthly cycle.
As with ordinary PMS, there seems to be an inherited predisposition towards PMDD, which suggests a genetic link. Other risk factors for PMDD include a personal or family history of depression, mood disorder, postnatal depression, discrimination or trauma. Many women with PMDD also suffer from other health problems, such as IBS, arthritis, allergies, thyroid problems – although it’s not clear how these are linked.
From what Ive observed, women with PMDD tend to be less likely to find that their symptoms respond to the recommendations that work so well for other women with PMS, such as diet changes and exercise. And some things which work for many women with PMS, such as agnus castus, actually seem to have the opposite effect (possibly because women with PMDD are progesterone-intolerant). Equally, when holistic lifstyle approaches don’t work, PMDD sufferers often get limited relief from medical therapies such as synthetic hormones or antidepressants.
It is therefore not surprising that women with PMDD who endure chronic monthly symptoms which are so severe and disruptive to normal life, demand new approaches, and there are a number of blogs and websites specifically written by and for PMDD sufferers, such as Moods and Musings.
Should PMDD Be Classified Separately From PMS?
As things stand, PMDD is not currently recognised in the World Health Organization’s International Classification of Diseases as a separate diagnosis to PMS. But there are currently moves by the PMDD community to get PMDD recognised as a depressive illness.
In the UK, this campaign has led by Cat Stone of Moods and Musings. Her plea for PMDD sufferers to lobby their local MP to get them to support the classification of PMDD as a separate illness has been supported by the National Association for Premenstrual Syndrome (NAPS).
In the US, the campaign to include PMDD in the Diagnostic Manual of Mental Disorders (the American Psychiatric Associations bible for mental-health professionals) is already well underway. However, there is a growing debate about the implications of registering PMDD as a separate illness’. These include concerns about the increasing medicalisation of womens bodies and the branding of all womens problems as mental health issues to be treated by antidepressants. The antidepressant market is already huge – and growing all the time – and commentators have pointed out the potential for the phamarceutical companies to make profits out of treating PMDD, in a way that may not be in the best interests of women.
PMDD is undoubtedly a tough nut to crack, and I have every sympathy for PMDD sufferers. We still don’t fully understand the causes of PMS or PMDD, and the science explaining whether PMDD is really a different beast from PMS, and if so how, can’t come soon enough. The relationship between PMDD and depression and other conditions also needs to be explored more fully. More research and information is needed to inform the debate about how best to address the needs of women with PMDD / extreme PMS.
What do you think? Do you think PMDD should be classified as a separate depressive disorder?
Thanks for reading!