The Woes of PMS

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Severe PMS as a Mental Disorder

As a first year clinical psychology graduate student, I had mixed feelings when I learned that severe Premenstrual Syndrome (PMS) was officially recognized as a mental illness in The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5; a diagnostic tool used by therapists worldwide). Premenstrual Dysphoric Disorder (PMDD), “a condition characterized by intense emotional and physical symptoms that occur between ovulation and menstruation”, is categorized under depressive disorders. It is a supercharged version of PMS, in which affected women experience extreme mood shifts that could disrupt their work and damage their relationships in addition to the regular PMS symptoms such as bloating, breast tenderness, fatigue, and changes in sleep and eating habits. 75 percent of women are estimated to experience some form of PMS whereas 3 to 9 percent report symptoms of PMDD.

PMDD’s symptoms such as markedly depressed mood, decreased interest in usual activities, lack of energy, hypersomnia or insomnia, are similar to Major Depressive Disorder’s (MDD) yet they are cyclical, and occur between ovulation and menstruation. To qualify for diagnosis, one needs to show five of 11 potential symptoms in the week before the menses, and the symptoms should cause disruption with work, school, usual activities or relationships with others. As for the treatment, counseling, antidepressants, birth control pills, nutritional supplements, herbal remedies, diet and lifestyle changes are suggested. More detail on treatment approaches can be found here.

Currently, it is believed that normal hormonal fluctuations interact with serotonin systems, which in turn triggers pain, anxiety and depressive symptoms. Also PMDD has been associated with history of sexual abuse, domestic violence and perceived sexual discrimination as well as past unipolar depression, anxiety and other psychiatric disorders. On the other hand, Caplan, a research associate at Harvard University, claims that societal and interpersonal factors are usually the main cause rather than biological ones. She described PMS symptoms as the “last straw” for women in difficult life situations such as domestic abuse or job loss.

Although, PMDD has been included in the DSM for a long time now, many health professionals debate its existence and usefulness. The proponents argue that validation of the discomfort will encourage additional research and development of new therapies, and recognize women have special needs in mental health. Moreover, they argue that acknowledgment will increase the likelihood of insurance coverage and even alleviate the stigma attached.

On the other hand, a comprehensive literature research on the issue summarized the following as the reasons for opposing inclusion of PMDD as a mental disorder. The arguments are as the follows:

Concern 1: the PMDD label will harm women economically, politically, legally, and domestically

Concern 2: Putting a label on hormonal changes only in women is harmful

Concern 3: Research validating PMDD has been faulty

Concern 4: PMDD is a culture-bound condition

Concern 5: PMDD is due to situational, rather than biological, factors

Concern 6: PMDD was fabricated by pharmaceutical companies for financial gain.

Although the current evidence validates PMDD’s existence, personally, I was ambivalent about recognizing it as a mental disorder since the diagnosis can pathologize the menstrual cycle and stigmatize affected women by labeling them as ‘mentally ill’. Also, such labeling can prevent the individuals from discovering other factors in their lives that may be causing distress. I hope recognizing PMDD will not prevent the mental health professional from exploring potential causes other than the hormonal changes.

Yet as Chrisler states, whether PMDD is a mental disorder or not, it’s important to validate women’s experiences since “Whatever they’re experiencing, they’re experiencing”.

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