Healthy Living

Should Severe PMS Be Considered A Mental Disorder? Why Psychiatrists Added It To DSM-5

PMS
A debate has erupted over whether severe PMS, or PMDD, should be considered a mental disorder. Helga Weber, CC BY-ND 2.0

The “PMS on steroids” has been categorized as a distinct mental disorder by psychiatrists in the new Diagnostic and Statistical Manual, the DSM-5, which was released in May 2013. While some women with the rare disorder feel their symptoms are validated by its inclusion in the manual and thus can be provided with a sense of community, others are concerned about the possible repercussions of the new label, especially the possibility of a ‘crazy’ stigma for women on their periods.

Premenstrual dysphoric disorder (PMDD) is the more severe form of premenstrual syndrome (PMS), and can be both physically and emotionally taxing, as well as damaging, for work and relationships. Physical symptoms for both PMS and PMDD include fatigue, bloating, breast soreness, and disruptions in sleep habits; the emotional symptoms include irritability, mood swings, anxiety, or a feeling of hopelessness. While PMS is common for women to experience one to two weeks before their menstrual cycle, PMDD is more disabling and severe, and is also quite rare — only affecting between three and eight percent of women, according to PubMed Health.

For some women who already have underlying depression and anxiety issues, PMDD can intensify things: “Women with depression may have worse symptoms during the second half of their cycle and may need changes in their medication,” according to PubMed. So for women who have felt isolated by their symptoms, the inclusion of their condition in DSM-5 helps them to not feel so alone. "There comes a point where you need to realize there's a name for what you're going through,” Megan Olney told NPR. “It helps you to realize you're not alone in your struggles.”

However, opponents of the inclusion of PMDD in DSM-5 claim that it can be detrimental to the role of women in society, by pushing the idea that women rather than men are predisposed to “crazy” behavior due to their periods. Sarah Gehlert, who studies health disparities at Washington University in St. Louis, believes that PMDD could also be overdiagnosed, as women experiencing mild PMS symptoms may mistake it for PMDD. She also is concerned that considering PMDD a mental disorder could have legal repercussions. “Say a poor woman was in court, trying to see whether she could keep custody of her child,” Gehlert told NPR. “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.”

Clearing Up Confusion?

Previous researchers who published a study in Gender Medicine in 2012 claimed that there was very little to no evidence that something like PMS even existed, concluding that “this puzzlingly widespread belief needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality.” While the study caused an outrage from women and men who said mood swings certainly existed because of hormonal change or physical pain like cramps, the researchers were simply being skeptical about how the emotional state of women could be linked to their reproductive function, not entirely ruling out the possibility. And as Elizabeth Kissling wrote on Ms. Blog in 2012:

Part of what makes PMS difficult to study, and difficult to talk about, is the multiple meanings of the term. In the research literature, there are more than 150 symptoms–ranging from psychological, cognitive and neurological to physical and behavioral–attributed to PMS. There is no medical or scientific consensus on its definition or its etiology, which also means there is no consensus on its treatment.

So perhaps the inclusion of PMDD in DSM-5 will clear up some of the confusion, and allow it to be diagnosed and treated properly. There are three main criteria to be diagnosed with PMDD, according to NPR. The symptoms must correspond with a woman’s menstrual cycle for at least two months, and they must be disruptive to a woman’s daily life and normal activities. Thirdly, women must report that depression only occurs during the weeks leading up to their period, not any other time. A woman must have “symptoms under a certain hormonal state that are not there under another hormonal state,” Dr. C. Neill Epperson, director of the Penn Center for Women’s Behavioral Wellness, told NPR.

According to PubMed Health, the causes behind PMS and PMDD are unknown, but it is likely linked to hormonal changes during the menstrual cycle. Along with antidepressants such as Prozac and Zoloft, some women take birth control pills, try herbal remedies, or work on diet and lifestyle changes to help ease PMDD symptoms. Eating foods with plenty of vegetables and fruit, as well as taking care to get regular aerobic exercise, may help improve symptoms.

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