What is premenstrual dysphoric disorder? (PMDD)

The following article was written by Palmeira Practice counsellor Tamsin Taylor.

Ever have a day when everything in your life is exactly the same as yesterday, but it suddenly feels like the bottom has dropped out? When your psyche feels like a raw wound?

That’s what premenstrual dysphoric disorder (or PMDD) feels like. It’s premenstrual syndrome (PMS) to the Nth degree—when your feelings reach debilitating extremes that interfere with your relationships or your ability to function, and sometimes even your desire to go on living.

What is PMDD, and how common is it?

Premenstrual Dysphoric Disorder (PMDD) is a severe and debilitating form of premenstrual syndrome (PMS) that affects between 3 to 8% of women with menstrual cycles. PMDD is characterised by a range of emotional and physical symptoms that typically occur in the two weeks before menstruation and improve shortly after the onset of the menstrual period.

Women who experience premenstrual dysphoric disorder often feel immense and significant emotional lows that can impact their work, relationships, and even desire to carry on living.

These symptoms are much more intense and disruptive than typical PMS. Symptoms can change and fluctuate which makes it difficult to track and diagnose this condition. Sadly, it is common for medical professionals to misdiagnose and not recognise the symptoms as PMDD. Understanding of the condition is growing slowly, so sufferers can feel misunderstood with little guidance of how to help themselves.

Whilst counselling cannot cure the symptoms, counselling can help you process the feelings that arise from living with the condition and the fallout from the ‘bad’ days and weeks. Being supported through this journey by a therapist that understands this condition and has experience working with other long term PMDD sufferers is helpful and reassuring.

Typically, clients with PMDD want to find ways to control their interactions with loved ones. It is very common for close relationships to be affected by extreme mood changes of the sufferer. Guilt and self-loathing are common, understanding and processing these feelings is a big part of the work. A common concern is around issues of starting a family. Many women will fear getting pregnant as they worry their condition will adversely affect any future children. Women with children often feel great shame around their ability to parent in a way they feel is consistent and in line with their parenting values.

One of the most dangerous and distressing symptoms of PMDD is mood-related changes. Some people may experience suicidal feelings which can be very frightening for individuals who may feel happy and content at other times of the month. Women report mood changes including increased irritability, sadness, anxiety, and emotional sensitivity in the luteal phase (the two weeks before menstruation) which improve within a few days of menstruation. When women experience these dramatic mood changes, they can find relationships difficult, working can become impossible, and life can feel scary and overwhelming. It can feel difficult to understand who you are.

Physical and cognitive symptoms of PMDD

Physical Symptoms can include breast tenderness, bloating, headaches, and joint or muscle pain. Some individuals with PMDD may experience cognitive symptoms such as difficulty concentrating, forgetfulness, and confusion. Persistent fatigue and low energy levels are common. Insomnia or excessive sleepiness can be part of PMDD. Changes in appetite, including overeating or food cravings, are possible.

A whole range of physical symptoms can affect the body, from bloating and tenderness through to severe headaches.

PMDD is thought to be related to hormonal fluctuations that occur during the menstrual cycle, particularly changes in oestrogen and progesterone levels. However, the exact cause is not fully understood.

To be diagnosed with PMDD, a person must meet specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include the presence of at least five of the aforementioned symptoms, including one mood-related symptom (like irritability, mood swings, or sadness). These symptoms must occur consistently in the luteal phase (the two weeks before menstruation) and improve within a few days of menstruation.

How to manage PMDD

Managing PMDD often involves a combination of approaches, including lifestyle changes, medication, and therapy. Improving the diet and taking supplements can have a positive impact for some sufferers. Finding a knowledgeable nutritionist can be extremely helpful. Regular exercise, stress reduction and good sleep is vital, as it is for us all, but for PMDD suffers these basic elements of well-being take on an even bigger significance.

For further support around PMDD, contact Palmeira Practice counsellor Tamsin Taylor.