Premenstrual Dysphoric Disorder (PMDD) is a term used by the American Psychiatric Association, and made its first appearance in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition published 2008. It is categorised as a; "depressive disorder not otherwise specified", and suggests it is a chronic life altering condition that requires specific psychiatric involvement.
Should you chance upon a knowledgeable gynaecologist and utter the phrase "PMDD" you will likely experience a dismissive reaction, and instead be diagnosed with severe premenstrual syndrome (PMS). Current evidence tells us that PMS occurs as a result of a neurological reaction to a woman’s cyclical hormonal fluctuations. This is cold hard biology with ever increasing evidence pointing towards a genetic predisposition to the condition.
Interestingly however, many women will report symptoms to be worsened during periods of stress, hardship, grief and life changes such as a new job, which gives rise to the debate that there is a psychological element to the condition that cannot be ignored.
Mr Nick Panay; Consultant gynaecologist, chairman of the National Association for Premenstrual Syndrome (NAPS) and director of West London Menopause & PMS Centre, has authored a best practice guideline in association with NAPS for the treatment of severe PMS. Within this he details the effectiveness of ovarian suppression treatment combined with Cognitive Behavioural Therapy (CBT), which supports the argument that the mental wellbeing and the psyche play an important part in the lives of those living with the so called PMS.
Being terribly British and having the stiff upper lip can therefore, only have a detrimental effect on severe PMS sufferers. While I do not dismiss the strong biological influences involved in the aetiology of this disorder, I simply cannot ignore the huge vacant void that is the psychological impact of symptoms, week in, week out.
The average age for the onset of a girl's period is 12-13 years, however, hormonal changes can start as young as 7, while young girls are still developing key skills in emotion regulation and distress tolerance, and thrive within a routine and being able to begin to complete tasks autonomously. If then, the genetically predisposed child begins to have inexplicable mood swings, becomes self-conscious, anxious, and irritable, there can be no doubt that this will have a huge, and potentially destructive impact upon their cognitive, emotional and personality development.
By the time this young woman completes puberty and is experiencing severe PMS as clockwork, it can be of no surprise that she may also living with an underlying psychopathological disorder such as Borderline Personality Disorder, Body Dysmorphia, Generalised Anxiety Disorder to name but a few.
If one follows the optimum care guidelines for the treatment of severe PMS, it is expected that with effective ovarian suppression all PMS symptoms should be alleviated with the woman being expected to function normally as though she has not undergone psychological trauma on a monthly basis for years or even decades. This woman may then report back to her gynaecologist that all her symptoms have not been resolved, and she is left with an unknown diagnosis and no longer considered for more interventions such as a hysterectomy and oophorectomy as she has been unable to demonstrate this bottom line treatment has worked.
Moving forwards into a world where we are starting to learn that physical and mental health are not, and can never independent of one another. We must also learn about the complexities of the development of the psyche and how cyclical hormonal disorders can interrupt the natural processes.
This is why I use the phrase PMDD, because I believe that only in collaboration with psychologists and psychiatrists can we truly care and support ourselves and our loved ones with the disorder. Ovarian suppression with hormone replacement therapy alone will not result in quality of life. We cannot break our legs and expect to run a marathon when the cast is removed, just as we cannot expect to be suddenly whole again as soon as our ovaries are supressed either chemically or surgically.
This is the PMDD & Me revolution; to begin to work with therapists, to create a healthcare system that looks at the holistic picture and provides women with this debilitating disorder a chance for a beautiful life.