- Is PMDD a new condition?
- Why is it considered a medical/psychiatric disorder?
- Will having PMDD damage my health?
- Can teenagers get PMDD?
- Do people outgrow PMDD?
- Does it continue after menopause?
- Is PMDD inherited?
- Can it be caused by trauma or childhood abuse?
- Are families affected?
- How can families and friends help?
- How does depression relate to PMDD?
- Are violence and aggression linked to PMDD?
- Has PMDD been used as a legal defense?
Is PMDD a new condition?
Yes and no. The name, PMDD, is relatively new but descriptions of the condition extend back to the days of the Greek physician, Hippocrates (460-377 B.C.) who commented on women with suicidal thoughts and other severe premenstrual symptoms. The term premenstrual tension first appeared in 1931 and later evolved into the more familiar name -- premenstrual syndrome or PMS. As attention focused on the more severe mood and behavioral aspects of PMS, a group of experts formalized a disorder with the awkward name of late luteal phase dysphoric disorder (LLPDD) in the late 1980's. The name was subsequently modernized to the now familiar premenstrual dysphoric disorder or PMDD.
Why is PMDD considered a medical/psychiatric disorder?
PMDD is a medical/psychiatric disorder and not just "a way of life" for several reasons. First, the symptoms are very real and quite severe and affect a woman both physically and mentally. Second, while PMDD is a fairly common condition, most women do not suffer from it. Next, the symptoms are clearly linked to the menstrual cycle and do not occur if ovarian function is suppressed (e.g., pregnancy, menopause). Finally, the treatments of PMDD proven to be most effective are biologic treatments (especially medication that affect the brain chemical, serotonin).
Will having PMDD damage my health?
While PMDD can cause unpleasant, uncomfortable and even distressing symptoms and be quite disruptive to a woman's life, there is no evidence that women with PMDD are at higher risk for developing physical illnesses such as cancer, high blood pressure, heart disease, kidney disease and the like. Women with PMDD do appear to be at higher risk for having mood disorders (depression and manic-depressive [bipolar] disorder) and anxiety disorders and these, in turn, are sometimes associated with feeling or acting suicidal. There is no question that feeling suicidal is a serious health risk so if you feel suicidal, be sure to get professional help immediately.
Can teenagers get PMDD?
Premenstrual symptoms can begin anytime after a woman begins to menstruate and, on average, menstruation begins at around 12 ½ years of age in the U.S. Women tend to seek treatment for premenstrual symptoms in their late twenties and early to mid-thirties, so it is difficult to know exactly when milder premenstrual symptoms actually become severe enough to be considered PMDD. Even though PMDD is usually first diagnosed after adolescence, it can certainly occur in teenagers.
Do people outgrow PMDD?
PMDD is a condition linked to the menstrual cycle, so once it begins, PMDD may persist until menstruation stops at menopause (or during pregnancy). Symptoms can vary greatly from cycle to cycle and from woman to woman, and not all cycles may be severe enough to be considered PMDD. Nonetheless, for the diagnosis to be made, the symptom pattern of PMDD must be present during most cycles. There is need for long-term research studies to learn whether and if so, how many women have PMDD symptoms that disappear spontaneously (without treatment) before they reach menopause.
Does PMDD continue after menopause?
PMDD and premenstrual symptoms, in general, stop after menopause. Natural menopause, the time of a woman's last menstrual period, occurs in the U.S. at an average age of 51 years but this can range from the late 40's to the late 50's. Of course, menopause can occur earlier if the ovaries are removed surgically or become nonfunctional for some other reason. Remember that other conditions can cause symptoms similar to those of PMDD and those may well persist after menopause. Also, some women who go on hormone replacement therapy after menopause experience premenstrual-like symptoms.
IS PMDD inherited?
Genetics may play a role in PMDD. Studies have shown that identical twins are more likely to share the disorder (93%) than non-identical (fraternal) twins (44%), and daughters of mothers with PMDD are more likely to have it themselves. However, no specific genes have been identified to account for PMDD. It is best to simply say that genetics may put a woman at greater risk for developing the disorder.
Can traumatic events or childhood abuse cause PMDD?
There is some research to suggest that a history of childhood abuse or other types of trauma may be more common in women with PMS or, more specifically, with PMDD. However, it is difficult to know this for sure. It is certainly possible that early trauma could increase a woman's risk of developing PMDD.
Women who have experienced a severe trauma may develop a condition known as posttraumatic stress disorder (PTSD). If this is a concern, please learn more about PTSD by visiting our PTSD site.
Are families affected by an individual's PMDD?
Most certainly. Remember -- for premenstrual symptoms to qualify as PMDD, they must be severe enough to markedly interfere with a woman's life, including relationships with others. Family relationships can be badly disrupted by PMDD. This means relationships with spouse, children, parents, and significant others. This is especially true if PMDD remains undiagnosed and not recognized for what it really is -- a treatable medical/psychiatric disorder for which no one is to blame.
How can families or friends help people with PMDD?
It may not be easy to deal with symptoms such as depression, anxiety, irritability and moodiness that recur on a monthly basis. However, the support and understanding of family and friends can help ease the distress of PMDD. Recognizing PMDD for what it is, a treatable medical/psychiatric disorder, is important because this helps lessen feelings of guilt and blame. There may be times when a family member or friend is the first to suspect that a woman has PMDD, and this may be the first step towards professional evaluation and treatment.
How does depression relate to PMDD?
Depression is one of the more common symptoms of PMDD. Women often feel sad, blue, unhappy, down in the dumps, and/or hopeless as part of the PMDD symptom complex. But remember, the depressive symptoms of PMDD are linked to the menstrual cycle and must be absent at least during the week following menses. Also, depression is not necessary for the diagnosis of PMDD. Some women find anxiety and tension or anger and irritability to be the most disturbing symptoms and do not consider themselves depressed.
Women with PMDD also may have a coexisting depressive illness such as Major Depressive Disorder or Bipolar (manic depressive) Disorder. These conditions sometimes begin before the onset of PMDD and sometimes follow it. They differ from PMDD in not being linked to the menstrual cycle. While symptoms of these illnesses may worsen premenstrually, they persist throughout the entire cycle.
Are violence and aggression linked to PMDD?
Women with PMDD may be angry and irritable, but this is seldom associated with actual violent or aggressive acts. There may be very rare exceptions, especially if a woman is temperamentally predisposed to violence or aggression. There was a report of a woman with previously unexplained recurrent violent behavior (including stabbing a woman to death), in whom all of the acts occurred during the premenstrual phase of her cycle. There have been cases of child abuse in which the abuse was apparently a premenstrual occurrence. It's possible that PMDD may play a role in other forms of abuse as well. While most violent or aggressive behavior has nothing to do with PMDD, it is always worth exploring the possibility of an association.
Has PMDD been used as a legal defense?
PMS certainly has. In 1882 Kraft-Ebing wrote "The menstruating woman has a claim to special consideration by the judge because she is at this period 'unwell' and more or less psychologically disturbed."
In a 1981 case in England, a woman ran down her lover, pinning him to a utility pole with her car and killing him. She was found guilty of manslaughter with PMS being considered "a mitigating factor." It is likely that PMS (and PMDD) has been a diagnosis both used appropriately and abused within the legal system. When used as a defense against a criminal charge, PMS appears far less likely to be a substantial defense than it is to result in consideration of a reduced sentence.
