Understanding PMDD: Symptoms and Intersectional Perspectives

Premenstrual Dysphoric Disorder (PMDD) is a severe, chronic medical condition affecting individuals assigned female at birth (AFAB) who experience significant distress related to their menstrual cycle. While often compared to premenstrual syndrome (PMS), PMDD is more severe and debilitating, impacting daily functioning and quality of life. Understanding the symptoms and recognising the need for an intersectional approach to diagnosis and treatment is crucial.

Symptoms of PMDD

PMDD symptoms typically occur during the luteal phase of the menstrual cycle, which starts after ovulation and ends when menstruation begins. Symptoms can vary in intensity and may include:

1. Mood-related Symptoms:

   • Severe irritability or anger: This can result in frequent arguments or conflicts with others, impacting relationships both at home and work.

   • Persistent sadness or depression: This can be profound and may include feelings of worthlessness or overwhelming hopelessness.

   • Feelings of hopelessness: This can make it difficult to see a positive future or find motivation to engage in daily activities.

   • Anxiety or tension: This often includes feelings of being on edge, nervous, or experiencing panic attacks.

   • Sudden mood swings: Rapid changes in mood can occur without clear triggers, making emotional regulation challenging.

   • Increased sensitivity to rejection or criticism: This can lead to heightened emotional responses to perceived slights or negative feedback.

2. Behavioral and Cognitive Symptoms:

   • Difficulty concentrating: This can affect the ability to complete tasks, affecting performance at work or school.

   • Fatigue or lack of energy: This can be overwhelming, making even simple tasks feel exhausting.

   • Changes in sleep patterns (insomnia or hypersomnia): Difficulty sleeping or sleeping too much can further exacerbate fatigue and mood symptoms.

   • Overeating or specific food cravings: These cravings often focus on sugary or carbohydrate-rich foods, which can impact overall health.

   • Decreased interest in usual activities or social withdrawal: Activities that were once enjoyable may lose their appeal, leading to isolation and loneliness.

3. Physical Symptoms:

   • Chest tenderness or swelling: This can cause significant discomfort and pain.

   • Headaches or migraines: These can be severe and debilitating, often coinciding with other PMDD symptoms.

   • Joint or muscle pain: This can make physical activity challenging and increase overall discomfort.

   • Bloating or weight gain: This can affect body image and self-esteem, adding to emotional distress.

   • Gastrointestinal issues such as constipation or diarrhea: These symptoms can vary but are often disruptive to daily life.

Intersectional Perspectives

The diagnostic criteria for PMDD, like many other medical conditions, are largely based on a white, cisgender model of medicine. This narrow focus can result in underdiagnosis or misdiagnosis for individuals from diverse backgrounds. Understanding PMDD through an intersectional lens involves considering how race, ethnicity, gender identity, and socioeconomic status can impact the experience and recognition of symptoms.

1. Cultural Variations:

   • Cultural beliefs and practices: These can influence how symptoms are expressed and perceived. For instance, in some cultures, discussing menstrual-related issues may be stigmatized, leading to underreporting of symptoms and reluctance to seek help.

   • Cultural expressions of distress: Different cultures may have unique ways of expressing psychological and physical distress, which may not align with Western diagnostic criteria.

2. Racial and Ethnic Disparities:

   • Barriers to healthcare access: Individuals from marginalised racial and ethnic groups often face systemic racism, language barriers, and cultural misunderstandings that hinder access to accurate diagnosis and effective treatment.

   • Mistrust in medical systems: Historical and ongoing discrimination in healthcare can lead to mistrust and hesitation to seek medical help, impacting the diagnosis and management of PMDD.

3. Gender Identity and PMDD:

   • Transgender and non-binary experiences: Transgender and non-binary individuals AFAB may experience PMDD, but their symptoms can be overlooked or dismissed due to biases in the healthcare system. It's crucial for healthcare providers to approach PMDD with sensitivity and inclusivity, ensuring that all individuals receive appropriate care regardless of their gender identity.

   • Hormonal treatments: Hormone therapy for gender transition can impact menstrual cycles and PMDD symptoms, necessitating specialized care and understanding from healthcare providers.

4. Socioeconomic Factors:

   • Economic barriers: Lower socioeconomic status can limit access to healthcare providers knowledgeable about PMDD, leading to delays in diagnosis and treatment. Financial constraints can also restrict access to medications and therapies that could alleviate symptoms.

   • Work and family stressors: Socioeconomic challenges can amplify the stressors that exacerbate PMDD symptoms, creating a cycle of increased distress and reduced ability to manage symptoms effectively.

Recognising the Need for Inclusive Diagnostic Criteria

The current diagnostic criteria for PMDD, as outlined in the DSM-5, focus on a specific set of symptoms that may not encompass the full range of experiences for all individuals. To provide effective care, healthcare providers must consider a broader spectrum of symptoms and experiences, recognizing that PMDD can manifest differently across diverse populations.

Approaches to Management and Treatment

Effective management of PMDD requires a comprehensive approach tailored to the individual's unique needs and circumstances. This may include:

1. Medical Interventions:

   • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) can be effective in reducing mood-related symptoms.

   • Hormonal Treatments: Birth control pills or hormone therapy can help regulate menstrual cycles and alleviate symptoms.

   • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): These can help manage physical symptoms such as pain and headaches.

2. Lifestyle Modifications:

   • Diet and Nutrition: A balanced diet rich in whole grains, fruits, vegetables, and lean proteins can help stabilize mood and energy levels. Reducing intake of caffeine, sugar, and alcohol may also be beneficial.

   • Exercise: Regular physical activity can improve mood and reduce symptoms of depression and anxiety.

   • Sleep Hygiene: Maintaining a consistent sleep schedule and creating a relaxing bedtime routine can improve sleep quality.

3. Psychological Support:

   • Support Groups: Connecting with others who have PMDD can provide emotional support and reduce feelings of isolation.

   • Mindfulness and Stress Management: Techniques such as meditation, yoga, and deep breathing can help manage stress and improve overall well-being.

Conclusion

Understanding the symptoms of PMDD is essential for proper diagnosis and management. Acknowledging the intersectional factors that influence the experience and recognition of PMDD can lead to more inclusive and effective healthcare. By considering the diverse backgrounds and identities of individuals living with PMDD, healthcare providers can better address their needs and improve their quality of life.

Progressive Therapeutic Collective (PTC) is committed to providing compassionate, inclusive care for individuals with PMDD. We recognise the importance of an intersectional approach and strive to ensure that all clients receive the support and treatment they deserve.