When Premenstrual Dysphoric Disorder drives your mood swings...

Are you feeling overwhelmed and out of control? It could be a case of Premenstrual Dysphoric Disorder that could be triggering your anxiety, stress and insomnia, writes Dr Vihan Sanyal

It’s sad how women exhibiting snappy or irritable behaviour are often believed to be PMSing! Only women who have PMS symptoms know how debilitating and frustrating the condition can be. Stress and negatively charged living conditions do play a major role in certain gynaecological conditions like PMS and PMDD. In fact, even endometriosis and uterine fibroids have a direct correlation with a woman’s emotional state and overall mental health. An independent study has found that the likelihood of mental disorders like anxiety, phobia and depression are much higher in women with premenstrual conditions.

So what is Premenstrual Dysphoric Disorder (PMDD) and how does it affect one’s mental health. The condition has been given special importance in the Diagnostic and Statistical Manual of Mental Disorders as a depressive disorder. We know that fluctuations in hormonal levels (oestrogen and progesterone) affect neurochemicals like serotonin and dopamine. Neurochemicals are responsible for cognitive functions and mood regulation. A considerable portion of women who are being treated for PMDD has underlying mental health conditions. It is imperative for women to get evaluated by mental health professionals to ensure that they have been correctly diagnosed and are receiving the medical treatment required.

Many women are aware of PMS (Premenstrual syndrome), however, very few are aware of a condition called PMDD or Premenstrual Dysphoric Disorder which is a severe form of premenstrual syndrome. PMDD usually affects women in their reproductive years, typically in their twenties and tends to last until menopause. The exact cause of PMDD is unknown. We do know that genetics and family history of PMDD and disturbed menstrual cycles do play a significant role in someone being diagnosed with the condition.

PMDD has a few distinct features which help with clinical diagnosis. For someone to be diagnosed with PMDD the symptoms need to be present a week before the onset of menses, interfere with daily life and symptoms go away within the first few days of the flow. The symptoms in other mood disorders are more constant and are not cyclical in nature. This is a major differentiating factor in diagnoses of PMDD over other mental health conditions. In addition to this, they must exhibit five psychological symptoms: Spike in anger/irritability, elevated levels of anxiety and stress, the onset of sadness and hopelessness, uncontrollable mood swings, sense of feeling overwhelmed and lack of control, insomnia and sleep disturbances, difficulty in focusing and lack of concentration, disturbance in appetite, fatigue. Patients also complain of other physical symptoms like breast tenderness, swelling, joint pain, bloating and headaches. Weight gain has also been associated with this condition in certain cases.

Studies have found that women diagnosed with PMDD had co-occurring personality disorders than women who do not have PMDD. A study showed one-third of women with PMDD had symptoms of borderline personality disorder. Psychiatric indicators of PMDD are not only limited to mood symptoms but also include anxiety and panic. Once we have correct diagnoses of the condition, we can explore treatment options available. Many doctors and professionals ask women with PMDD to maintain a mood diary. Women who maintain a mood diary during their cycles are more aware of the relationship between their cycle and shift in mood. This information also helps the clinician during treatment.

As most menstrual and female reproductive disorders are affected adversely by emotional stress, it’s best to focus on various de-stressing activities during the course of the treatment. Psychotherapy offers a variety of tools that help improve mental health including counselling, Cognitive behavioural therapy (CBT) and Hypnotherapy. It is crucial to impart coping skills in ways of breathwork (breathing techniques), lifestyle changes and deep relaxation exercises to ensure they have greater control over their stress levels and relief from symptoms of PMDD. Here are five things everyone should do on a regular basis to de-stress:

Breathing exercises: There are some easy and effective breathing techniques that one can learn and should practice on a daily basis.

It’s best to start and end the day with breathwork. Breathing exercises promote relaxation and when practised on a daily basis can help reduce anxiety and stress.

Outdoor time: Going for regular walks in the open or playing outdoor sports can drastically reduce stress levels and promote sound mental and physical health.

Neurochemicals get a boost with every physical activity and this often acts as a natural anti-anxiety and anti-depressant.

Play with pets: If you are fond of animals, then you should spend time with pets and play with them as that relaxes and helps in de-stressing.

Pamper yourself: Treat yourself at every opportunity. Don’t be too hard on yourself. Don’t wait for others to pamper you, pamper yourself!

(The author is a psychotherapist.)