Premenstrual Dysphoric Disorder affects only 3-8% of women. It is a severe form of Premenstrual Syndrome or PMS. Almost all women suffer some kind of symptoms when their menstrual period is due. They may become snappy and grumpy, they may deal with cramps, backache or tender breasts, however, PMS sufferers can manage these symptoms effectively and their lives are not disrupted by their menstrual period.
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PMDD sufferers experience many if not all possible physical symptoms, but the distinguishing factor of PMDD is the extreme swings in mood and how they feel about themselves and others.
PMDD is a cyclical disorder. It will affect a woman every single month. Most ladies with PMDD will experience physical discomfort and emotional changes that begin around a week before their period, lasting till bleeding commences. However, due to being sensitive to hormone changes, some women experience symptoms during the ovulatory phase of their cycle too.
It is thought that a women with PMDD is more sensitive to the body's naturally changing hormones. It is also thought that these changes can bring about a drop in serotonin in the brain, which can cause a number of unpleasant symptoms. Serotonin is the body's natural feel good hormones, and many PMDD sufferers experience symptoms of low serotonin.
Physical changes and symptoms can include the following:
Abdominal cramps, period pain, backache, hip pain, tender breasts, nausea and sickness, lethargy, fatigue, insomnia, changes in appetite, sensitivity to sound and smell, headaches, memory loss, bloating, loss or boost to libido and weight gain.
Emotional changes and symptoms can include:
Markedly depressed mood, feelings of hopelessness, heightened anxiety, increased tension, sudden shifts in mood, tearfulness, overly sensitive, persistent angry or irritable outbursts, increased personal conflicts, frustration, panic attacks, persecutory delusions, racing thoughts, feeling overwhelmed or out of control, indecisiveness, and confusion.
Loss of interest in usual activities, unable to think clearly to make simple decisions, cancelling outings or events, hiding indoors and avoiding contact with others, damaging relationships via texts, online or verbally, losing friends, being unable to cope with usual tasks or requests, difficulty in keeping employment, difficulty focusing on studies or work.
An important note on Dysphoria.
PMDD is distinguished from PMS by the use of the word dysphoric. PMDD sufferers often describe their symptoms as a feeling of 'going mad' or 'going insane'. They feel out of control of their emotions and find their minds full of racing negative thoughts. Some say it feels like being possessed and many women will describe themselves as Jekyll and Hyde.
The dysphoria element is often overlooked yet is one of the hardest things for a woman to deal with. For a certain amount of days or weeks out of the month right before their period and/or around ovulation, a PMDD sufferer will experience a complete shift and change in being.
Dysphoric states bring about a complete change in perception for the sufferer. They may believe they are being persecuted in some way. That friends and family are fed up with them and dislike them. They may feel panic over not being believed or understood. They feel a great amount of frustration that despite whatever attempts they made during the rest of the month to 'help themselves get better' the feelings and depression are back, with full force and they are yet again caught up in the whirlwind of dysphoria.
A women with PMDD is faced with an eternal cycle of symptoms. The PMDD 'episodes' or 'states of dysphoria' will turn up without fail every month. The only thing that seems to change is the severity. Some months will pass without too much damage to relationships, work or the self, but other months will be explosive and destructive, to the sufferer and those around them.
How do you know if it's PMDD and not something else like depression?
PMDD is characterised by is cyclical nature and the fact that for at least 7-10 days of the month between periods, the woman has no symptoms. They are, for want of a better word, 'normal'. Many women call this their 'good' days or 'up' time. They can maintain relationships, cope with life, home, kids, and work. They are confident, happy and organised. They feel normal, stable and able to cope. They can go out and socialise, answer the phone and participate online. They have a clarity of mind to know what they want and can make decisions again. It really is like a black cloud has lifted and they are able to function normally again.
Depression will not lift in this way. If you suffer from depression, every day is a 'down' day or 'downtime'. PMDD sufferers may experience depression during their 'down' days, but it is a feeling that always lifts, and relief is found.
PMDD is often misdiagnosed as bi-polar disorder due to the extreme changes in mood. Bi-polar sufferers may suffer a couple of episodes a year of extreme up's or downs. These episodes can last months, but when the Bi-polar sufferer becomes stable again they are able to maintain a 'normal' life, sometimes for months, between episodes. The closest form of Bi-polar to PMDD is rapid-cycling Bi-polar, where the diagnosis is for 4 or more episodes in a year. PMDD sufferers don't get a few months between down times, they suffer every month, 12 times a year, double that if they are affected at ovulation as well.
If there is underlying depression or mental health problems, you may then experience PME, Premenstrual Exacerbation. This is a worsening of your current condition due to and during the changes in the menstrual cycle.
Basically, if you feel fine for at least 7-10 days of the month and you have no symptoms, no mood swings, no negative effects to your life, yet a week before menstruation you sink into a depression, find your self anxious and unable to leave the house, or angry with volatile outbursts, then you are probably suffering PMDD. PMDD will lift once your period starts. Some ladies will get relief right from day 1, where as some will find the black cloud lifts on day 5 or 6. One thing is for sure, all the crazy feelings and emotions will pass, and most women just hang on for dear life until their period has ended and they are back into a couple of weeks of feeling stable and happy.
I think I have PMDD, how do I get my doctor to give me a diagnosis?
For PMDD to be diagnosed, you will need to be experiencing at least 5 of the above symptoms every month. They may not always be the same symptoms every month, but currently, the diagnosis is for a combination of at least 5 symptoms. These symptoms have to be extreme enough to interfere significantly with daily life, work, relationships, studies or social activities.
You will need to chart your symptoms for at least 2 months. Charting means keeping a track of all your symptoms throughout the month to build up a picture of your up and down times. If you have PMDD you will be able to see an obvious rise in symptoms during the last part of your cycle, and maybe at ovulation.
You can find mood charts online that you can download and print off. Some websites allow you to track symptoms online, and there are many iPhone and Android apps for keeping track of your cycle. How ever you do it, make sure you can take an actually paper copy in with you to your GP. For me, printing off a chart and filling it in worked better. Simple and not usually anything more that colouring in or ticking boxes.
Visit your GP, and take along some print outs about PMDD. There are many GP's who have still never heard of PMDD. That doesn't mean that they wont want to help, so it's always worth helping your doctor get you the right diagnosis. Start a chart as soon as you can, as you will need 2-3 months worth for your doctor to diagnose you correctly.