Do I Have PMDD? Here’s How to Tell and How to Get Help

Increasing our awareness and compassion is the best way to start.

Posted Aug 26, 2020

A few years ago when writing a book on depression in girls and women, I stumbled across the following quote that really captures a woman’s experience of Premenstrual Dysphoric Disorder (PMDD):

Ever have a day when everything in your life is exactly the same as yesterday, but it suddenly feels like the bottom has dropped out? When your psyche feels like a raw wound? That’s what premenstrual dysphoric disorder—or PMDD—feels like. It’s premenstrual syndrome (PMS) to the Nth degree—when your feelings reach debilitating extremes that interfere with your relationships or your ability to function, and sometimes even your desire to go on living. Raymond, 2018

Abigail Keenan/Unsplash
Why it's important to recognize PMDD and get help
Source: Abigail Keenan/Unsplash

While 80 to 90 percent of women experience some type of discomfort during the week or so prior to their periods, these symptoms usually cause no significant disruption to their daily functioning. Common symptoms are both somatic (breast tenderness, bloating, headache) as well as psychological (irritability, depressed mood, anxiety, and social withdrawal). In contrast, about 20 to 30 percent of women experience premenstrual syndrome (commonly known as PMS)—which includes at least one somatic symptom and one psychological symptom that are severe enough to interfere with daily functioning.

Premenstrual dysphoric disorder (PMDD), however, is the most severe of the premenstrual disorders and occurs in approximately 3 to 8 percent of all menstruating girls and women. Premenstrual dysphoric disorder (PMDD) is often misunderstood and even dismissed as frivolous. Yet it is finally being recognized as a chronic, severe disorder that affects millions of girls and women worldwide throughout their childbearing years. Because it can begin up to 2 years after a girl starts to menstruate and continue until menopause, a woman can experience up to 444 episodes of PMDD in her lifetime. This level of distress deserves attention so that women can receive the treatment they need. 

What Exactly Is PMDD?

According to the DSM-5, to meet criteria for PMDD, a woman has to experience at least one of the following four symptoms during the final week before menses onset:

She must also experience one or more of the following, to total five or more total symptoms:

  • Decreased interest in completing usual activities
  • Decreased ability to concentrate
  • Decreased energy
  • Change in appetite
  • Increase in specific cravings
  • Hypersomnia or insomnia
  • Feeling overwhelmed or out of control
  • Physical symptoms such as breast tenderness, feelings of being bloated, or weight gain.

Further, the symptoms should occur in the majority of menstrual cycles during the preceding year. Symptoms must also cause clinically significant distress or interference with daily activities and relationships. This “clinically significant distress or interference” is important to note in that PMDD is quite impairing to girls and women who suffer from it, causing significant distress not only during symptom onset but also as they anticipate the regular occurrence of symptoms each month.

How to Get Help

1. Track symptoms.

Most experts recommend that women who have premenstrual symptoms track their monthly cycles so they can monitor symptoms in order to obtain an accurate diagnosis. There are several tracking apps and monitoring checklists that are very helpful for this process. The International Association of Premenstrual Disorders (IAPMD) recommends Me v. PMDD.  For more information, also visit IAPMD and the UNC Center for Menstrually Related Mood Disorders.

In addition to providing diagnostic information, monitoring can serve as a form of treatment. Knowledge is power—if you know monthly symptoms are likely to occur at a certain time, you can have a plan in place for enhanced self-care.

2. Visit a health care professional.

PMDD is a medical condition, not something that a woman just has to endure. Your physician might prescribe an SSRI (e.g., Prozac, Celexa, Zoloft, Paxil, or Lexapro) or an oral contraceptive pill with a shortened hormone-free period (e.g., Yaz). You might also benefit from working with a counselor who uses a cognitive behavioral therapy approach. Your provider can also provide advice about supplements, nutrition, and exercise habits that can help.

3. Seek positive support. 

This is a time to draw upon your support system. Ask for help during these difficult days each month. Take time for self-care, relaxation, and rest. If additional support is needed, IAPMD also has free peer support sessions and support groups.

4. Prepare for exacerbation of negative thoughts, feelings, and other symptoms. 

There is a strong link between premenstrual disorders and what is known as premenstrual exacerbation (PME), meaning that symptoms of other mental disorders may be exacerbated (increased) for women during the week or two leading up to menstruation. That means that if you already have a negative body image or engage in disordered eating, these symptoms may tend to get worse pre-menstrually.

By staying aware of the exaggeration or distortion of negative thoughts like negative body image, it helps you gain perspective that these thoughts are not thoughts you would choose to have, that they are temporary and that they are not accurate.

5. Reframe the situation. 

Rather than believing “I have to do it all perfectly, all of the time,” let go of perfectionistic thinking and allow yourself some self-compassion. If you know that you tend to judge yourself harshly during this time (due to high anxiety, irritability, and negative thinking) you can say to yourself, “I wouldn’t choose this disorder and it is very difficult sometimes, but I don’t have to let it define my life." You can tell yourself that these thoughts and feelings will end, that you are coping the best that you can and that it is okay for you to take some time for yourself right now until you feel better.

Note: Special thanks to Charlotte Bateman for her inspiration for this blog post. You can visit her work here.

To find a therapist, please visit the Psychology Today Therapy Directory