PMDD is not a mental disorder - it is just severe PMS

Vincent Van Gogh - Sorrow

 The condition PMDD (pre-menstrual dysphoric disorder) is a type of PMS which is much worse than regular PMS symptoms, especially in terms of the emotional symptoms.

According to a peer reviewed article reprinted by the American Academy of Physicians, they describe PMDD as:

In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), PMDD is classified as “depressive disorder not otherwise specified” and emphasizes emotional and cognitive-behavioral symptoms.2  At least five of the 11 specified symptoms must be present for a diagnosis of PMDD (Table 1).¹  These symptoms should be limited to the luteal phase and should not represent amplification of preexisting depression, anxiety, or personality disorder. In addition, they must be confirmed prospectively by daily rating for at least two consecutive menstrual cycles. A symptom-free period during the follicular phase of the menstrual cycle is essential in differentiating PMDD from preexisting anxiety and mood disorders.

This means, PMDD has been given status as a serious mental disorder in the vein of major depression and bipolar disorder and in fact, some scientists believe that some women who experience PMDD are depressed, which is why anti-depressants are prescribed.

There are a number of experts who find fault with this diagnosis of PMDD as a mental disorder, notwithstanding that mental disorders have never been proved to exist (other than major mental illness) and that anti-depressants have been shown to do nothing for people with mild to moderate depression.

The problem as I see it with classifying PMDD as a mental disorder, is that it isnt. It is due to a number of factors being misaligned in the body (nutritional deficiencies, too much stress, no exercise, bad circulation) and these factors together can contribute to worsening of PMDD, yet when these issues are sorted out, the PMDD is completely reduced to manageable levels.

A recent study showed that 20% of women who did the diagnostic survey, met the criteria for PMDD, whereas 4.1% of men met the criteria for PMDD too. The authors of the study then suggested:

Therefore, these data suggest that PMDD may not be a premenstrual disorder per se. PMDD may instead reflect general cyclical changes in mood, and in women sometimes these changes occur during or near menstruation.

A number of other studies have criticised the assessment that PMDD is severe mental disorder, when it is clearly not.

If you have severe PMS-like symptoms that could be thought to be PMDD, check out my articles about what needs to be done and work with your natural health care practitioner to find a better way to manage your symptoms. You are not alone and you do not have to suffer with this problem. Just check with your doctor to make sure there is no underlying disorder (a real one).

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:715–8.
2. Bhatia SC and Bhatia S.  Diagnosis and Treatment of Premenstrual Dysphoric Disorder. Am Fam Physician. 2002 Oct 1;66(7):1239-1249.  Accessed 27 June 2010
3. Callaghana GM, Chacona C, Colesa C, Bottsa J, Larawaya S. An Empirical Evaluation of the Diagnostic Criteria for Premenstrual Dysphoric Disorder: Problems with Sex Specificity and Validity. Women & Therapy, Volume 32, Issue 1 January 2009 , pages 1 - 21 
4. Daw, J. Is PMDD Real? Monitor on Psychology, October 2002, Vol 33, No. 9 . Accessed 27 June 2010
5. Kissling, E. Women, Men and PMDD. Society for Menstrual Cycle Research, 15 October 2009.  Accessed 27 June 2010
6. Nash H, Chrisler JC. IS A LITTLE (PSYCHIATRIC) KNOWLEDGE A DANGEROUS THING? Psychology of Women Quarterly, Volume 21 Issue 2, Pages 315 - 322

PMS has started early for this month, already

PMS has started already this month, early.

I think because I have been rather inactive these past three weeks and have had to deal with a very stressful situation (which I am trying to extricate myself  from), that's most likely causing PMS to start early.

I haven't been active or doing much exercise these past three weeks, because I have been really sick with the flu from just before the start of my previous months' periods and I am only now just starting to get better! It's been a very virulent flu virus that got me and I am still coughing and have sinusitis as well as feel very lethargic and tired.

At the moment, it's just my breasts that feel rather full and heavier than normal and my stomach is bloated out, it juts out when I sit down and that's not normal for me when I don't have PMS.

I don't mind having full, heavy and even painful breasts and the fluid retention that goes on in the rest of my body, but I do not want the emotional symptoms - the anger, irrational thinking, depression, anxiety and everything else that goes with it, to a varying degree, for those days before my periods start.

Last night I did about 15 minutes of exercise - not much, but I didn't have much energy to do more. Today, I did 30 minutes of exercise, so I hope that, combined with eating more fruits and vegetables and taking all my vitamins/minerals, can help to prevent the worst of the fluid retention and other PMS symptoms.  I probably also need to do some meditation too. Maybe I will do some tonight, before I go to sleep, which will be very soon.

PMS and PMDD Causes - Part 1: Nutritional Deficiencies

Researchers state that there is no real known reason why PMS (or PMDD) occurs in some women and not in others. Let me tell you what I think why PMS (and PMDD) occurs (part 1):

1. Nutritional deficiencies
Diet is fundamental to good health. That is the bottom line. If you do not get enough of natural, unprocessed foods, you are doing yourself a total disservice in terms of your health.

If your diet is basically composed of a great deal of processed foods (anything you buy from a store that you do no cook yourself) and you have a lack of fresh vegetables, fruits, wholegrains, seeds, nuts, oily fish such as salmon, trout, then your diet will be deficient in many vital nutrients (vitamins, minerals, amino acids). No amount of supplements will correct this - on one hand you are effectively ensuring your body becomes inflamed and deficient from various nutrients and on the other hand, you try to balance this with supplements, when you need the whole foods for your health.

You need to eat the following foods to maintain good health and to help your body get back to optimal health:

• Vegetables - 7 servings each day and at least 3 of these servings should be dark, green or dark red leafy vegetables (different types of lettuce, kale, spinach, sorrel, broccoli, watercress)
• Fruit - 5 servings each day and try to make sure you eat lots of brightly coloured or dark coloured fruits, such as blueberries, raspberries, dark purple grapes, acai berries, cherries
• Wholegrains - 3-5 servings each day and this means not just bread, but cereals, pasta and noodles too (just make sure they are not saturated with sugar)
  
• Legumes - 1-2 servings each day, this means all types of beans, such as lentils, kidney beans, chickpeas (garbanzo beans)
  
• Fish - 3-4 servings per week of the oily variety, such as salmon, trout, sardines, mackerel, but just make sure you buy the fish labelled as "wild" or "deep ocean" because these fish will have the most nutrients and are less likely to be tainted by heavy metals such as mercury and lead
• Meat - 3 servings per week and only organic, because the non-organic varieties have various chemicals and hormones injected into them, which interfere with your own hormone production and can exacerbate PMS and PMDD
• Nuts & seeds - 2-3 servings per day and try to use organic, raw nuts, unsalted as they provide the most nutrients

You need to eliminate the following foods (or at least severely restrict them):

• Alcohol - too much alcohol has a detrimental effect on the body and is not useful when you have PMS or PMDD
  
• Sugar - many women with PMS and PMDD experience variations in their blood glucose levels and an excess of sugar will make the blood sugar levels spike quickly and fall dramatically, which has a detrimental effect on insulin levels, which are pumped out at great levels to reduce blood glucose levels - eating less foods high in sugar and more natural foods will keep blood sugar levels on an even level and this means that there will be less of an issue prior to menstruation, including a curbing of sugar cravings, which many women also experience at PMS time
  
• Processed foods - any type of food that comes in a packet (other than raw nuts and seeds)
• Take-away foods - any type of meal you buy from a take-away store
• Salt - try to decrease it in your meal, use herbs and spices instead and try to use organic sea salt, which has more minerals in it than normal processed salt

The essential fatty acids in oily fish as well as the nuts and seeds are vital for women suffering from PMS and PMDD. Studies have shown that this essential nutrients is necessary as they are precursors of prostaglandins, which are hormone-like substances that affect women when they have PMS and PMDD. The B vitamins, which are abundant in good quality meat and wholegrains are necessary for women suffering this condition, as they help to reduce symptoms. The magnesium found in many whole foods is a natural muscle relaxant.

PMS Defined

What is PMS?

PMS is defined as a set of symptoms that can occur for anywhere up to 2 weeks before a women menstruates. Yes, two weeks of hell for some women. There are five sub-groups of PMS symptoms, as described below:

1. PMS-P (PMS Pain)
Symptoms - cramps, reduced pain threshold, aches and pains, light or noise intolerance, joint pain.

2. PMS-A (PMS Anxiety)
Symptoms - anxiety, mood swings, nervous tension, irritability, irrational thoughts, jealousy, low self-esteem, inability to cope, insecurity, agitation, crying spells

3. PMS-C (PMS Craving)
Symptoms - sweet cravings, food cravings, headache, dizziness or fainting, increased appetite, fatigue, heart pounding (exaggerated insulin response to carbohydrates), lethargy, excessive thirst, nausea, low blood sugar

4. PMS-D (PMS Depression)
Symptoms - depression, forgetfulness, crying, mental confusion, insomnia, anger, erratic behaviour, clumsiness, crying spells

5. PMS-H (PMS Hyper hydration)
Symptoms - water retention, breast tenderness and/or enlargement, weight gain (more than 1.4kg), swelling of extremities, abdominal bloating, skin problems,

In addition to all these lovely symptoms above, PMS can aggravate pre-existing health conditions, like candida, herpes, allergies and make them a lot harder to manage.

Not all women will experience all the symptoms above every month and even some women that do experience most the symptoms will not experience them exactly the same every month.

PMDD
A very small percentage of women (between 2-9% of women who experience PMS) may have PMDD, where they experience symptoms so severe, they become destructive. PMDD symptoms have some similarity to moderate-major depression and occur in the two weeks before menstruation and subside when bleeding occurs. In addition to the emotional (or mental) symptoms, there are physical symptoms which also occur in the two weeks prior to menstruation and which subside as soon as menstruation starts (or soon after).

To be diagnosed with PMDD you must experience 5 or more of the following symptoms:

Psychological Symptoms

• anxiety and tension
• mood swings
• irritability
• fatigue
• depression
• changes in appetite
• sleep difficulties
• feeling overwhelmed and out of control

Physical Symptoms

• Bloating and breast tenderness

When PMDD is being diagnosed, the focus is usually on the psychological, behavioural, and emotional symptoms than the physical ones. The thing that should be noted, is that in PMDD the symptoms experienced are much worse than in normal PMS.

Anyone that suspects they may have PMDD needs to contact a medical professional to get all the support, advice and treatment required to manage it. Women with PMDD should also realise that it can be alleviated through nutritional means in conjunction with conventional treatment.

References:
1. "The Physicians Handbook of Clinical Nutrition" - Henry Osiecki

2. Vital Health Zone - www.vitalhealthzone.com

3. "You Can Beat PMS" - Colette Harris and Theresa Cheung