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Premenstrual Dysphoric Disorder: the menstrual-related mood disorder that’s more than just ‘bad PMS’

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We’re all familiar with PMS.

80% of women experience some form of physical or emotional symptoms just before their period starts. However, around 5-10% of women, experience what is known as Premenstrual Dysphoric Disorder or PMDD – a mood disorder that requires treatment to alleviate symptoms.

For these women, the week before their period marks the onset of symptoms so severe that getting on with daily life is impossible. These tangibly different yet similarly presenting conditions cause PMDD to be often confused for ‘severe PMS’. But, where PMS is uncomfortable or annoying, PMDD is debilitating.

PMDD was included in the Diagnostic and Statistical Manual of Mood Disorders as a ‘depressive disorder’ – just six years ago. Since then, the existence of the condition has been gaining awareness amongst women and the medical community. However, that PMDD is not widely spoken about or recognised means that more conversations and research into the condition are needed.  

PMDD often being described as ‘PMS on steroids‘ or ‘severe PMS’ signifies the possibility for accidental ignorance toward the condition.  When women are led to think of their incapacitating symptoms as ‘just PMS’ they may feel that their experience is ‘normal’.  The result of conflating symptoms causes many women wait to seek help until they reach their ‘breaking point’. By this time, women suffering from PMDD describe that their relationships, work and daily life have been significantly impacted.

How it impacts an individual’s life:

Gogglebox Australia’s, Isabelle Silbery, recently penned a deeply personal article recounting her feelings of desperation and frustration prior to being diagnosed with PMDD.

via Instagram: @IsabelleSilberry

Detailing an upsurge in arguments with her family accompanied by bouts of worthlessness, doubt, and despondence toward exciting things in her life – Isabelle called out for greater awareness and education for women regarding their cycles and the boundaries of what should be considered ‘normal.’

It was relentless. I hated myself, I hated my partner, I hated everything.

Isabelle says that her revelatory diagnosis stemmed from her mum, fortunately, catching a radio segment on triple R discussing a newly recognised disorder that bore markedly similar symptoms to her own.

Finding a printout on her pillow, she read about PMDD and was shocked and relieved to find she ‘ticked every box.’  Paranoia, fatigue, sensitivity – experienced only between ovulation and getting her period. Suddenly, Isabelle felt empowered – she wasn’t ‘going mad’ – there were answers.

Upon seeing a new specialist (who told her undoubtedly, she was experiencing PMDD) – Isabelle recalled asking:

Here I [am], 36 years old, having [had] my period for years now and birthed one child. How the hell did it take this long to figure it out?

Her doctor, Dr Lee Mey Wong from the Jean Hailes Clinic for Women’s Health, explained that ‘women who suffer from PMDD have what’s called a ‘vulnerable brain’, meaning they may have suffered some trauma in their formative years. This vulnerability can lead the brain to be acutely sensitive to the by-product of progesterone – a hormone the body makes every cycle. This sensitivity contributes to the onset of symptoms that characterise PMDD.

In the process of learning about herself and her body, Isabelle found there was a lot more about periods, cycle phases and women’s health, in general, that she wasn’t across – prompting her to question: 

Why aren’t we educated around our cycles more as young girls? Being told you get your period and to use a pad or tampon is not enough.  

Isabelle’s message was simple: women are often made to feel crazy when they feel something is wrong. Yet we know ourselves better than anyone, and we’re usually right.  Information is power, and we need to empower ourselves and each other to assert control over our bodies. It is time we all prioritise our health and stop our silent suffering. To do this we have to stop demonising our hormones and periods.

A UK-based journalist, Jenny Haward, also shared her story of figuring out she suffered from PMDD. For her, the early years of getting a period were characterised by some ‘mild bloating’ and an ‘off chance that [she] might shed a few tears over a not-particularly-sad film’ with 48-hours of light bleeding to follow.

But, by her 30s, this had changed. Haward describes that being someone who had never tracked their period, it took her a while to make the connection that what she had begun to term ‘the dark week’ was linked to her cycle.

‘The dark week’ would bring tingling in her extremities, bloating of her stomach and hands and what she terms the ‘PMDD hangover’ – Non-alcohol related but reminiscent of the hazy, sick feeling you get after a few too many, tinged with ‘The Fear’.

Haward describes the week before her period as charged with anxiety that pulsated through her, hyper-fixation on worries and exacerbated by insomnia – leading to fights with friends and terror toward work projects. But, as soon as her period arrived – she’d snap out of it.

Significantly, for Haward and many other women coming forward sharing their story – it took until the day she had to leave work, so ‘overwhelmed with misery and inability to function’ to call a doctor for an emergency appointment.

Haward wanted her story to reach women like herself and tell them: ‘there is help – you’re not making a fuss, or crazy or an awful person, and most importantly, you are not alone.’

PMS or PMDD?:

from Share the Dignity

Lynda Pickett, the Australian Project Coordinator for ‘Vicious Cycle: Making PMDD Visible‘, explains that PMS is an average onset of physical and sometimes mild emotional symptoms and typically doesn’t cause any life disruption.  On the other hand, PMDD is characterised by severe, life-impairing emotional symptoms that last 1-2 weeks before menses onset.

Recognising this difference between PMS and PMDD is crucial to understanding the significance of the disorder. While 1-2 weeks may sound manageable, when you factor in these symptoms occurring every month, every year – you can begin to get a clearer picture of the rollercoaster of emotion and life instability that sufferers face.

Symptoms:

Kin Fertility list the 11 symptoms of PMDD as the following:

  • Mood changes
  • Irritability or anger
  • Depression
  • Anxiety
  • Lack of interest in things you usually enjoy
  • Difficulty concentrating
  • Fatigue
  • Change in appetite
  • Insomnia
  • Feelings of being overwhelmed
  • Bloating and breast soreness

Experiencing five or more of these symptoms in a life-impacting way mean that you may meet the diagnostic criteria for PMDD.

What is it? Why do we need to talk about it?

PMDD Cycle – Buoy

PMDD is a disorder that sits between psychiatry, gynaecology and other mimicking conditions—making getting a diagnosis a lengthy process due to the necessity to rule other possibilities out.

In Australia, the average ‘lag to diagnosis’ can take eight years.

This lag is in part due to the experience of having symptoms downplayed by doctors as ‘just PMS’. This dismissal often requires a necessary determination on the part of the individual to challenge what they are being told.  Due to many doctors being unfamiliar with the condition, a referral is often necessary, or the individual has to search for answers themselves.

Lynda Pickett shared significant statistics relating to the number of people affected by PMDD:

Treatment:

Although there is no ‘cure’ for PMDD, there is a range of treatments available to help manage the symptoms.

Several medical therapies are effective, including antidepressants (SSRIs) which surveys show have provided relief to 75% of sufferers.

Oral contraceptives are also routinely prescribed to treat PMDD. Due to the pill’s interference on ovulation and the production of ovarian hormones, the pill can give greater control over the menstrual cycle and therefore reduce the severity of symptoms.

Further, many women report that additional things like reducing caffeine and alcohol intake and taking supplements such as magnesium, calcium and B6 can help. As well as making lifestyle changes in the lead up to their period in particular, such as more exercise, sleep and generally taking it easy, can make a significant difference.

Support:

Joining PMDD support groups can also give sufferers a much-needed sense of community and connection when coming to terms with their diagnosis and managing their symptoms on a day-to-day basis.

Lynda Pickett says she ‘doesn’t know where she’d be without her PMDD Peeps‘, the group name shared by her fellow PMDD community.  The hashtag ‘#PMDDPeeps’ is widely used across Instagram and Twitter to connect sufferers with PMDD.

Facebook groups for individuals with PMDD, partners, post-op groups or child-free women are also widely available. These groups exist to give and receive support from people who are in the same boat.

Other great resources and groups who are bringing people with PMDD together include:

www.viciouscyclepmdd.com = a patient-led project that is focused on raising awareness and raising the standard of care for those living with PMDD.

www.iapmd.org = A global charity that offers peer support, education, research and advocacy.

www.mevpmdd.com = a PMDD symptom app.

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When Healthy Eating Becomes a Disorder

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The media has always promoted weight-loss and the latest diets, and now social media provides a platform for the health industry to constantly expose us to marketing of diets and “health” products. As strict eating and exercise routines are normalised, body shame and eating disorders are developing.

Orthorexia? Many of us have never heard of it. But Orthorexia Nervosa is an eating disorder that involves an unhealthy obsession with eating healthy, and it is thriving in the age of health, diet culture and social media.

A person who suffers from orthorexia obsesses over defining and maintaining the “perfect diet,” and fixates or avoids particular foods, such as sugar or carbohydrates. The condition involves strict food avoidance, sometimes to the point that a person will consume fewer than 10 foods per day.

Some people with orthorexia avoid many foods, including fat, sugar, salt, animal or dairy products; certain ingredients they deem unhealthy. Alternatively, they may strictly eat only ‘fats’ (keto), paleo, ‘raw or uncooked’ products. If a person with orthorexia believes ‘fat’ is the evil ingredient that must be excluded, they will strictly adhere to this rule. If paleo is the ideal diet, they will follow it religiously. What begins as healthy eating leads to inflexible food planning, studying ingredient lists and rules, and evolves into a serious risk to health.

While going ‘paleo’ or ‘keto’ mightn’t sound so bad, and the more we come to understand orthorexia and associated behaviours, the more concerning it becomes. Most of us want to pursue a healthy, nutritious and balanced diet and everywhere we look there is the promise of a new perfect diet – a solution to attaining perfect health. This captures the two biggest difficulties to prevention and treatment of orthorexia in today’s society: identification and responding to the force of diet culture.

How do we tell when someone is suffering orthorexia?

One problem is differentiating between orthorexia and regular healthy eating. Not only is it difficult to diagnose, but it is difficult for people to notice or negatively perceive it in the first place, as there is no clear “point” at which to identify when healthy eating becomes restrictive.

In our current culture, cutting out certain food groups like sugar or fat is commended. We are encouraging of friends and family making positive changes to their diet and exercise routines. Making healthy changes to diet can be beneficial and even life saving. What’s the harm?

Friends, colleagues or family members are always starting a “great new diet,” they are “fasting until midday,” or have “quit sugar.” This is often followed by, “I’ve never felt better!” Who are we to tell them it’s wrong when cutting out certain foods is the norm? Following a popular diet or being vegan does not mean a person needs orthorexia treatment, but as eating disorder specialist’s Timerline Knolls warn, “if you see common warning signs and symptoms associated with dangerous eating patterns, it may be time to step in.”

Fuelled by diet culture, a person suffering orthorexia’s focus on health is what makes it so dangerous. Orthorexia has the same obsessive quality of other eating disorders but it goes unchecked because a person suffering may not be “thin” as a result of their disordered eating patterns. Comparing anorexia and orthorexia, a person suffering anorexia is likely to adhere to strict rules around weight and how much they eat, and a person with orthorexia has rules about what they can and cannot eat. Melbourne based Accredited Dietitian Lauren Kelly says, “if I sat down with a person with orthorexia and they told me what they have been eating, I would be concerned, as they’re not eating what they usually would.”

It was not until the late 90’s that orthorexia was defined and there is still no official diagnosis. But to help distinguish between healthy eating and orthorexia, Bratman and Dunn recently proposed a two-part diagnostic criteria. Firstly, there is an obsessive focus on healthy eating that involves emotional distress around food choice. This can cause compulsive behaviours, preoccupation with dietary choices, anxiety or even shame when dietary rules are broken. Severe restrictions often escalate over time; a diet might become so strict as to eliminate entire foods groups or a juice cleanse might develop into an addiction to ‘cleanses’ or ‘fasts.’

It is sobering to remember the two planes of thought that might be operating when a friend or family member is on a new diet. We might see the person eating healthy, losing weight and hear them speak positively about their new and improved life. What we might not see is the studying of labels and measuring out of ingredients. And what we cannot see is the mental health struggles, negative thoughts and consuming preoccupation that a person with orthorexia is experiencing inside.

This disruption to daily life is the second aspect of the diagnostic criteria. Not only does orthorexia pose medical risks such as malnutrition and complications like hormonal imbalance and bone health linked to eating disorders, but it intrudes on how a person lives their life. A person suffering orthorexia will not live a freely. They will often be engulfed by personal distress and low self-worth, leading them to become socially isolated.

Diet Culture and Social Media

Perhaps the biggest concern is how to mitigate against eating disorders like orthorexia operating in a world of diet culture. When we open Instagram, we are saturated by hundreds of accounts and images of celebrities and influencers showing us the new diet they are following. Understanding orthorexia is difficult without a clear diagnosis or wide recognition in society. But if you speak to any dietitian or nutritionist, they probably know all about it.

Lauren Kelly’s biggest concern is social media. Kelly states that the dietetics industry never used to see it as a problem, but have now realised how prevalent diet culture is, “imagine a 16-17 year old watching everything an influencer or celebrity is doing and eating on social media.” With the force of diet culture it is hard to imagine issues with comparison and body image ever go away.

A confronting discovery reveals a higher prevalence of orthorexia in dietitians, nutrition students, exercise science students and yoga instructors. But well-known diet culture expert, and Accredited Dietitian, Christy Harrison is well aware of this problem, saying that the increase in “oppressive diet culture” and “healthism,” provide fertile ground for orthorexia tendencies to form, and it is driven by the health industry, including accredited nutritionists.

The link between social media and negative effects on body image, social comparison and disordered eating is categorical. Instagram is flooded with food sharing, slim waists, big bums and clothes that seem to drape perfectly on figures we are told to envy. Sounds like a perfect storm for impressionable young people, particularly young women. It is no wonder that a 2017 German study found Instagram use is directly linked to symptoms of orthorexia nervosa.

Instagram and the diet industry tell us that if we eat, exercise, look and live a certain way we will be our “best self.” We forget about the selective exposure of images and messages on Instagram, that constantly reinforce the same ideas and images. Influencers are paid to endorse certain clothing and food labels, who further profit from diet culture.

It is easy to feel a little hopeless about the combined impact of the health industry and social media, especially on young women, but there are many positives. The “health at every size” movement is growing among dietitians, nutritionists and celebrities, including models with a lot of Instagram influence. Diet culture remains a force to be reckoned with but powerful movements around body positivity, wellness, self-care, mental health and feminism are fighting back.

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23% of women are more likely to be prescribed antidepressants while on the pill.

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With one in four Australian women on the oral contraceptive pill, few are aware of the link between the pill and mental health conditions.

With more than 100 million women worldwide and one in four Australian women taking oral contraceptive pills, new research is showing a strong link between the pill and mental health decline.

Researchers from the Albert Einstein College of Medicine in New York have conducted a study examining the brains of women taking oral contraceptives.

Research found that women taking the pill had a significantly smaller hypothalamus volume compared to those who weren’t taking this form of birth control.

The hypothalamus is a small region of the brain located near the pituitary gland responsible for producing hormones and regulating essential bodily functions such as moods.

Dr. Michael Lipton, head of the study, concluded that a smaller hypothalamic volume was also associated with greater anger and showed a strong correlation with depressive symptoms.

Depression affects twice as many women as men and it’s estimated one in four Australian women will experience depression in their lifetime.

Since the 1960’s, this tiny hormone-packed tablet has been treated as a miracle pill admired by women who now have the power to plan their periods and pregnancies.

With depression being one of the most predominant and devastating mental health issues in Australia, the prized benefits of the pill no longer outweigh the newly discovered evil it can create.

So what exactly is the pill?

The oral contraceptive pill is a tablet taken daily that contains both estrogen and progesterone hormones. It works by stopping the ovaries from producing an egg each month, preventing it from being fertilised.

The pill is used for many different reasons including; pregnancy prevention, improving acne, making periods lighter and more regular, skipping periods and improving symptoms of endometriosis and polycystic ovarian syndrome (PCOS).

While the pill has many benefits for women, research suggests that it can be linked to causing mental health issues, a detrimental side effect that doctors aren’t telling patients.

Evidence from a large Danish study on links between oral contraceptives and low mood rings alarm bells as 23% of women on the pill are more likely to be prescribed an antidepressant compared to those who aren’t.

The study also found that depression was diagnosed at a 70% higher rate amongst 15 to 19 year olds taking the pill and women between the ages of 15 and 33 are three times more likely to die by suicide if they have taken hormonal birth control.

Medical practitioners are quick to point out the less harmful physical side effects of taking oral contraceptives, yet seem to fail to mention the psychological damage it can trigger to a women’s mental health.

The praised pill has seen doctors handing it out like candy on Halloween to every women complaining of cramps, blemished skin or wanting an ‘easier’ option for birth control.

While medication should only be prescribed when medically necessary to patients, the pill is being prescribed routinely and by default from doctors.

So why are the mental health side effects of oral contraceptives being hidden from unsuspecting patients who are being prescribed them?

Dr. John Littell, a family physician, explains that the side effects of the pill are not often told to patients as they are seen as not important.

“Physicians in training during the past thirty years or so have been taught to find any reason to put women on some form of contraception without mentioning the possible risks associated with these methods.”

This is alarming news as Dr. Littell also mentions that when talking about the side effects, doctors are trained to see them as less of a concern than the overarching “problem” of pregnancy.

“The pill is often prescribed without any sense of hesitation from the prescribing physician, stating risks are viewed as less important than encouraging the woman to take it,” Dr. Littell explains.

Many women are now breaking free from the synthetic hormone cocktail being put into their body daily that is mixing with their emotions.

With research telling us what the doctors won’t, it’s no surprise why the most common reason women now change or stop taking the pill is because of mental health side effects.

Articles written by women titled “Why I’ll never take the pill again” and “My nightmare on the pill” explore firsthand the impact this pill has on women and the decline of their mental state.

Psychologist Sarah E. Hill suggests that almost half of those who go on the pill stop taking it within the first year due to intolerable side effects, with the main one reported being unpleasant changes in mood.

“Sometimes it’s intolerable anxiety, other times it’s intolerable depression, or maybe both simultaneously,”

“Even though some women’s doctors may tell them that those mood changes aren’t real or important, a growing body of research suggests otherwise,” Hill states.

Digital media brand The Debrief has launched an investigation linking mental health to the pill, surveying 1,022 readers between the ages of 18 and 30.

93% of women surveyed were on the pill or had previously taken it and of these women, 58% believe that the pill had a negative impact on their mental health.

45% of women experienced anxiety and 45% experienced depression while taking oral contraceptives.

43% of these women sought medical advice about their mental health, and over half the women believed that doctors did not take their concerns seriously.

With studies revealing the truth and doctors trying to hide it, the alarming facts point to a deadly pill polluting the brains of innocent, unsuspecting women.

While the oral contraceptive pill still remains the most popular and accessible form of birth control in Australia, it should be taken with caution and use should be monitored daily to prevent the occurrence of harmful side effects.

 

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