Bpd Like Symptoms

[lostsoul]

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Premenstrual Dysphoric Disorder

Last Updated: October 22, 2004 Rate this Article

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Synonyms and related keywords: PMDD, premenstrual dysphoria, late luteal phase dysphoric disorder, LLPDD, depression, labile mood, anxiety, irritability, anger, premenstrual syndrome, PMS, premenstrual tension syndrome, premenstrual distress, menstrual depression, menstrual cramping, menstrual bloating

AUTHOR INFORMATION Section 1 of 10

Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

Author: Thwe T Htay, MD, Clinical Assistant Professor, Department of Internal Medicine, Texas Tech University Health Sciences Center, Midland Memorial Hospital

Coauthor(s): KoKo Aung, MD, MPH, FACP, Associate Program Director, Assistant Professor, Department of Internal Medicine, Texas Tech University Health Sciences Center; John Carrick, MD, Consulting Staff, Department of Psychiatry, Flagstaff Medical Center; Romeo Papica II, MD, Research Associate, Department of Internal Medicine, Texas Tech University Health Sciences Center

Thwe T Htay, MD, is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Editor(s): Ronald C Albucher, MD, Assistant Chief, Psychiatry Service, VA Ann Arbor Healthcare System; Clinical Assistant Professor, Department of Psychiatry, University of Michigan School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; David Chelmow, MD, Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Department of Obstetrics and Gynecology, Tufts-New England Medical Center; Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry, Assistant Professor, Department of Medicine, Froedtert Hospital, Medical College of Wisconsin; and Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA

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INTRODUCTION Section 2 of 10

Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

Background: Premenstrual dysphoric disorder (PMDD) is a diagnosis used to indicate serious premenstrual distress with associated deterioration in functioning. PMDD is characterized by depressed or labile mood, anxiety, irritability, anger, and other symptoms occurring exclusively during the 2 weeks preceding menses. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the symptoms must be severe enough to interfere with occupational and social functioning, as opposed to the more common premenstrual syndrome (PMS). PMDD is a severely distressing and disabling condition that requires treatment.

Hippocrates described a group of conditions that occurred prior to the onset of menses, in which women might develop suicidal ideation and other severe symptoms. In 1931, Frank described 15 women experiencing severe premenstrual symptoms and coined the term premenstrual tension syndrome. Although Frank first described PMS 70 years ago, PMDD is a relatively new concept.

In 1987, the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) included criteria for late luteal phase dysphoric disorder (LLPDD). In the DSM-IV, published by the American Psychiatric Association, the name was changed from LLPDD to PMDD, with criteria that were almost identical to those of LLPDD (only 1 item was added). The DSM-IV included PMDD as an example of a depressive disorder not otherwise specified. In October 1998, a panel of experts evaluated the evidence then available, and a consensus was reached that PMDD was a distinct clinical entity. Subsequently, in November 1999, the US Food and Drug Administration (FDA) Neuropharmacology Advisory Committee supported this concept. Several treatment options for PMDD have been investigated and developed in the past few years.

Pathophysiology: Major theories to explain the pathophysiology of PMDD are the (1) ovarian hormone hypothesis, (2) serotonin hypothesis, (3) psychosocial hypothesis, (4) cognitive and social learning theory, and (5) sociocultural theory.

The ovarian hormone theory hypothesizes that PMDD is caused by an imbalance in the ratio of estrogen to progesterone, with a relative deficiency in progesterone. Based on this theory, Dalton treated her PMS patients with progesterone suppositories in the 1960s. However, recent studies of the level of estrogen and progesterone among women with PMS were inconclusive because of methodological difficulties. The current consensus seems to be that the normal fluctuations in gonadal hormones trigger central biochemical events related to PMDD symptomatology in some predisposed women.

The serotonin theory hypothesizes that normal ovarian hormone function (rather than hormone imbalance) is the cyclical trigger for PMDD-related biochemical events within the central nervous system and other target tissues. PMDD shares many of the phenomenologic features of depression and anxiety states that have been linked to serotonergic dysregulation. Increasing evidence suggests that 5-hydroxytryptamine also may be important in the etiology of PMDD. Decreased serotonergic activity in women with PMDD has also been implied by the observation of reduced platelet uptake of serotonin and serotonin levels in peripheral blood. The sensitivity to perturbations of the central serotonin system in women with PMDD is altered premenstrually. The administration of the serotonin agonist m-chlorophenylpiperazine may induce mood elevation. Agents that transiently diminish serotonin activity have been associated with behavioral changes, including irritability and social withdrawal.

The psychosocial theory hypothesizes that PMDD or PMS is a conscious manifestation of a woman's unconscious conflict about femininity and motherhood. Psychoanalysts proposed that premenstrual physical changes reminded the woman that she was not pregnant and, therefore, was not fulfilling her traditional feminine role. Obviously, proving this theory through scientific evidence is quite difficult.

The cognitive and social learning theory hypothesizes that the onset of menses is an aversive psychological event for women susceptible to PMDD. Moreover, these women might have had negative and extreme thoughts that further reinforce the aversiveness of premenstrual symptoms. They then develop maladaptive coping strategies, such as lability of mood, absence from school or work, and overeating in an attempt to reduce the immediate stress. The immediate reduction of stress acts as a reinforcement, leading to the regular recurrence of symptoms during the premenstrual period.

The sociocultural theory hypothesizes that PMDD is a manifestation of the conflict between the societal expectation of the dual role of women as both productive workers and child-rearing mothers. PMDD is postulated to be a cultural expression of women's discontent with the traditional role of women in the society.

Among the theories described above, the serotonin theory is increasingly popular. Although genetic predisposition and societal expectations may play a role, the strongest scientific data implicate serotonin as the primary neurotransmitter whose levels are affected by ovarian steroid levels. Other neurotransmitter systems that have been implicated include the opioid, adrenergic, and GABA systems.

Frequency:

In the US: Epidemiological studies indicate that as many as 80% of women experience emotional, behavioral, or physical premenstrual symptoms. From 3-8% of women meet the diagnostic criteria for PMDD.

Internationally: PMDD affects 3-8% of women in their reproductive years worldwide, imposing an enormous burden on women, their families, and the health care system. A recent study from India reported a similar frequency.

Mortality/Morbidity: PMDD is a multifactorial syndrome that affects 3-8% of women in their reproductive years and has varying degrees of severity that interfere with work, social activities, or interpersonal relationships.

Race: Although premenstrual clinics are reported to be almost exclusively attended by white women, community-based studies found no difference in the prevalence or severity of premenstrual symptoms between black women and white women. Some isolated reports indicate varying individual symptoms but not the overall prevalence of premenstrual symptoms among different racial groups. Black women tend to have a higher prevalence of food cravings than white women. White women are more likely than black women to report premenstrual mood changes and weight gain. Pain featured most highly in a sample of Chinese women in Hong Kong.

Age: Apparently, women in the late third to middle fourth decades of life are most vulnerable to experiencing PMDD.

[lostsoul]

What is Premenstrual Syndrome?

Premenstrual syndrome (PMS, or Late Luteal Phase Dysphoric Disorder) is a cluster of symptoms, comprising physical and emotional changes, associated with the second part of menstrual cycle. Many women experience some symptoms, but for most women, these changes are minor, cause no severe distress and don't significantly affect social or occupational functioning (APA, 1987).

The essential feature of PMS is a cyclic pattern of severe emotional and behavioral symptoms occurring typically during the last week of the luteal phase and remitting within a few days after the onset of follicular phase (i.e., symptoms begin one week before and remit within a few days after the onset of menstruation). The diagnosis of PMS is not given if the symptoms are not sufficiently severe to cause major social or occupational impairment (APA, 1987).

According to DSM-III-R (APA, 1987), the diagnostic criteria are (the following is a citation):

In most menstrual cycles during the past year, symptoms occurred during the last week of the luteal phase and remitted within a few days of after onset of the follicular phase. In menstruating females, these phases correspond to the week before, and a few days after, the onset of menses. (In non-menstruating females who have had a hysterectomy, the timing of luteal and follicular phase may require measurement of circulating reproductive hormones.)

At least five of the following symptoms have been present for most of the time during each symptomatic late luteal phase, at least one of the symptoms being either (1), (2), (3), or (4):

marked affective lability, e.g., feeling suddenly sad, tearful, irritable, or angry

persistent and marked anger or irritability

marked anxiety, tension, feelings of being "keyed up," or "on edge"

decreased interest in usual activities, e.g., work, friends, hobbies

easy fatigability or marked lack of energy

subjective sense of difficulty in concentrating

marked change in appetite, overeating, or specific food cravings

hypersomnia or insomnia

other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of "bloating", weight gain.

The disturbance seriously interferes with work or with usual social activities or relationships with others.

The disturbance is not merely an exacerbation of the symptoms of another disorder, such as Major Depression, Panic Disorder, Dysthimia, or a Personality Disorder.

Criteria A, B, C, and D are confirmed by prospective daily self-rating during at least two symptomatic cycles (end of quotation).

PMS symptoms may be experienced not only by menstruating women, but also by hysterectomized women who retain ovarian function. The symptoms may begin at any time after the first menstruation, but worst symptoms are usually reported in women between 30 and 40-years old. The risk of PMS increases with occurrence of major hormonal events (puberty, pregnancy, childbirth, tubal ligation, use of oral contraception, hysterectomy) and major stress (Havens, 1991).

According to some reports, 70 to 90% of women have recurrent menstrual problems. However, only 20 to 40% of women report some degree of interference with their usual functioning, and 2-5% are incapacitated by the symptoms.

[lostsoul]

i was just thinking about women and bpd... again...

i get these things all month long (well 6 weeks long cos that's my cycle length) but i do get lots worse before my period

i had never heard of premenstrual dysphoric disorder before and have checked out this place with lots of comments and stuff from women who have it

they all drive their men away, just like bpd women, with their craziness. many report sudden suicidal urges and angry outbursts

just thought it was interesting. i'm not suggesting bpd is really pdd. just interesting that hormones make people crazy and hey, pity the bpd who also suffers from pdd. i'm adding it to my list! i did a test and everything!

[e11ie]

This is something that is really interesting to me, I have noticed that whenever in the past I was sectioned I was always in the middle of a period and though I've had the diagnosis of BPD I've always considered that the majority of my problems are caused by PMT I've had 4 children and never been ill whilst pregnant but it always returns a few weeks after the birth. Where did you find a test for this?

[Barebones]

im lucky now my medication took away my periods but i used to be bad when i had them had it bad all mylife. so interesting article losty

[verbena]

I thought this part was most interesting:

The psychosocial theory hypothesizes that PMDD or PMS is a conscious manifestation of a woman's unconscious conflict about femininity and motherhood. Psychoanalysts proposed that premenstrual physical changes reminded the woman that she was not pregnant and, therefore, was not fulfilling her traditional feminine role. Obviously, proving this theory through scientific evidence is quite difficult.

Either I don't notice, or my symptoms have lessoned - maybe as a result of so much medication, but it's been easier for me in that respect, and I think I'm easier to live with than I was. It's the medication.

Lots of interesting stuff there, Soul.

XXX

Ann

[e11ie]

I thought this part was most interesting:

The psychosocial theory hypothesizes that PMDD or PMS is a conscious manifestation of a woman's unconscious conflict about femininity and motherhood. Psychoanalysts proposed that premenstrual physical changes reminded the woman that she was not pregnant and, therefore, was not fulfilling her traditional feminine role. Obviously, proving this theory through scientific evidence is quite difficult.

I had to smile at that theory cos I've got 4 kids so think I've definitely fulfilled my traditional femine role :P

[Vorpalblade]

that was an interesting read. thakns.

Blade

[Little Creature]

This is curious; I was in Sertraline (Zoloft) and Lamotrigine (a stabilizer). When I started to get better, my shrink told me to discontinue the Sertraline, and so I did.

A couple of months later, (and I'm on the pill, my meds can be teratogenic -potencially causing damage to the embryo), the week before the period and the week during it I was absolutely suicidal, desperate, anxious, self harming, etc.

I phoned my shrink (I really like that guy, too bad he didn't move with me) and we came to the conclusion that inadvertedly we were treating the PMDD with the Sert. and discontinuing it caused a reappearing of the symptoms.

Strange, huh?

[pip]

Just as an aside

Prozac is liscenced for PMDD

[Miko]

My family member has PMS 26 days out of every 30 and it only went away when she was carrying her daughter.

It didn't get treated.

She has a number of times been taken to hospital (or let herself in) during those 26 days.

I doubt she got a suitable antidepressant either.

[dylis]

i was just thinking about women and bpd... again...

i get these things all month long (well 6 weeks long cos that's my cycle length) but i do get lots worse before my period

i had never heard of premenstrual dysphoric disorder before and have checked out this place with lots of comments and stuff from women who have it

they all drive their men away, just like bpd women, with their craziness. many report sudden suicidal urges and angry outbursts

just thought it was interesting. i'm not suggesting bpd is really pdd. just interesting that hormones make people crazy and hey, pity the bpd who also suffers from pdd. i'm adding it to my list! i did a test and everything!

hi lost soul

I got both - pmdd and bpd (together with anxiety/depression and agoraphobia) - although tis difficult knowing where one begins and one ends - just a complete mass of a mess really!! but for the two weeks of pmdd my other problems/symptoms are very severe, where as the other two weeks i can cope better. agoraphobia is extremely bad during pmdd too, i can barely leave the house, where normally im not too bad so long as i stick within my safety zones.

as for the serotonin studies. prozac is now being prescribed to be taken for two weeks of the menstrual cycle and many women have said it helps.

thanks for posting. interesting stuff

dyl xx

[Dawn]

Interesting post lostsoul.

Certainly lots of similarities.

Wonder what the guys think of all this?

[jodi]

I was diagmosed with bpd 6 years ago but was never told!!!!!!!

When my daughter was 5 months old I was raped by a so called mate, as a result i fell pregnant and so had to have a termination.

A few weeks after i found that I was crying for at least 3 weeks of the month and i was a heap. I went to my dr and he said i had a severe case of pms and put me on fluoxetine - prozac.

I didnt think these helped but I had noticed that i had stopped crying all the time.

I obviously fell into a depression about the whole thing and what with other things going on in my life.

i noticed when i was due on i was a mad raging person. I would often feel suicidal and felt like being violent - i am such a gentle person and cant stand violence.

i have never worked out what was causing what with me.

My pmt is very mild now, i am aware of it but am in control of it.

I am also no longer taking fluoxetine but am now taking cilopram - or whatever its called!!!!

Im not sure that we will ever know which is to blame but it scary to get those out of control feelings.

I was like a jekyll and Hyde!!!!

[mort]

Wonderful article.

I was prescribed prozac for pmdd and it helped a bit. Unfortunately I had to stop taking it coz of other side effects. Now I'm in dbt my t always notes down where in my cycle I am because she has seen a link with my bpd behaviours and pmdd.

Thanks to lostsoul for original post and others who have brought it to my attention today.

((((hugs to you all))))

mort x

[pandaprincess]

Jodi: I'm so sorry about all the crap you've endured.

I can identify with the PMT thing: I'm not allowed my moontime anymore cos it made me dangerous! I get a shot of hormone in my arse to stop stuff from happening, and now I'm a lot safer to be around

I'm not naturally a violent person either, so I found it really hard going getting into fights all the time, and not even knowing what had set me off. I dont miss my hormones, but I miss being connected to the cycle. I feel disconnected and amputated from nature I guess...

Prozac made me WILD!

[dylis]

Wonderful article.

I was prescribed prozac for pmdd and it helped a bit. Unfortunately I had to stop taking it coz of other side effects. Now I'm in dbt my t always notes down where in my cycle I am because she has seen a link with my bpd behaviours and pmdd.

Thanks to lostsoul for original post and others who have brought it to my attention today.

((((hugs to you all))))

mort x

Hi mort

Have you tried taking prozac just on the 14 days leading up to your period? Then stopping it until the next cycle? That's what the medical professionals are suggesting now. Maybe then you wouldn't have such a degree of side effects. Some women swear by Agnus Castus too. (I've spent a bloody small fortune though but nothing worked for me )!!

Hugs to you

dyl xx

Jodi: I'm so sorry about all the crap you've endured.

I can identify with the PMT thing: I'm not allowed my moontime anymore cos it made me dangerous! I get a shot of hormone in my arse to stop stuff from happening, and now I'm a lot safer to be around

I'm not naturally a violent person either, so I found it really hard going getting into fights all the time, and not even knowing what had set me off. I dont miss my hormones, but I miss being connected to the cycle. I feel disconnected and amputated from nature I guess...

Prozac made me WILD!

hi panda - this is what im worried about - was on prozac for 7 years and stopped about 4 years ago. now iv just started on them again. i don't want to be a crazy woman again but the depression is killing me. think il take 3 months then start doing the 14 days a month thing.

fingers crossed

dyl xx

[mort]

Thanks again dylis.

I've just started new meds but I'll see what my pdoc says.

Ditto to the small fortune spent on herbal stuff and vitamins.

mort x

[pandaprincess]

My psychiatrist has been considering putting me back on the Prozac. It was the only time in my life when I wasn't actively suicidal... the craziness was the only downside really, and that it turned me totally rampant!

At least if I'm utterly insane then I wont be in any pain :wacko:

[pip]

I am on Prozac too

Not for PMDD(which also has links to blood glucose levels)

I digress, sorry

I have Poly Cystic Ovary Syndrome

- so my ovaries don't play the game like yours!!!!!!!!!

I save a fortune in tampax!!!!!!!

LOL

pip

x

[allpsychedout]

Thank you, lostsoul, for passing on these articles to us! I didn't go through much of it myself, but I did direct one of the new members who is a great friend of mine, to read them. It will prove most helpful to her, I believe!

Just discovered this subforum a couple of days ago actually. It's great! I truly appreciate being able to read articles such as this. :-)

allpsychedout

[celticmyst]

Thanks a lot allpsychedout for telling me about these posts. They ARE helpfull and I recognize a lot because my problems are also mostly after ovulation, and end after the last day of my period. I have 1 good week. B)

[rosealeedawn]

I found this post very helpful. I have BPD and have been charting when I seem to spiral out of control and when my husband and I fight the most and the hardest and it's always 1-2 weeks before my period starts. I feel like a possesed animal! I am paranoid, tired, have insomnia, bad dreams, extreme depression, thoughts of not existing anymore, massive insecurity! Fights with husband that lead to physical and verbal abuse from him and me, self-injury, THE WORKS! It really is like a demon has taken over my brain and body, I'm 33 and it seems to be getting worse with age and maybe due to medication and IUD? I was actually going to make a doctors appointment tomorrow about it. Maybe I'll wait until my first appointment with a psychiatrist and talk to her about it? I don't fancy going on prozac, I felt like a robot that gained loads of weight, but am willing to try anything at the moment because it does interfere with any work or social life I have and most importantly my marriage. I just moved from California to live in England with my English husband of 3 years. I feel so much more stable and mentally calm since I've gotten here and feel like my BPD is much more managable, a feeling I thought I would never have while in California (drug abuse, highs and lows, loads of insecurities and paranoia's.) But then it hits...bloody PMS! I am so relieved to hear that there are other women that go through the same nightmare I do and will be finding EVERYTHING I can about this subject and diagnosis. Thank you!

[InnerPeace]

PMS, coffee and alcohol are the things that tip the balance for me. They all create that extra strain and affect our brain chemistry. Bread made with white flour and other processed foods don't help either.

[rebeccaborderline]

Ive checked many times, but can see no correlation between my moodswings and my cycle....

Alcohol a definate no-no though, and coffee sends me nuts

rebeccaborderline