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PMDD: Suicidal thoughts are the order of the day

A third of women with premenstrual dysphoric disorder attempt suicide. You can read here why the disease is underdiagnosed.

A recent study published in the journal BMC Psychiatry published reports that 34% of people with premenstrual dysphoric disorder (PMDD) attempt suicide. The study is the largest of its kind examining the suicidal thoughts and behaviors of people diagnosed with the disorder. The diagnosis can currently only be made on the basis of a daily symptom assessment by medical staff.

Independent of other disorders

Because previous studies of suicide and suicidal ideation relied on less valid self-reports about premenstrual dysphoric disorder, the new results provide the strongest scientific evidence to date that the disorder is likely an independent contributor to suicidal thoughts and actions.

“We found an extremely worrying rate of suicidal ideation and attempt among people with PMDD. This underscores the need to take this issue seriously,” said Tory Eisenlohr-Moul, assistant professor of psychiatry at the University of Illinois Chicago and lead author of the study. “These results provide powerful evidence that the link between PMDD and suicide is independent of depression, post-traumatic stress disorder, or other mental illnesses — known to promote suicidal thoughts and attempts.

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Mental and physical symptoms are unbearable

PMDD is a cyclical, hormonal disorder that affects approximately 1 in 20 women of reproductive age. The condition is often underdiagnosed, misdiagnosed, or dismissed altogether by healthcare professionals, despite patients reporting debilitating anxiety, hopelessness, and a variety of physical symptoms for up to two weeks before menstruation.

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To better understand PMDD, researchers analyzed information from the Global Premenstrual Disorder Survey, which included 3,153 people from over 56 countries. Analysis of responses from 599 respondents who reported a previous diagnosis of PMDD by a healthcare provider based on daily assessments (23% of respondents) found that 34% had attempted suicide during an episode of PMDD. On average, patients visited 6 doctors over 12 years before receiving a PMDD diagnosis.

The data also showed high rates of lifelong active suicidal ideation (72%), planning (49%), intention (42%) and preparation (40%) to attempt, and non-suicidal self-harm (51%) in patients with PMDD diagnoses . Low-to-middle income, a history of major depression or post-traumatic stress disorder, and nulliparity were predictors of lifelong active suicidal ideation and attempting. Older age and borderline personality disorder were other predictors of lifetime attempts.

Interaction with psychological diagnoses

Rates of self-harming thoughts and behaviors were also broken down between those who had a PMDD diagnosis alone and those who received at least one additional mental health diagnosis. Even among those who had never received any other mental health diagnosis, rates were high: 67% reported active suicidal ideation, compared to 74% who also had a psychological comorbidity.

Eisenlohr-Moul would have expected a much larger difference between the categories. She says the data suggest that women who are neurobiologically sensitive to hormonal changes, as is the case with PMDD, are at increased risk for suicidal thoughts and behaviors.

“One of the great challenges with PMDD is that the medical community not only does not seem to understand this condition, but simply does not believe in its existence,” says the lead author. “Physicians often dismiss patients’ concerns, partly because women’s ailments are taken less seriously than men’s, but also because of persistent and even sexist stigma and misconceptions about menstruation in general.”

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PMDD needs to be taken seriously

“PMDD is not a hormone imbalance. It is a neurobiological sensitivity to natural and normal changes in progesterone and estrogen levels,” explains Eisenlohr-Moul.

“Our study shows how devastating PMDD can be,” said Sandi MacDonald, co-founder and executive director of the International Association for Premenstrual Disorders. Although PMDD has been included as a major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders since 2013, there is still no recommended standard screening for suicidal ideation in patients with this condition.

This article is based on a press release from the University of Illinois, Chicago. We have the original publication for you here and linked in the text.

Image source: Sasun Bughdaryan, unsplash

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