Menstruation is a phenomenon which every female goes through. The mood swings, the hormonal changes that it causes during the whole menstrual cycle is drastic yet bearable for most of the woman, but for some woman these symptoms of hormonal changes can be unbearable, unusual and cause clinically significant distress in their lives, in order to highlight and provide credibility to the woman facing these issues a righteous step has been taken by the Diagnosis Statistical Manual of Mental Health with the inclusion of Premenstrual Dysphoric Disorder, adding to the menstrual disorders.
What is a Dysphoric Disorder?
Lateral luteal phase dysphoric disorder renamed as Premenstrual Dysphoric Disorder is a dysphoric disorder which means that the person experiencing it is in a state of continuous unease and has recurrent feelings of dissatisfaction, these feelings when observed in a severe form under premenstrual syndromes during the luteal phase of a female’s menstrual cycle, i.e. the time between the ovulation and beginning of the period, might cause a possibility of this disorder.
Why is the inclusion of PMDD in DSM important?
The inclusion of this disorder in DSM, is based on the Mood disorder work group for DSM V where a panel of experts in women’s mental health participated to evaluate the previous criteria for premenstrual dysphoric disorder. It was assessed whether there is sufficient empirical evidence to support its inclusion as a diagnostic category, and commented on whether the previous diagnostic criteria are consistent with the additional data that have become available. This work group consisted of specialists who had expertise in premenstrual dysphoric disorder or reproductive mood disorders. There has been a debate upon the inclusion of a disorder that is very largely associated with mood disorder and has large possibilities of comorbidity with Mood disorders of DSM, so what is the point of creating a whole new disorder criteria?
The point is the evidence and the differences in the cluster proposed in the diagnosis of this disorder, Premenstrual Dysphoric Disorder is characterized by mood lability and irritability, i.e. extreme change of strong emotions (e.g. uncontrollable crying or laughing),while one can say this is a mood disorder only, but that’s not the appropriate concept for it as mood disorders often are concerned with depressed mood, diminished interest and pleasure while in PMDD, the pattern of predictable symptom onset and offset with phases of the menstrual cycle remains a key feature distinguishing premenstrual dysphoric disorder from other cyclic mood disorders(e.g. bipolar disorder). Other than that physical symptoms such as bloating and breast tenderness are both unique and among the most frequently reported premenstrual symptoms in women suffering from premenstrual dysphoric disorder. These highlighted evidence mark PMDD as a disorder that needs to be addressed differently and individually thus marking relevance on it’s distinct diagnosis.
The DSM Criteria for PMDD
Inclusion of PMDD clearly ends the debate on topics like over diagnosis or misdiagnosis of this disorder which is why the need for a proper diagnostic criteria is fulfilled by DSM, which states the timing: “at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses”, these five symptoms are based on marked affective lability, marked irritability, marked depressive mood, marked anxiety tension or feeling of being at the edge. This empirically based diagnosis can be a solution to outweigh the potential for unfounded stigmatization or demeaning remarks that some groups fear. Not just that the plethora of misinformation on internet misguiding woman by creating wrong assumptions about their hormonal system can be dissolved by the accuracy of this criteria, in a way giving substantial knowledge to woman to understand their menstrual cycle. This is why moving PMDD from a research criterion to a full fledged diagnosis has ample number of benefits, one of these is the worldwide acknowledgement and recognition of such disorder which has now led to inventions of certain pharmacological treatments for PMDD. It also diminishes wrong assumptions of the clinicians ,and generalizations of menstrual syndromes for females suffering from PMDD. This inclusion is an advantage for the minority of women that suffer this disorder, as it gives them clue towards the treatment they need and the abnormality of it can provide them with proper concern and care, relief they require during the process of this disorder so that they are understood around the work as well as personal sphere of their lives.
Conclusion
This inclusion reminds us of the controversial statement by the Former Minister of Woman and Child Development of India, which was about menstruation not being a handicap, and it should not warrant a specified paid leave to avoid harassment and discrimination. Although this is a debate with too many views but I personally feel that as a country with a great population of woman leading in various industries as well as adequate homemakers how can we as a society not link menstruation with harassment and stigmatization by knowing more, and we will surely know more when we will have relevant information about menstrual and premenstrual diagnosis. On a broader perspective, the inclusion of PMDD in DSM, makes people aware of the seriousness of the pain and struggle of menstruating women and the disorders with it that many women suffer, until menstruation is not normalized how can I believe that premenstrual symptoms will be normalized?
One must not create a stigma about it and just treat it as a “tantrum” or “not a big deal” but indulge in knowing more about the difficulties such disorders create in the lives of the women around us.
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