Are you unhappy? Bloated? Is it hard to concentrate? Do you have food cravings? Breast tenderness?
If you read the Diagnostic and Statistical Manual of Mental Disorders (DSM),
published by the American Psychiatric Association, you will find your
symptoms listed under “premenstrual dysphoric disorder” (PMDD). In
other words, because of those symptoms, a therapist or doctor could
label you as having a mental disorder.
DSM is the bible of psychiatric diagnosis, used by nearly every
hospital, clinic, doctor and insurance company, as well as Medicare and
Medicaid. Since PMDD first was mentioned in the DSM in 1987, people
have received the mistaken impression that it’s real and that it’s a
mental illness. With the manual’s fifth edition currently in
preparation, that notion seems likely to be strengthened rather than
Contrary to popular
opinion, the creation and use of psychiatric categories is rarely based
on solid science, as I learned when I served on two DSM committees. The
absence of science leaves a void into which every conceivable kind of
bias has been found to flow—including sexism. The DSM’s own PMDD
committee reviewed more than 500 studies for the 1994 edition and
concluded that no high-quality research supported the existence of
PMDD, yet PMDD was placed in the manual anyway.
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Do some women report feeling worse before their periods than at other
times of the month? Certainly, although in some countries and cultures
more than others. Premenstrual discomforts are also more often reported
by women who were sexually abused as children, are struggling with
abuse or harassment, or are just plain overburdened. But that is worlds
away from a mental illness.
powerful DSM authors proposed adding PMDD in the mid-1980s and proposed
adding it to the next edition of the manual. It would represent an
extreme form of PMS—the popularly accepted “syndrome” of physical and
emotional symptoms between ovulation and menstruation. To qualify, it
would have to include five familiar PMS-type symptoms, at least one of
them a “mood disorder” such as feeling hopeless, “on edge,”
self-deprecating, irritable, angry or tearful. No one keeps
comprehensive records of how often a PMDD diagnosis is given, but based
on PMDD committee estimates, approximately half a million American
women could be given the PMDD label.
Hundreds of researchers have tried unsuccessfully to prove that women
are more likely to have mood problems premenstrually than at other
times. University of British Columbia researcher Christine Hitchcock
says, “Something like half of women say they have premenstrual
problems, but when you ask them to keep daily ratings of their moods,
the data don’t reflect that.” Another study showed that men identified PMDD symptoms in themselves as commonly as women did.
Despite this, when Eli Lilly and Company’s patent on antidepressant
Prozac was about to expire, the pharmaceutical giant successfully asked
the Food and Drug Administration to approve it to treat PMDD, providing
a patent extension worth millions. Eli Lilly repackaged Prozac in pink
and purple and rechristened it the feminine-sounding “Sarafem.” Other
drug companies rushed to market similar products. They deliberately
listed physical problems associated with menstruation for
some women, such as breast tenderness or bloating, and added a list of
mood problems from the PMDD list that virtually every human being
The PMDD mood symptoms are also listed for menopause, although they are supposedly caused at menopause by deficiency
in the hormones whose increasesupposedly causes PMDD. I half-jokingly
predicted that we would soon hear about premenarcheal dysphoric
disorder between a baby girl’s birth and her first period, thus
pathologizing women’s moods from birth to death.
Women should be wary of believing claims that high-tech research has
now proven that PMDD is real. We should also advocate a national
conversation—even congressional hearings—about the often hidden,
devastating consequences of simply being given diagnostic labels such
as PMDD. Finally, we should stop pathologizing ourselves and other
women and help each other look at what’s really behind our feelings.
The full text of this article appears in the Summer issue of Ms. magazine, available on newsstands or by joining the Ms. community at www.msmagazine.com.