‘That time of the month’ brings a host of unpleasant emotions—sadness, an increased appetite, mood swings, brain fog, and anxiety, to name a few.

Commonly known as Premenstrual Syndrome (PMS), these symptoms appear a week before and usually subside once you start your period.  But for some, PMS morphs into a more severe form called Premenstrual Dysmorphic Disorder (PMDD).

What is PMDD?

PMDD is marked by intense mood disturbances and physical symptoms like aches and breast tenderness. The symptoms are so acute that they interfere with daily life till the onset of the period. PMDD often gets misdiagnosed as a mental health disorder since the emotional symptoms are far more severe than PMS. 

What causes a Premenstrual Dysmorphic Disorder (PMDD) misdiagnosis?

The defining feature of PMDD is the intensity of symptoms, particularly those related to your emotional health. Someone experiencing PMS may feel sad. But for someone with PMDD, the sadness turns into hopelessness coupled with persistent suicidal thoughts.

Research shows that this happens due to the heightened sensitivity to reproductive hormones before your period begins. The hormones trigger changes in brain chemicals and neurological pathways responsible for mood management.  It has also been found that those with PMDD have alterations in their genes responsible for controlling these hormones. This is precisely what leads to a potential misdiagnosis.

Bipolar disorder and borderline personality disorder have a few overlapping symptoms, such as mood swings, heightened emotional reactions, suicidal thoughts/behaviour, etc.

When these symptoms are reported but no enquiry is made regarding the timing of the symptoms, it can result in PMDD being misdiagnosed as a mood or personality disorder such as bipolar or BPD. Mental health research's gender-neutral or biased nature sees BPD affecting women more, while hormonal stereotypes may predispose women to a BD diagnosis.

BD and BPD are not associated with the menstrual cycle. The symptoms may appear without a predictable pattern. But in the case of PMDD, the symptoms show up during a particular phase of the cycle and impact your daily functioning for that duration.

Can there be a dual diagnosis?

BD and BPD can co-exist. Research shows that while BD and BPD are distinct disorders, a fair share of patients receive a dual diagnosis. Menstruators with these disorders/other mood disorders may also experience exacerbated symptoms before their period. This is known as Premenstrual Exacerbation (PME)

How to receive a correct diagnosis for PMDD?

To be diagnosed with PMDD, you must:

1. Experience at least one or more of the following symptoms related to your mood:

• Heightened irritability or anger
• Intense feelings of sadness or depression
• Overwhelming anxiety or stress 

2. Experience at least one of the following symptoms related to your overall health:

• Having trouble concentrating on a task
• Persistent fatigue and low energy levels 
• Engaging in binge eating or experiencing specific food cravings 
• Disruptions in sleep patterns, such as excessive sleeping or difficulty falling asleep 
• Feeling overwhelmed or out of control
• Uncomfortable physical symptoms, such as breast tenderness, bloating, body aches, and weight gain
• Intense mood swings or becoming suddenly tearful for no apparent reason

3. Notice these symptoms only in the week or two before you get your period

Observe an improvement in the symptoms once you get your period, and note their absence in the postmenstrual weeks. To make a diagnosis, the doctor may also ask you to keep track of your symptoms. If any of the symptoms are present outside the two weeks before your period, it may indicate a mood disorder but not PMDD.  Ideally, track your symptoms for at least two menstrual cycles for accuracy. 

Medically reviewed by:

Dr. B.S. Mahesh, Clinical Psychologist

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