Correlates of confirmed premenstrual dysphoria

[Premenstrual symptomatology, somatization and physical anhedonia]

INTRODUCTION

Physical (headache, abdominal pain, e.g.), emotional (irritability, diminution of self-esteem, e.g.) and/or behavioral disturbances (fatigue, decrease of libido, e.g.) appear frequently during the premenstrual phase of menstrual cycles. Of moderate to severe intensity, these varied symptoms sometimes hinder the usual personal, social and/or professional functioning by generating significant suffering. Thus, premenstrual syndrome (PS) and premenstrual dysphoric disorder (PDD) are closely related to depressive disorders in many prior studies. In spite of solid links associating depression with premenstrual disorders in the literature, the psychological dimension of the premenstrual symptomatology still remains underestimated.

OBJECTIVE

The objective of this study is to examine the nature of possible relationships between a moderate premenstrual symptomatology and different modes of information processing with physical and emotional stimuli, such as somatization and physical anhedonia, well-known symptoms of depressive disorders.

METHOD

One hundred and five students in psychology from the François Rabelais university (France), aged between 18 to 50 years old (M=20.98, SD=3.43), were invited to fill in French versions of the Menstrual Distress Questionnaire [25] (Moos, 1991), the somatization subscale of the Symptom Check-List 90 [26] (Derogatis & Cleary, 1977), and the Physical Anhedonia Scale [28] (Chapman et al., 1976). Pearson correlation coefficients were calculated and a multiple regression analysis was conducted with Statistica software.

RESULTS

Main results reveal that premenstrual symptomatology is positively related to somatization (r=0.58; P<0.001) and negatively to physical anhedonia (r=-0.27; P<0.05). Physical anhedonia (β=-0.20; P<0.05) and somatization (β=0.55; P<0.001) may take part in the appearance of a premenstrual symptomatology.

CONCLUSION

These results allow us to enrich our knowledge on the origin and the nature of the premenstrual symptomatology, which would be physiological, psychological and social, in order to adapt and widen the therapeutic options by proposing, in parallel with the specific medical treatments, psychological interventions based on cognitive and behavioral techniques aiming a decentralization and a restructuration of the physical symptoms.

Fulfillment of the premenstrual dysphoric disorder criteria confirmed using a self-rating questionnaire among Japanese women with depressive disorders

BACKGROUND

Some women with depressive disorders experience severe premenstrual symptoms. However, there have been few studies in which premenstrual symptoms in women suffering from depressive disorders were assessed. In this study, we aimed to investigate premenstrual symptoms in women with depressive disorders using the premenstrual dysphoric disorder (PMDD) scale.

METHODS

We administered questionnaires to 65 Japanese female outpatients who had been diagnosed with a major depressive disorder or dysthymic disorder and to 303 healthy women as control subjects. The questionnaire consisted of items on demographics and the PMDD scale, which was modified from the premenstrual symptoms screening tool (PSST) developed by Steiner et al. (Arch Womens Ment Health 2003, 6:203-209).

RESULTS

Twenty-eight women (43.1%) with depressive disorder fulfilled certain items of the PMDD scale. These women are considered to have coexisting PMDD and a depressive disorder, or to have premenstrual exacerbation (PME) of a depressive disorder. On the other hand, 18 women (5.9%) in the control group were diagnosed as having PMDD. The depressive disorder group who fulfilled the PMDD criteria had more knowledge of the term premenstrual syndrome (PMS) and took more actions to attenuate premenstrual symptoms than the control group with PMDD.

CONCLUSIONS

Our findings demonstrated that the occurrence of severe premenstrual symptoms is much higher in women with depressive disorders than in healthy subjects. This is partially due to this group containing women with PME, but mainly due to it containing women with PMDD. The higher percentage of PMDD suggests similarity between PMDD and other depressive disorders. Furthermore, educating healthy Japanese women and women with depressive disorders about premenstrual symptoms and evidence-based treatment for them is necessary.

Effect of positive reframing and social support on perception of perimenstrual changes among women with premenstrual syndrome

Traditional menstrual cycle research reflects a stereotypical negative bias that does not encompass the complexity of the phenomena. For example, even though the majority of menstrual cycle literature has focused on negative changes during the perimenstruum, some women report positive changes. This article describes a unique intervention aimed at reframing perceptions of menstrual cycle experiences for the purpose of diminishing perimenstrual impairment. The intervention was a health promotion program that provided social support and a positive reframing component for women with premenstrual syndrome (PMS) across four menstrual cycles. Through use of a preexperimental design, data were collected on 18 women. Daily measures included prospective assessment of perceptions of perimenstrual changes (impairment and activation). Retrospective assessments of moods (anxiety and depression), social resources (personal resources and marital satisfaction), and perimenstrual change perceptions were gathered at three time periods--before, during, and after the experimental condition. Data analyses included descriptive and multivariate strategies. Results indicated that, although perimenstrual activation did not increase significantly, impairment did decrease. In addition, there were significant changes from baseline to follow-up on state depression and personal resource variables. Findings from this study underscore the need for further investigation of the wide continuum of women's diverse menstrual cycle experiences.

The efficacy of cognitive behaviour therapy in treating premenstrual dysphoric changes

This study assesses the efficacy of cognitive behaviour therapy (CBT) in treating premenstrual dysphoric changes. The CBT condition (n = 24) aimed to modify dysfunctional thinking as a means of impacting on negative premenstrual symptoms and changes. The components of CBT were cognitive restructuring and assertion training. A comparison condition called 'information-focused therapy' (IFT) (n = 9) aimed to present information only and did not address belief restructuring. The components were relaxation training, nutritional and vitamin guidelines, dietary and lifestyle recommendations, aspects of child management training and assertion training. Results indicated that the amelioration of anxiety, depression, negative thoughts and physical changes can be effectively addressed by either CBT or IFT. The extent to which a women's belief system is critical in the experience of premenstrual distress requires further empirical investigation.

Correlates of premenstrual dysphoria in help-seeking women

Comparisons were made between the premenstrual changes reported by nontreatment-seekers (NTS) (n = 32) and those of treatment-seekers (TS) (n = 52). The Premenstrual Assessment Form Luteal Phase and Follicular Phase versions were completed and the Beck Depression Inventory, the Automatic Thoughts Questionnaire and the State-Trait Anxiety Inventory were completed at both the luteal and follicular phases. Prospective daily ratings were made for two treatment cycles on the Daily Ratings Form and TS were screened for a mood-disorder history. Using the commonly cited 30% decrease in dysphoric levels from the pre- to postmenstrual phases as the criterion of prospective confirmation, women with prospectively confirmed dysphoria (PMD +) were not significantly more symptomatic than those without prospective dysphoric confirmation (PMD -). However, TS were more symptomatic than NTS on measures of depression, anxiety and frequency of negative automatic thoughts but not on mood behaviour and physical changes reflected in the PAF scales. No demographic differences were found between TS and NTS. Results did not support the issue of requiring 'confirmation' of self-reports within a help-seeking group or the use of the 30% criterion in particular. Findings further suggest that the 95-item PAF may be inadequate in differentiating TS from others.

The relationship between mood, somatization, and alexithymia in premenstrual syndrome

To examine the relationship between mood, somatization, and alexithymia in premenstrual syndrome (PMS), 66 women with a prospectively confirmed diagnosis of PMS were compared with a group of 49 non-PMS control women on a battery of self-administered tests measuring depression, anxiety, somatization, and alexithymia. Based on their scores on the Beck Depression Inventory, the PMS patients were subdivided into a high-depression and low-depression group and compared with the non-PMS control group on all test measures. Significantly greater somatization and alexithymia were reported in the high-depression PMS group, and no differences were found on any of the test measures between the low-depression PMS and non-PMS control groups.

Investigation of the reliability and factor structure of a questionnaire for assessment of the premenstrual syndrome

Data are presented from 696 women who completed a 35-item retrospective self-report PMS questionnaire. Item analysis resulted in the elimination of six items which predominantly reflected physical symptomatology. The resultant (29-item) questionnaire demonstrated a coefficient alpha value of 0.94 corresponding to a very high level of internal consistency and split-half reliability. It is argued that discrepancies in previous PMS research based on questionnaire data may, in part, be due to inadequate attention being devoted to achieving homogeneity of the PMS construct. A high level of internal consistency is a necessary condition for global PMS scores to be meaningful. Factor analysis of the revised questionnaire resulted in a two factor model corresponding to 'dysphoria' and 'dysfunction'. This leads to a simple four quadrant typology of PMS which may further understanding of this 'purer' PMS construct.

The premenstrual syndrome: a twin study

Data are presented from 157 monozygotic and 143 dizygotic female twin pairs of reproductive age who completed a self-report questionnaire on the premenstrual syndrome (PMS). For global PMS scores, the correlation coefficient for the monozygotic twins (0.55) was double that of the dizygotic ones (0.28). The results are consistent with the hypothesis that aggregation for global PMS scores is determined by genetic factors acting additively over a number of loci. Two alternative explanations are suggested: that monozygotic twins share greater environmental similarities than dizygotic ones; or that PMS scores may be a reflection of some other underlying characteristic (such as neuroticism), which is itself genetically determined.

A psychosocial profile of women with premenstrual dysphoria

Sixty women from the community were used in this study to identify a profile of women who experience premenstrual dysphoria. Women with prospectively confirmed premenstrual dysphoria (PMD +; N = 24) were compared to women with prospectively unconfirmed premenstrual dysphoria (PMD -; N = 15) and controls (PMD control; N = 21). Over one menstrual cycle daily records of physical, emotional and behavioural symptoms were completed on the Daily Ratings Form. Other self report measures obtained were the Premenstrual Assessment Form, Rotter's Internal External Locus of Control, the Locke-Wallace Marital Adjustment Scale, and the State-Trait Anxiety Inventory. A psychiatric history was obtained during an interview. Analyses showed that premenstrually, PMD + and PMD - groups could be significantly differentiated from controls on reports of premenstrual dysphoric changes and levels of state and trait anxiety. Postmenstrually, they could be significantly differentiated from controls firstly, by history of affective disorder and locus of control and secondly, by premenstrual dysphoric changes. There were no significant differences between the PMD+ and PMD- women on most of the self report measures either at pre or post menstrual assessments. The present findings suggest that the characteristic profile of PMD+ and PMD- women is one of being symptomatic premenstrually in relation to dysphoric changes and levels of state and trait anxiety. Postmenstrually these symptoms appear to be superimposed on a background of a history of affective disorder and an external locus of control orientation.

Men's perception of premenstrual changes on the premenstrual assessment form

Outcome research has shown that partner-spouse support can enhance the therapeutic outcome in a number of clinical problems. In the area of premenstrual tension, studies of treatment have apparently overlooked this issue of partners' support. This study was designed to address how men perceive premenstrual changes. 99 undergraduate men were asked whether they believed that women had premenstrual changes reflected on the 18 unipolar scales of the Premenstrual Assessment Form. Responses suggest that young men acknowledge that some women experience dysphoric features like hostility, mood swings, and low self-esteem as well as physical discomfort and behavioural changes. Clinical implications are outlined.