The relationship between dysmenorrhea and selected personality variables

The association between somatization and perceived ability: roles in dysmenorrhea among Israeli Arab adolescents

OBJECTIVE

The aim of this study was to investigate whether somatization and attitudes toward menstruation predict the incidence of pain intensity and dysmenorrhea among Israeli Arab adolescent females.

METHODS

Participants were 160 Israeli Arab adolescents, including 50 Muslims, 50 Christians, and 60 Druze. A 20-item questionnaire was used to assess attitudes regarding menstruation. The short version of the Brief Symptom Inventory was used to measure the level of somatization.

RESULTS

Factor analysis of the Attitudes Toward Menstruation Instrument revealed two significant composites: perceived ability and impurity during menstruation. High levels of somatization predicted pain intensity and low levels of perceived ability predicted the prevalence of dysmenorrhea. Although the Israeli Muslim adolescents revealed higher levels of somatization as compared with their Christian and Druze counterparts and the Druze revealed the lowest levels of perceived ability compared with the other subgroups, no significant role for ethnicity and impurity was found. No differences were found between groups in scores of menstrual pain and prevalence of dysmenorrhea. Higher levels of somatization and lower levels of perceived ability, as well as a greater portion of Muslim and Druze and higher levels of religiosity, were found among rural residents.

CONCLUSIONS

The role of cultural variables and personality traits in the complexity of dysmenorrhea as a socio-bio-psychological phenomenon is proposed in light of contemporary interactive models. It is suggested that within the Israeli Arab minorities the impact of cultural background on health affects more the perceptual and cognitive levels and are not generalized to overt behavior and morbidity such as dysmenorrhea.

Disruptions of social relationships accentuate the association between emotional distress and menstrual pain in young women

This study examined the effects of social support on dysmenorrhea and whether social support moderates the relationship between negative emotions and painful symptoms. Women (N = 184) completed questionnaires on menstrual symptoms, depression, anxiety, and social networks. Depression and anxiety were strongly associated with menstrual pain. Women who no longer had access to their prior support providers manifested more symptoms than did women with stable social relations. In addition, this disruption in their social networks moderated the relationship between distress and menstrual pain. Results indicate that loss of social support is a significant contributor to menstrual symptoms and point to the importance of considering specific aspects of social support in studying its effect on health.

The experience of dysmenorrhea and its relationship to personality variables

The aims of this study were: to relate women's subjective experience of primary dysmenorrhea to psychogenic needs assessed longitudinally at the age of 15 and at the age of 25 in a nonclinical sample; to compare the psychogenic needs of women with severe primary dysmenorrhea with those of other women who never have experienced dysmenorrhea; and to examine whether women with severe dysmenorrhea were less conventionally feminine than women who never have experienced dysmenorrhea. At 25 years, 42% of the women experienced dysmenorrhea and 15% experienced pain that limited their daily activity. Differences in psychogenic needs according to the Cesarec Marke Personality Schedule and in psychological masculinity and femininity according to the Attitude Interest Schedule were found in women with severe primary dysmenorrhea compared with women who never experienced dysmenorrhea. The results indicate that women with severe dysmenorrhea have less self-esteem at 15 years, but compensate for this at 25 years by being more achievement-oriented and aggressive than women who never experienced dysmenorrhea. Further, women with severe dysmenorrhea are more conventionally feminine than women who never have experienced dysmenorrhea.

Sensitivity to cold pressor pain in dysmenorrheic and non-dysmenorrheic women as a function of menstrual cycle phase

Pain responses (threshold, tolerance, and visual analog ratings) to the cold pressor task were studied in 46 normally menstruating dysmenorrheic and non-dysmenorrheic women during 2 phases of the menstrual cycle. Twenty-six women provided measurements during the follicular (days 8-14) and 20 during the luteal (days 15-21) phases of the menstrual cycle. A significantly lower pain threshold was obtained during the luteal as compared to the follicular phase. Pain tolerance showed a similar but non-significant trend. Visual analog ratings were significantly lower in dysmenorrheic women during the follicular than the luteal phase. Also, these ratings were lower than those of non-dysmenorrheic women in the follicular phase. This finding may support an adaptation-levels model, in that dysmenorrheic women report less pain than do non-dysmenorrheic women because they compare cold pressor pain with internal menstrual pain.

The patient with dysmenorrhea

Although dysmenorrhea is a common gynecologic complaint, adolescents and young women frequently believe that no therapy is available and do not seek medical help. Diagnostic and therapeutic advances now allow the physician to effectively evaluate and treat patients with menstrually related discomfort. Although treatment of dysmenorrhea represents a challenge to the physician, careful assessment of the pain combined with application of new therapeutic modalities can result in successful treatment of patients who would have formerly lived with their discomfort.

The dysmenorrhea personality: actuality or statistical artifact?

A group of 31 women who were experiencing severe dysmenorrhea were matched by age with a group of 31 women who had no dysmenorrhea symptoms. Women in both groups took the 16PF. Some major methodological and statistical flaws found in previous research of this type were corrected. The results convincingly showed that 16PF personality profiles for the two groups were extremely similar. Finally, there were no indications of any personality abnormalities.

Primary dysmenorrhea. Relationship to personality and attitudes in adolescent females

Primary dysmenorrhea is experienced by 40-80% of adolescent females. Traditionally, the literature discussing the etiology and management of this entity has given greater weight to psychologic than to physiologic factors. However, four previous studies addressing psychosocial variables failed to show a relationship to primary dysmenorrhea. In this study, personality factors and certain attitudinal variables were not found to be significantly related to the presence of primary dysmenorrheic pain. Current evidence strongly suggests that uterine contractility, hormone variables, and prostaglandins are causative in most cases of primary dysmenorrhea. Therefore, it is recommended that primary dysmenorrhea be regarded and managed as a physiologic phenomenon in the majority of adolescent females.

Evidence for a psychological etiology of menstrual disorders: a critical review

Past research which has been interpreted as support for a psychological etiology of menstrual distress is critically reviewed. This research is analyzed with respect to methodological issues such as the assessment of menstrual distress, the measurement of psychological parameters, and statistical procedures and with respect to experimenter bias apparent in the interpretation of results. It is concluded that the available empirical evidence is inadequate to support psychological causation of menstrual distress.

New concepts in dysmenorrhea

The etiology of primary dysmenorrhea, which is the most common gynecologic complaint and cause of lost working hours, remains obscure but merits careful scientific investigation. Recent studies suggest that increased endometrial prostaglandin production and release may be responsible for dysmenorrhea. Prostaglandins cause myometrial contractility that, if excessive, leads to uterine ischemia and pain. This hypothesis has led to clinical trials of antiprostaglandin agents such as indomethacin and fenamates, which inhibit the synthesis of prostaglandin through the prostaglandin synthetase system as well as antagonize their action at the cell receptor level. The good response of dysmenorrhea to other conventional forms of therapy such as oral contraceptives and dilatation of the cervix can be partly explained on the basis of a reduced level of prostaglandins in the menstrual fluid with such therapy. There is a definite need for further evaluation of the antiprostaglandin compounds in the treatment of dysmenorrhea so that sound formulations can be evolved for the elimination of this incapacitating disorder.

Studies in medical psychology: a brief survey

An understanding of the individual's personality structure may be used to help patients employ their strengths effectively in combating physical illness. Models of personality types based upon psychoanalytic psychology may be utilized. A large number of recent articles on medical psychology are surveyed as representative of current interests in this field, and a few studies are discussed which deal more fully with personality and illness.