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Psychological Reactions Contribute to Onset of Premenstrual Disorders

New findings from a team of American researchers indicate that women who have certain mental reactions to monthly menstruation may have increased chances of developing a premenstrual disorder, including the mood disorder known as premenstrual dysphoric disorder.

In America, most women of childbearing age experience at least minor symptoms of premenstrual syndrome (PMS); a much smaller number of women develop a severe form of this syndrome and qualify for a diagnosis of premenstrual dysphoric disorder. In a study published in February 2015 in the Archives of Women’s Mental Health, researchers from three U.S. institutions explored the role that mental outlook plays in determining women’s risks for premenstrual problems. Specifically, the researchers looked at the impact of a psychological tendency called self-focused attention.

PMS and Premenstrual Dysphoric Disorder

Premenstrual syndrome is characterized by symptoms that can include an unusually depressed or anxious mood, breast tenderness or swelling, abdominal bloating, headaches, sleep disruptions, loss of energy, acne, painful muscles or joints, unusual irritability or psychological tension, memory or concentration problems and appetite alterations. In any given month, the vast majority of American women (85-plus percent) will experience one or more of these symptoms in the week(s) prior to menstruation. Known or potential contributing factors to the onset of PMS include hormone fluctuations associated with the monthly menstrual cycle, chemical imbalances inside the brain, consumption of caffeine or alcohol and low intake of certain minerals or vitamins.

Roughly 3 percent to 8 percent of all women with premenstrual syndrome will develop symptoms of premenstrual dysphoric disorder (PMDD). This condition is officially recognized by the American Psychiatric Association as a mental illness; it belongs to the same group of ailments as major depression, persistent depressive disorder and all other diagnosable forms of depression. Potential symptoms of PMDD include the same “down” mental states associated with other depressive illnesses (e.g., sadness, hopelessness or helplessness), a disruptively angry or irritated mental state, bouts of excessive food intake (i.e., binge eating), panic attacks, a reduced or absent ability to feel pleasure and some of the same physical problems found in women with premenstrual syndrome.

Self-Focused Attention

Psychiatrists and psychologists use the term self-focused attention to refer to an entrenched tendency to favor feelings generated in the mind over the information coming into the body from the five senses. As a rule, this tendency is destabilizing to the individual and increases the likelihood that he or she will have a poorly developed sense of self and frequently experience strong and largely negative emotions such as fear, contempt, anger, guilt or disgust. Broadly speaking, the link between self-focused attention and a negative emotional state is stronger in women than in men. Self-focused attention also appears with some regularity in people with diagnosable mental health problems.

Link to Premenstrual Disorders

In the study published in the Archives of Women’s Mental Health, researchers from the Mayo Clinic, the University of Maine and the Veterans Administration used a small-scale project involving 52 women to explore the connection between self-focused attention and increased chances of developing a premenstrual disorder. Twenty-four of these women had diagnosable problems with premenstrual syndrome or premenstrual dysphoric disorder. The remaining 28 women were unaffected by these problems and acted as a generally health comparison group. The women in both groups were asked to take part in laboratory experiments designed to increase their level of negative emotions/feelings. After evoking the negative mental states, the researchers looked for signs of self-focused attention.

When the researchers compared the women affected by PMS or PMDD to the women unaffected by either premenstrual disorder, they concluded that the women with premenstrual problems had substantially higher levels of self-focused attention than the women not dealing with these problems. Critically, the women with a premenstrual disorder did not initially experience higher levels of negative emotions/feelings than their unaffected counterparts. Instead, self-focused attention essentially amplified the reaction to these feelings and increased the odds that a woman would respond to her emotional state in a dysfunctional manner.

Based on their findings, the study’s authors believe that women with premenstrual syndrome and premenstrual dysphoric disorder may react unusually poorly to the hormone and mood changes associated with the monthly menstrual cycle. In turn, this type of poor reaction (based on self-focused attention) may make any given woman more vulnerable to the combined physical and mental/psychological changes that characterize the premenstrual stage and menstruation.

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