Women who suffer from consistently severe mood swings [PMDD] during their menstrual periods are now being diagnosed with mental illness.
Premenstrual dysphoric disorder [PMDD], sometimes referred to as ‘PMS on steroids’, is formally recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
But the decision to categorize this condition as full-fledged disorder has divided opinion, with critics stating that it only contributes to stereotypes about women being emotionally unstable once a month.
Indeed, one commentator wrote on Jezebel.com: ‘I actually have PMDD and take birth control to help it (which does work, btw [sic]). Personally, I do find it insulting that PMDD is lumped into the category of psychological disorders.
‘Although I do sometimes get intensely depressed for a short amount of time before my period, I think the physical symptoms that accompany the emotional stuff and the fact that it’s entirely period related should qualify it as a body problem and not a mental one.
‘Admitting you have PMDD definitely has some social stigma also.’
The criteria for diagnosis include ‘marked irritability’, ‘anger’, ‘increased interpersonal conflicts’, ‘feelings of hopelessnes’, ‘lethargy’, ‘insomnia’ and a ‘marked change in appetite’ during ‘most’ menstrual cycles.
The symptoms have to correspond with the menstrual cycle for a minimum of two successive months and must be truly disruptive to a woman’s ability to carry out her normal activities. That’s different than in premenstrual syndrome (PMS), where most symptoms are ‘mild’.
Finally, to be diagnosed with PMDD, patients must report that they are not depressed all the time, only in the days leading up to their periods.
The condition is thought to affect three to eight per cent of women.
Advocates say it will lead to more accessible treatment and greater understanding of the condition, but others argue it will add to America’s growing prescription drug abuse problem.
Gary Greenberg, author of The Book of Woe: The DSM and the Unmaking of Psychiatry, wrote in The New Yorker: ‘Every revision of the DSM causes controversy; that’s what happens when experts argue in public about the nature of human suffering.
‘But never has the process provoked warfare so brutal, with attacks coming from within the profession as well from psychiatry’s usual opponents.’
Some critics have suggested that the new guidelines will make mental illness more common. For instance, according to the DSM-5 those who eat to excess 12 times in three months will be a candidate for binge eating disorder.
The Daily Beast jokingly wrote: ‘[This] makes us think twice about the last time we devoured a pizza pie (last week) or ate three doughnuts in one sitting (this morning).’
And prominent names in the psychiatric profession have highlighted the serious consequences of the revisions.
Duke University psychiatrist Allen J. Frances, who was tasked with putting together the fourth edition of the DSM published in 1994, but did not work on the updated handbook released in May, expressed concern over the changes.
‘A new diagnosis can be more dangerous than a new drug,’ he told The Daily Beast.
And clinical social worker Joe Wegmann said it was based on ‘no credible research’ and would trigger an ‘zealous binge’ of over-diagnosis.
A new section on areas that ‘need further research’ has also been incorporated into the DSM-5.
This means that conditions including sex addiction and internet overuse require additional research before they can be incorporated into the official diagnoses.
The DSM-5 was 11 years in the making and was written and published by the American Psychiatric Association.
The first edition of the DSM – widely considered the ‘bible of psychiatry’ – was published in 1952 and today it still influences practitioners around the world.