Are we pathologizing PMS?

A psychologist who served on two DSM committees argues that premenstrual dysphoric disorder is bunk.

Published September 8, 2008 6:42PM (EDT)

Despite being a proud girly-girl, there's one thing I have in common more with men than with most of the women I know: I've never had bad PMS. While I've seen enough friends of mine laid low by brutal cramps to feel like I've dodged a very real bullet, I was intrigued by this article from Ms. magazine (via Alternet), which argues that the mental symptoms associated with Aunt Flo are way overblown, to the benefit of Big Pharma. Premenstrual dysphoric disorder, the official Diagnostic and Statistical Manual of Mental Disorders diagnosis for extreme PMS, may not exist at all, but the drugs for it sure do.

Writes Paula J. Caplan, who has served on two DSM committees: "The DSM's own PMDD committee reviewed more than 500 studies for the 1994 edition and concluded that no high-quality research supported the existence of PMDD, yet PMDD was placed in the manual anyway." Caplan also points out that one study found men complained of PMDD symptoms as often as women did, and that the same symptoms are also listed for menopause -- which involves a decrease in the hormones whose increase ostensibly causes PMDD. "I half-jokingly predicted that we would soon hear about premenarcheal dysphoric disorder between a baby girl's birth and her first period, thus pathologizing women's moods from birth to death."

Meanwhile, PMDD drugs have become a lucrative business. Eli Lilly and Co., for instance, managed to extend the patent on Prozac by repackaging it as PMDD drug Sarafem. But the use of an antidepressant to treat premenstrual symptoms brings up an old question: Is PMDD a real mental disorder, or are we just so afraid of women's emotions we assume the stronger ones must be some kind of hormonal overreaction? Caplan is in favor of the latter hypothesis, arguing that not enough attention is given to "the often hidden, devastating consequences of simply being given diagnostic labels such as PMDD." (Think how often women who haven't been diagnosed have to hear "Is it that time of the month?" when we express anger or sadness.) It's time, she says, to "stop pathologizing ourselves and other women and help each other look at what's really behind our feelings."

By Kate Harding

Kate Harding is the author of Asking For It: The Alarming Rise of Rape Culture--and What We Can Do About It, available from Da Capo Press in August 2015. Previously, she collaborated with Anna Holmes, Amanda Hess, and a cast of thousands on The Book of Jezebel, and with Marianne Kirby on Lessons from the Fat-o-Sphere. You might also remember her as the founding editor of Shapely Prose (2007-2010). Kate's essays have appeared in the anthologies Madonna & Me, Yes Means Yes, Feed Me, and Airmail: Women of Letters. She holds an M.F.A. in fiction from Vermont College of Fine Arts and a B.A. in English from University of Toronto, and is currently at work on a Ph.D. in creative writing from Bath Spa University

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