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An Inflammation Theory for Premenstrual Dysphoric Disorder

And what it means to an approach for treatment.

There are plenty of people out there who believe that PMDD can be successfully combated with mind over matter and that we should just buck up or get over whatever it is we’re feeling. They have no idea what they are talking about nor the challenges we face.

That said, there is some truth in their approach, just not in the way they think. Our mind IS ultimately our responsibility, even when we can’t control it. PMDD does require that we be hypervigilant of our thinking because it completely distorts it. And if we aren’t aware of it, we get taken under by it, and we believe the lies and bullshit thoughts that mean to hurt and even destroy us and those we love. Maybe that’s why I’m constantly coming up with new theories about my symptoms; I’m determined to not only understand PMDD but triumph over it, to accept it for what it is without letting it ruin my life. 

Hence, My Latest Theory…

For a moment, consider that perhaps the mental symptoms associated with PMDD could be likened to an inflammation of a sort. If one is suffering from an inflammatory disease like arthritis or lupus or allergies, there is likely to be swelling, heat, irritation, and pain. One can treat each of those things separately, taking painkillers, using cold packs or steroid creams, or taking anti-inflammatory drugs. Or, one can get at the roots of what is causing the inflammation to begin with. To do so, it is recommended that dietary changes be put in place, that exercise be done regularly, and that attention be paid to foods and activities that make the inflammation worse so that they can be avoided. It is also advised that meditation or other practices that help one cope with stress be learned and practiced. It’s good advice for any ailment, really: diet, exercise, avoiding added stress, and cultivating relaxation.

My theory is that certain symptoms, crying jags, depression, anxiety, rage, self-sabotage, rumination, and the like, are signs of another type of inflammation… inflammation of the mental body… in other words, ego. When I am experiencing the most dreaded of my PMDD symptoms and I feel like some other evil twin has taken over, could that package of symptoms not be likened to the swelling, irritation, and pain of inflammation? Is it really that outrageous an idea? And what would this mean in regards to our approach to treating PMDD? 

Defining Some Terms

But maybe I’m not quite getting my thought across. First, I need to define the terms here and make a few things clear. So understand I am referring only to the mental and nervous symptoms related to PMDD, not the physical ones.

The Free Dictionary defines inflammation as: a localized protective reaction of tissue to irritation, injury, or infection, characterized by pain, redness, swelling, and sometimes loss of function. It has also been defined as the body attacking itself in instances where the inflammation is actually a mistake, brought about when the body’s immune system goes into overdrive. I am defining inflammation here as an egoic protective reaction to deeply held and often unconscious emotional wounds and injuries characterized by fear, anxiety, depression, etc. resulting in a loss of normal function… the mind attacking itself… often when no real threat exists.

The traditional psychological definition of ego is “a part of the mind that senses and adapts to the real world,” according to Merriam-Webster. For my purposes, I’d like to expand on that by taking a more Buddhist view that ego can be defined as self-grasping ignorance. Ego, quite simply, is the deluded self. And it is this “deluded self” that seems to take over during PMDD, magnifying the things we fear. 

Applying the Theory

Now, applying those definitions to the theory that I am presenting, we can draw the conclusion that PMDD causes an inflammation of the deluded self. Makes sense, doesn’t it? It explains why so many of us feel like we have two personalities every month.

Typically, treatments for PMDD target symptoms. Women are given birth control or anti-depressants or anti-anxiety meds. But if these mental and nervous symptoms of PMDD (depression, anxiety, mood swings, rage, crying jags, etc) are seen as an inflammation rather than as individual symptoms requiring separate treatments, then shouldn’t we be supported in taking an approach parallel to that recommended for physical inflammation? That would, in theory, knock out the entire lot. Right? Maybe it wouldn’t happen overnight (no healing plan ever does). But if we consistently took steps to reduce the inflammation, we’d feel better and better over time, wouldn’t we? And with no side-effects! 

A Diet of the Mind

So let’s go back to the treatment protocols for someone with a physical inflammatory condition and apply them to my theory of egoic inflammation. Let’s consider each of them one at a time starting with watching what you eat. What does the mind eat? We could say it eats thoughts. So, we need to be alert. Maybe we can’t always control what we think, but with enough awareness, we have some say whether or not we believe what we think. We have to introduce doubt to those insistent thoughts that put us down, tell us we’re not safe, and that urge us to hurt ourselves and rage against the world. Plus, if we become aware of the internal lies that drive our behaviors and bring us into a state of suffering, judgment, or self-loathing, it makes the next step that much easier. We can also do our best to introduce positive thoughts or ideas that make us feel good. We can recall happy memories, practice affirmations, watch movies that make us laugh, and engage in activities that lift our spirits as much as possible. (Believe me, I understand that sometimes, that just isn’t going to work. So what? It doesn’t mean it is never going to work, and I’d rather stack the cards in my favor than never even try!) 

Exercise

What about exercise? How does that pertain to the mind? As I just mentioned, we can’t control what we think. Or can we? Maybe not overnight, but there are exercises that one can practice to help us train the mind such as mindfulness, forgiveness, or loving kindness meditation. If that’s too out there for you, try turning off the TV and learning something new… study a language or learn a new software program. The point is to engage the mind in productive ways that over time will improve your sense of self and others. If the mind is sharpened in these ways, it will be less likely to go down those endless spirals of negativity that lead to nowhere fast. In other words, practice feeling good wherever and whenever you can. Gratitude is one of the easiest and fastest ways to do this. Take time out to actually appreciate what’s going right in your life. And when you hear that voice trying to tell you that it all sucks, push back! Find something, anything, that counters the argument. Now that’s exercise! 

Avoiding Triggers

To avoid exacerbation, awareness is key. We need to cultivate awareness of the internal and external triggers that feed our inflammation. We can also avoid making big decisions when we know our heads simply aren’t clear enough to make them and avoid the headaches that come with ill-timed choices. We may not have control over what is happening around us, but with awareness, we can have control over our response if a) we cultivate enough awareness to catch it first while it is happening and eventually before it happens and b) we are realistic and nonjudgmental about our options (or lack of them) and c) we trust… ourselves and life itself. True, PMDD makes it very difficult not to react, often in ways that don’t match the stimulus. There’s certainly no point in judging ourselves for that. But there’s no point in giving up and giving in completely either. We have to take responsibility for what we can control and make it our mission to manage ourselves effectively. Can we leave the judgments behind and instead, simply try to notice what we’re doing, how we’re thinking, and whether or not there is anything we can do to feel better? Then we can, to the best of our ability, take steps to minimize our suffering either by leaving a situation, taking a walk or nap, placing a boundary, or by trying something completely different. Or at the very least, we can refuse to make ourselves feel even worse by ruminating about what we are presently powerless to change. 

Relaxation

Finally, how do we get the mind to relax? Actually, in very similar ways to how we relax the body. After all, they aren’t separate entities. Mind and body are connected and inform each other. So adopt a relaxation practice with yoga, deep breathing, meditation, biofeedback, or massage. Each and all of these things can help relieve feelings of anxiety, racing thoughts, rage, and other mental symptoms associated with PMDD. We probably all know someone who isn’t well. Maybe he or she has heart disease, for example. And maybe that person still piles on the salt and eats burgers every week and refuses to exercise while at the same time throwing back pills accompanied by a host of side-effects to regulate blood pressure. That’s one way to go. I hope you see this way as one that simply isn’t good enough for you. It's irresponsible to the body. But with PMDD, it isn’t our body for which we need to take responsibility. It’s our mind. It’s a real catch-22. We have a condition that makes it impossible to control our minds, but we are still responsible for taking every step we can to make things better for ourselves. There’s no way around it! We simply have to come to grips with the paradox and the unfairness of it all. 

A Consistent Approach to Healing

It’s all too easy to look for the quick fix that relieves our suffering instantly and ignore the things that would take not only effort and time but the willingness to feel deeply. Unfortunately, we have a condition for which very little has been found to be consistently effective in treating it. In other words, it isn’t really even a choice to take the quick-fix road. Maybe that’s our lesson and what is pointing us in a new direction.

I’m proposing here a more difficult but more effective and long-lasting choice. Change. Deep change. PMDD compels us to exercise mindfulness and cultivate awareness for our survival, not because “we just need to think happy thoughts and get over it already,” but because doing so is the difference between unmitigated suffering and unbearable quality of life and the management of suffering and the best quality of life possible.

I know first-hand what I am asking of myself, and you, and I know first-hand it isn’t an easy path, this path of self-awareness and transformation. It’s the path of walking through hell with your eyes wide open and your skin exposed. It’s a path of radical self-responsibility. It’s a path of maturity and self-acceptance. It’s scary because we know we will fall many times and that there will be many battles we simply cannot win. Still, we must always move toward healing, wholeness, and wellness. I’m up for the challenge. In fact, I see no other way. Who’s with me?

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