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The Most Simple Definition
PMDD is a very complex condition that presents itself uniquely in different women. In short, women with PMDD have a sensitivity to the naturally occurring hormonal shifts that take place within the menstrual cycle. This sensitivity is akin to an allergic reaction that causes mental, emotional, and physical symptoms which may include withdrawal, depression, fatigue, rage, mood swings, suicidal ideation, crying jags, sadness, anxiety, hypersensitivity, and changes in sleep, appetite, digestion, concentration, and energy, all the result of this hormonal sensitivity.
While the symptoms of PMDD may be annoying to the loved ones, friends and coworkers of the woman with PMDD, they tend to be extreme and debilitating rather than just a mere inconvenience to the woman experiencing them. In other words, there is very little she can do to "snap out of it", "improve her mood", or "take a pill". She can only manage the onslaught to the best of her ability, and this sometimes requires taking actions that lie outside social norms and expectations, such as isolating, sleeping more, calling in sick, or setting aside responsibilities until symptoms improve. It may sound very convenient to those who themselves would love a day off, but rest assured, a woman with PMDD is not experiencing a holiday. On the contrary, she's in the depths of hell.
PMDD is called a dysphoria for a reason. It creates a brainstorm of very painful, agonizing thoughts. Reality becomes distorted and threatening. Women can experience irrational jealousies, self-hating thoughts, and paranoia which can then lead to angry outbursts, self-sabotaging actions, or other uncharacteristic behaviors or self-harm. There is an associated stigma and shame she must also fight off. It is a nasty cycle that requires a mighty self-awareness in order to cope.
As mentioned, PMDD is the direct result of changes in the menstrual cycle and therefore, the best means of discovering if one has it, as opposed to, say, bipolar or borderline personality disorder, is to track the menstrual cycle along with all arising symptoms. This can then be presented to and discussed with a medical professional specializing in the condition.
Medically, there is no cure nor treatment which has been consistently shown to improve the condition other than the removal of both ovaries...a radical, life-altering option. Other approaches to treatment include anti-depressants and birth control methods. These, of course, come with their own set of side effects and are often just a shot-in-the-dark, sometimes helping and sometimes adding to the problems. Dietary changes are also often recommended. However, each woman responds to the options quiet differently. Finding what works, if anything, can be a very difficult and trying exploration itself.
What You Can Do
It is all too easy for friends and loved ones to be on the receiving end of this dysphoria. It really isn't personal, and I guarantee (assuming you are relatively healthy) the woman you love is having the worse time of it, struggling to keep her life together when two weeks or so out of every month, all self-control dissipates no matter how much she wishes it didn't, spending the remaining time each month in a state of repair, catch-up, and preparation for the next month. It is an exhausting, ongoing trial.
The most important thing you can do is try not to add flames to the fire. Hold off and have necessary and/or difficult conversations only when symptoms improve. Be conscious of your own expectations and understand that they may be unrealistic. Provide space when space is asked for. Provide comfort when comfort is asked for. Better yet, get to know the language under the surface; sometimes, it is too much to even ask for what we need, so ask questions.
This will be a trial and error exploration for you too; the closer you are to the woman in question, the more likely it will be difficult. But if both sides can be quick to forgive when any storms pass, you'll be better poised to face the future. In fact, help her forgive herself, because that is often times the hardest thing for her to do.
Ultimately, a woman with PMDD is still a woman. She still wants to be loved and accepted for who she is...who she is at that time of the month...and who she really is underneath it all.
If you would like to know more about PMDD, please visit the Gia Allemand Foundation.
This video might also offer perspective on the challenges of a non-physically manifesting health issue.