Normally I would say I’m a happy person, but nothing was normal the year I was diagnosed with premenstrual dysphoria.
We weren’t just in a global pandemic. Both of my children were going through the diagnosis process for an autism spectrum disorder and my eldest child was awaiting testing for a genetic disorder. When I started having mood swings, it seemed like a natural byproduct of the stress I was under as a single mom in these circumstances.
When the mood swings turned into suicidal thoughts, I knew things were bad, but I didn’t understand why. My impulse control didn’t seem to work, I cried more than ever in my life, I kept forgetting things I should have remembered, and I was exhausted the whole time.
Then, without explanation, I was fine. I was better than fine. I was happy and energetic and couldn’t even understand what had made me so sad.
Understanding the overlapping symptoms
With symptoms like these, it’s not difficult to understand why so many people, especially women, are diagnosed with bipolar disorder. There are many similarities.
- Both PMDD and bipolar disorder occur in cycles.
- Both disorders alternate between depressive and manic energy.
- Both even have components of suicidal thoughts.
- Both involve depression and loss of interest in normal pleasures.
- Both include periods of excessive exhaustion and periods of high energy.
- Both PMDD and bipolar disorder include brain fog and low self-esteem as symptoms during the depressive episodes.
These overlapping symptoms often lead to medical professionals reaching an immediate conclusion and diagnosing patients as bipolar. It is possible for individuals to have one or both disorders with or without a premenstrual exacerbation. Imagine you are a doctor trying to decide which symptoms tick which boxes and which diagnosis is the correct one.
How to know if you have PMDD
It’s not hard to understand how confusing it can be to make the correct diagnosis. However, there is one key difference that characterizes PMDD and should be ruled out before settling on a standard bipolar diagnosis. It depends on the cycle itself.
While bipolar disorder is completely unpredictable, PMDD runs like clockwork. It begins during the luteal phase of menstruation – about 14 days of a 28-day cycle. It lasts until the week after menstruation.
As I was trying to understand my mood swings, I started using a mood tracker I received in a subscription box.
Every day I should color a room to indicate my mood. After tracking my moods for two months, a clear pattern emerged.
Happy colors dominated the calendar until a week or two before my period, and then the pattern changed to sad and angry colors until I bled for a few days. The pattern was so specific that I realized I probably had PMDD.
I had the advantage of being a former therapist. I had a rudimentary knowledge of PMDD. I couldn’t remember much, but I knew of its existence. When I saw the sample, I immediately booked an appointment with a gynecologist to confirm my suspicions.
PMDD is more than a cyclical mood disorder. It is considered a neuroendocrine disorder due to the brain’s inability to cope with hormone changes.
It’s like the body suddenly has an allergic reaction to normal hormonal fluctuations. Although this disorder is related to hormone fluctuations, it is not a hormone imbalance. The cyclical nature may initially lead clinicians to consider bipolarity, but without tracking the symptoms it is impossible to make that determination.
The real reason Bipolar is the standard diagnosis
Persistent misogyny could lead medical professionals to dismiss the symptoms as less severe premenstrual syndrome (PMS) or attribute the symptoms to stress or other mental health issues. Although the days when women were officially diagnosed with hysteria are over, the gender bias is still alive and well.
In fact, a 2019 article in Biol Psychiatry by Baller and Ross summarizes the problem:
“The real puzzle is how do we under-investigate and under-treat a disease that affects 5% of all women and that accounts for 14.5 million disability-adjusted life-years lost each year in the United States. Perhaps we are still bound by our societal values regarding the validity of the condition. Or maybe women in general are resilient enough to accomplish what they need to do despite the toll PMDD is taking on their personal and emotional lives.”
Baller and Ross point out that research into PMDD only began in the 1980s and was not included in the Diagnostic and Statistical Manual of Mental Disorders until 2013. Gender bias in the medical industry means that diseases specific to women are under-researched and under-funded. Although erectile dysfunction affects less than 20% of men, it is still researched five times more than PMS, which affects over 90% of women.
Gender bias is just the tip of the iceberg. Racial bias widens the gap for women of color even further. Because research does not address all genders equally, disorders like PMDD are often underdiagnosed, discarded, or ignored. We might as well be labeled hysterical given how seriously many medical professionals take this diagnosis.
What to do if you think you have been misdiagnosed
There’s a reason a bipolar diagnosis won’t treat your PMDD. Treatment for bipolar disorder includes anticonvulsants, antipsychotics, and SSRIs. Treatment of PMDD focuses on SSRIs. Both bipolar and PMDD treatment recommend ongoing therapeutic support, but bipolar recommends support groups and hospitalization as needed.
If you think you have been misdiagnosed, here are some steps you can take.
1. Get a second opinion
You have the right to get a second opinion. In fact, it is recommended that you get one when in doubt. Find a doctor you can trust. If you feel like your current doctor is dismissing your concerns, it may be time to find a new patient for treatment. You must be your strongest advocate throughout the diagnostic process.
2. Track your symptoms
While tracking daily symptoms for at least two months can be tedious, it is one of the crucial criteria for diagnosing PMDD. It could also help your doctors decide if you could have both bipolar and PMDD or another condition. Be proactive about your health by tracking changes.
3. Find a consultant
If you haven’t seen an advisor yet, it might be time to see one. Whether you have PMDD or bipolar, a psychologist’s support in your treatment could be invaluable. Learning to manage the symptoms can save your life.
4. Practice self-care
Regardless of whether you have symptoms of either condition, self-care is essential. Navigating the ups and downs of these disruptions is exhausting — and often discouraging. Make a plan for how you will deal with the bad days.
PMDD and bipolar disorder are not interchangeable. Neither should the diagnoses be.
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Crystal Jackson is a former family therapist who writes across genres to include blog posts, poetry, short stories, children’s books, and literary fiction.
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