Let me explain, in my own experience, the difference between PMDD and menstrual psychosis (Brockington, 2005) having lived both. Now I will note that menstrual psychosis does not usually occur every cycle, it may happen for a few consecutive cycles in a row and stop permanently, it may start and stop over a period of years, it may last for a year or just a single month. Its also important to note that there is so much stigma attached to mood disorders and hormones and mental health, there is even more stigma attached to psychosis, in many cases those that may be experiencing psychosis will never get help because of that stigma. I was nearly one of them.
PMDD is brutal enough, but can you imagine welcoming months where its just PMDD? When PMDD seemed so much easier to deal with? No, not many can. Not the individuals who struggle with PMDD on a cyclical basis and not those who have never experienced it. There are those like me though, not many, we are a tiny sliver of the population and I wish that population didn’t exist at all. Menstrual psychosis is both alike and unlike postpartum psychosis. Both are acute phases of psychosis that end, with menstrual psychosis, the end may be at the onset of menstruation, or shortly after. Both are seen as conditions not to admit to, to not get help, and as monstrous. Unlike postpartum psychosis, menstrual psychosis can strike an individual at any point of their reproductive age/cycle, several of the cases are that of teenagers who never experienced pregnancy (Brockington, 2005). Some symptoms of psychosis are mania, delusions, suicidal and/or homicidal thoughts/actions, hallucinations, depression, insomnia, paranoia, dissociation and there are more but those are the main ones. Those are ones that I personally experienced, though I never acted on any homicidal thoughts, there were enough to make me want to lock myself up and throw away the key or to die by suicide just to prevent me from hurting anyone if I truly got lost in the maelstrom.
If you are experiencing any of these symptoms mentioned above now or have in the past, please seek out help! You have rights and you can have a say in what kinds of treatment you receive regardless of the cause, but you owe it to yourself to get help.
There is hope. You are not alone.
I had PMDD from the start of menstruation. For me it started as horrible cramps, bloating, flu like symptoms, migraines, depression, anxiety, and self harm. It affected my education, my friendships, my family and myself greatly. I developed numerous destructive habits and behaviors. Every month was a battle that I did not know the cause and was just downplayed that every other woman who menstruated struggled with. I had no idea. My mom had no idea. My doctors had no idea. I also had PCOS, which in truth I was thankful for because even though I hated what it did to my body, I was stable in the months in which I did not get my cycle. And when it stretched on for months and months of me not getting my cycle and being infertile, I felt relief. I hated birth control, it always made me feel ill and off but I would take it for a few years, then stop, then start. I ended up missing a lot of work, every month the migraines and the mood swings would take over. The debilitating cramps and always getting sick. It took a toll on my relationship and my career, I couldn’t be trusted. I can’t blame them, I didn’t trust me either. I struggled through my 20s, went through college, held multiple jobs, found stability finally but still it was only at the grace of those around me and who supported me.
Menstrual Psychosis – Hell has a name and it is hormone fluctuations.
I did not have menstrual psychosis until after the traumatic birth of my second child. At that point I was told it was postpartum psychosis. Later, you can find menstrual psychosis written down in my medical files, they just never told me. It didn’t go away though after 8 months postpartum. It kept coming back, no in the same extreme way each month, but every few months or so, it crept in and I was lost again. I don’t know why some months were so much worse than others. I do know that I was misdiagnosed for a long time, bipolar does not include those symptoms of psychosis. I do know that my psychiatrist was way over their head. I do know that all the doctors and hospitals I saw should have connected the dots to my cycle or listed to me when I told them that it was connected. I know I was failed by our medical community at large. Can I fault them? No one wants to admit to psychosis and treating psychosis is still barbaric to this day. Not that ripping out my ovaries and uterus is not barbaric but it just isn’t the same when it comes to the brain.
Psychosis does not mean you are a psychopath.
The worst parts of the psychosis was the mania and delusion and then the hallucinations that followed. I experienced the mania/hypomania more often than I experienced the hallucinations, always before I ovulated. Estrogen is a feel good hormone after all. I experienced the hallucinations after ovulation, when progesterone spiked. The spike sent me to the lowest places I could never imagine. I experienced mostly auditory hallucinations, but the developed as images sometimes, mostly in my head but sometimes I felt them hanging over me. I hallucinated angels tell me to end the suffering that my children were going to have to live through. They told me to kill myself so many times. I fought and I fought, but only a small part of my brain at those times knew this wasn’t right, this wasn’t real. Thankfully it won most of the time. I’m not afraid to admit I tried to die by suicide. No, I do not think its selfish. I don’t care what anyone else says. I know what I faced, I know what I felt, and I know that it was for protection. I’m still here, I’m still fighting, I’m trying to get the word out.
I struggled with paranoia and impulse control. I still can struggle now, but its not to the same extent. I didn’t believe that people were out to get me, rather that everyone judged me and found me wanting. I was also delusional in certain instances, believing I could be or do something that I just couldn’t or shouldn’t even attempt. I also struggled with dissociation, such as derealization and depersonalization. Where I felt nothing was real or that I was not part of my body, like an outsider. I even experienced out of body experiences in some of the worst moments.
All of these symptoms were on top of the regular PMDD symptoms, the rage and irritability, the rapid mood swings, the flu like symptoms, the cramps and migraines. I could barely breathe but when I had months were it was just the PMDD stuff, I felt relief. I could deal with that. The psychosis always came back though.
My memories are faulty, as is often the case when people suffer psychosis and I struggle with PTSD from it all now. I struggle because I can’t remember my daughters when they were little, or concerts I went to with my husband. I can’t remember so much or really who I was before all this mess. I get glimpses, but its like looking through a stained glass window, its distorted, both beautifully and disturbing in the lack of clarity, wholeness.
Nearly two year ago, I found out about PMDD and went down a new path of treatment. I ended up having surgery to remove my ovaries, uterus, and cervix and now am in surgical menopause. I manage my hormones with estradiol hormone replacement and as long as I keep it stable I do as well as someone who has gone through psychosis can be expected to. While my life may not be fun or what others expect life should be, I know where I have been and I am thankful every day that I do not have to face that. I survived years of menstrual psychosis, without being locked up and the key thrown away. There is hope.
If you or someone you know is struggling with PMDD or another hormonal mood disorder please consider checking out the resources over at the International Association of Premenstrual Disorders, iapmd.org, a nonprofit organization that is dedicated to help those who suffer from these debilitating illnesses.
April is PMDD awareness month. Please pass this on!
- Brockington, I. (2005) Menstrual Psychosis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414712/