Let’s talk about Premenstrual Dysphoric Disorder and experiencing mania or psychosis! Yes, this does happen. Yes, it is often misdiagnosed. Yes, it can be treated. Yes, you can live a better life. PMDD can be a very hard disorder to live with. When you get thrown in manic or hypomanic symptoms or possibly psychosis, it can make life unbearable. It is important to talk about this as it is nothing to be ashamed of, its more common than we all think, and there are things to do that can help. First, is to understand how and when mania/hypomania or psychosis may present for you. It’s true it’s not the most common issues when dealing with PMDD, but women do experience it so let’s talk about it.
Mania or hypomania are different and are experienced differently. If you are experiencing these symptoms it does not mean you are bipolar even though it is most commonly associated with bipolar disorder. Manic episodes generally last a week and include a feeling of euphoria, elevated energy or irritability. Manic episodes also generate racing thoughts, rapid and pressured speech, decreased need for sleep, grandiose ideas, rapidly changing conversational topics that are unrelated, restlessness, impulsivity, poor judgement, and engaging in risky activities. Hypomania is usually an episode that lasts 4 days and includes many of the above symptoms but not to the same extent, it is milder. Especially be on the lookout for increased participation of goal oriented activities or engaging in activities that have a likelihood of negative consequences.
Mania or hypomania may occur both before or after ovulation. For myself I experience hypomania and sometimes mania, prior to ovulation. I felt wonderful, I felt I could conquer the world, I engaged in way too many activities, was very impulsive and compulsive and overall I ruined many parts of my life. It was very tricky to identify what was being happy or what was hypomania. Yes, I received a misdiagnosis but upon finding the right path for me and understanding more about my hormones, how they affected me, and tracking carefully I could be conscious of my hypomanic episodes and reach out to family to help me. Sadly, bipolar medications were not of any help since it was a hormonal issue for me.
I want to address psychosis now. I happened to suffer from postpartum psychosis and sadly it continued to be a monthly experience for me there after for years. It was one of the most traumatic experiences monthly for myself and my family. Because of misdiagnosis and not knowing that hormones can in fact induce psychosis, I felt so horribly alone. I felt broken and that I was a burden on those around me and was only traumatizing them. As many of you well know, PMDD has a nasty way of making you feel like you need to save your family from yourself, when you add in psychosis with hallucinations that tell you the same thing, sadly it is more than enough to drive women over the edge and to suicide. I’m including this list of possible symptoms many of which women with PMDD suffer through each month, the kicker is going to be the second part of this list.
- Social withdrawal/social isolation or loneliness
- Agitation, restlessness, hyperactivity, or excessive excitement
- Anxiety, nervousness, fear, or hypervigilance
- Hostility, anger, aggression
- Depersonalization (a combination of intense anxiety and a feeling of being unreal, detached from oneself, or that one’s thoughts are not one’s own)
- Loss of appetite
- Worsened hygiene
- Disorganized speech like rapid and frenzied speaking, incoherent speech, and excessive wordiness
- Disorganized behaviors, like a lack of discretion or restraint
- Catatonic behavior
The second part to identify an episode of psychosis:
- delusions (beliefs with no basis in reality),
- hallucinations (for example, hearing, seeing, or perceiving things not actually present),
- the sense of being controlled by outside forces, or paranoia
- disorganized thoughts.[i]
This list is not here to scare you, this list is simply to let you know that if you are experiencing any of these symptoms along with your PMDD, you are not alone. It is helpful to have information that can guide you on the right path to treating yourself and taking back your life. It wasn’t until years later that I had heard about premenstrual psychosis, as it is no longer studied in the medical profession. At one time it did exist, so its is entirely possible for a small population of women who suffer from PMDD, to also exhibit psychosis during their cycle. It is of utmost importance to know you are not alone, to know that these are symptoms of a chemical sensitivity and something that can be treated.
After ovulation, and my progesterone spiked I would suffer from psychosis, with hallucinations, paranoia, disordered thinking. I would also experience moments of depersonalization and rage. It was like my mind had been hijacked. I was a little girl sitting in the corner of my mind, watching my body go through these horrors, hearing the words come out of my mouth that I could not control but wanted so desperately too.
PMDD is not an easy thing to battle month to month, as soon as you get a short reprieve, then you are right back at square one. We try so hard to mask our difficulties but I’m here to tell you that it is crucial to getting the help we all need to be completely upfront about what we are going through. You are never alone, there are millions of women who battle PMDD and who even have similar stories to you. I know I am not alone. I chose to go the surgical route when I was 32 and have a total hysterectomy and oophorectomy. I no longer combat PMDD, I no longer destroy our lives with hypomania, and I no longer suffer bouts of psychosis. However, because of my battle with PMDD and all that it brought to the table I do have Complex Post Traumatic Stress Disorder. Please know, even when PMDD ends, we experienced trauma, we lived through trauma, and it is okay to still struggle in our daily lives. There will always be someone there to listen, someone who understands, you will never be alone.
If you or someone you know is dealing with PMDD, has episodes of mania/hypomania or psychosis, please reach out first and foremost. No one wants to go through this. There is help. While mood stabilizers may not always work, sometimes antipsychotic medications can help women who suffer with PMDD. There are always risks to taking medications, but there are risks not getting the help we need too. The first step is to always track, every day, to find a pattern to the symptoms. Many menstrual tracking apps can be useful and include many symptoms as well as the ability to write notes should you need to include further details. Talk to your loved ones, talk to your doctor. Let them know your fears about discussing this topic, what you are hoping for and what you don’t want to happen. It is your life and it is your body, you do have the right, even when you are suffering mentally and emotionally to control what happens to you. Reach out to peer support groups and educate yourself as much as you can. There is hope, it takes a lot of work, but there is hope.