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In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) offered potential relief to people affected by conditions that had only just been formally recognised in this new publication. One of those new additions was the Premenstrual Dysphoric Disorder (PMDD), a severe mood disorder characterised by its debilitating effects on women* in the week leading up to their menstruation.
Biological hypotheses on these effects propose an increased sensitivity of the central nervous system to normal hormonal fluctuations. Diagnosis criteria of this disorder contains symptoms ranging from affective lability, irritability and anger, to anxiety, depressed mood or an overall sense of hopelessness. Besides its primary effects, additional symptoms include fatigue, difficulties concentrating, sleeping, or physical symptoms such as breast tenderness, bloatings or headaches.
While the extent and guises of hopelessness can differ, the overall risk for suicidality has shown to be significantly higher among women* affected by PMDD. Hence, increased suicidal thoughts and self-harm tendencies, especially present during the luteal phase, demand better treatments to prevent suicidal attempts.
Thus, when PMDD was added to the DSM-5, over 31 million affected women* worldwide had their symptoms acknowledged for the first time. Experiences that had disrupted their lives every single month, and yet had been overlooked for so long. Consequently, relief was expected; the addition – supposedly – marked a big step and implied that greater progress was about to be made. But was it?
While the new addition did provide a diagnosis for symptoms that had only been listed in a provisional form before, misconceptions, false diagnoses and mistreatments still remain today – 12 years later. As of writing, the anticipated progress is yet to materialize and the recognition of PMDD through its listing in the DSM-5 seems more symbolic than an actual investment in meaningful clinical and scientific change.
In fact, studies show significant barriers to treatment engulfing all areas of women*’s lives. As PMDD remains a disorder that is still severely under-researched, many providers lack knowledge about the disorder despite frequently treating clients who seek help for such symptoms. Additionally, neglect of PMDD diagnostic guidelines and medical gaslighting has often been reported, leading to misdiagnosis and inappropriate treatments for PMDD. Indeed, one recent study shows that only 8.4% of obstetrician-gynecologists surveyed have reported adherence to the official PMDD diagnostic guidelines, while 78.5% of the clients seeking help reported a dismissal of their symptoms.
However, this only reflects shared experiences by women* seeking help; the vast majority of people with PMDD symptoms do not reach out to providers at all. Reasons for this include individual barriers that can be traced back to societal structures. Many women* downplay their symptoms due to internalized stigmas and societal norms that treat menstruation as a taboo topic causing internalised shame and self-blame.
Oftentimes, women* choose to normalise menstrual pain rather than feeding into the typical stereotype that has always been lingering around and is still commonly used – the “hysterical woman”. While invalidating someone’s pain and emotional responses is generally seen as insensitive and considered unacceptable, experiences shared by a “hysterical woman” are not held to the same standard. Responses are seen as exaggerated, overly dramatic and perceived as coming from a place of instability. Alongside invalidation of women*’s experiences, it also illustrates a crucial underlying phenomenon. Namely, society’s view of women*’s pain as negotiable, resulting in silently withstanding such severe symptoms.
If pain experienced by women* is undermined, and symptoms normalised, no research is needed on the female* body. Equally, historical research derived exclusively from the study of the male body remains valid and unchallenged. Furthermore, no restrictive biological conditions means no need for change in a workplace structure that cannot (or does not want to) accommodate those needs. Work can remain a priority and pain or disrupting symptoms can be dealt with at home.
But what if women*’s homes require them to undermine their symptoms as well in order to operate? Societal norms and gender roles leave no room for women* suffering from disorders such as PMDD. By raising women* into expected self-sacrifice, the demand for domestic labour is covered and ensures that the patriarchal status quo remains.
PMDD affects over 31 million women* globally, and yet the little space and awareness given to such a disorder, resulting in a lack of research and medical knowledge, is frightening.
Perhaps more frightening, PMDD becomes a mirror reflecting patriarchal patterns; illustrating how women and their health are treated in society.
While the addition of PMDD as an official disorder appeared as a promising first step, one may ask whether it was made as a commitment to women’s health or simply a concealment of genuine progress. One step might have been made, but no real change will occur unless we march toward greater scientific and sociological comprehension regarding PMDD and wider female health.
*assigned female at birth
Amelie Happe
amelie.l.happe@gmail.com
Bibliography:
Hantsoo, L., & Epperson, C. N. (2015). Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Current Psychiatry Reports, 17 (11). https://doi.org/10.1007/s11920-015-0628-3
Hantsoo, L., & Payne, J. L. (2023). Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neuroscience & Biobehavioral Reviews, 149, 105168. https://doi.org/10.1016/j.neubiorev.2023.105168
Nayak, A., Wood, S. N., & Hantsoo, L. (2025). Barriers to Diagnosis and Treatment for Premenstrual Dysphoric Disorder (PMDD): A Scoping Review. Reproductive Sciences. https://doi.org/10.1007/s43032-025-01861-3
Yan, H., Ding, Y., & Guo, W. (2021). Suicidality in patients with premenstrual dysphoric disorder–A systematic review and meta-analysis. Journal of Affective Disorders, 295, 339–346. https://doi.org/10.1016/j.jad.2021.08.082
A.P.E. 
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