Understanding PMDD: A Guide for Therapy Clients

Understanding PMDD: A Guide for Therapy Clients

by Candyce Young, MSEd, MHC-LP

Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS) that affects a significant number of women. Oftentimes causing serious emotional, psychological, and physical symptoms. While PMS can bring irritability and discomfort, PMDD is much more intense, making it difficult for those affected to function in their daily lives. ​

What is PMDD?

According to the University of Oxford 31 million women around the world experience PMDD. Due to PMDD being a fairly new diagnosis it is estimated that the percentage of women living with PMDD is much higher (University of Oxford, 2024).
PMDD is a mood disorder that typically occurs 7 to 10 days before menstruation starts. The symptoms of PMDD are far more debilitating than PMS and often interfere with work, relationships, and overall quality of life. It’s not just "bad period cramps"—PMDD can bring a combination of emotional, physical, and behavioral symptoms that make it challenging to cope with alone.

What are the Symptoms of PMDD?

PMDD symptoms can vary from person to person, but some common signs can be broken down into 5 categories: Mood swings, Depression, Physical symptoms, Cognitive issues, and Changes in behavior. Let's explore each of these categories in more detail:

Severe mood swings

• People with PMDD may experience intense irritability, sadness, or anger. These mood changes often feel out of control and may include feelings of hopelessness or extreme anxiety. These mood swings can interfere with important relationships and daily activities.

Depression

• Feelings of despair, worthlessness, and low energy are prevalent, with some people experiencing thoughts of self-harm or suicide during their worst episodes. Unfortunately, as PMDD has often been overlooked as a mental health concern, those experiencing depression symptoms may not feel validated and understood by loved ones.

Physical Symptoms

• These can include fatigue, insomnia, joint or muscle pain, headaches, and bloating. These symptoms can range from mild to severe, and can lead to the need to take time off of work or keep someone from hobbies, self care, or caring for others.

Cognitive Issues

• Concentration and memory problems, also known as “brain fog,” are common and can make daily tasks feel overwhelming. This can interfere with remembering things that need to get done, fulfilling a role at work, or caring for self/others.

Changes in behavior

• Overeating, irritability with family members, or withdrawing socially are also common signs of PMDD.

What Causes PMDD?

The exact cause of PMDD is still not entirely understood, but it is believed to be linked to hormonal fluctuations that occur during the menstrual cycle. In particular, the hormonal changes related to estrogen and progesterone may affect neurotransmitters in the brain, such as serotonin, which plays a role in mood regulation. Genetics, environmental stressors, and a history of trauma can also contribute to the severity of PMDD.

Can Therapy Help People Experiencing PMDD?

Living with PMDD can be incredibly challenging, but there are ways therapy can help manage symptoms. Here are a few strategies that may be beneficial:

Cognitive Behavioral Therapy (CBT)

CBT is one of the most effective types of therapy for managing mood disorders like PMDD. It focuses on identifying negative thought patterns and replacing them with healthier, more balanced thinking. This can help clients develop coping strategies for handling the emotional rollercoaster of PMDD.

Mindfulness & Relaxation Techniques

Stress exacerbates the symptoms of PMDD, and mindfulness practices like meditation, deep breathing exercises, and yoga can help reduce anxiety and enhance emotional well-being.

Lifestyle Adjustments

Therapy can also guide clients through practical lifestyle changes that may alleviate symptoms. This can include diet adjustments, regular physical activity, and establishing a consistent sleep schedule—all of which are shown to improve overall mood and health.

Support Systems

Sometimes, just having a space to talk about the emotional strain of PMDD can be incredibly healing. Support groups and family therapy can help individuals feel understood and supported during their most challenging moments.

When Should I Seek Help for PMDD?

If you’re experiencing symptoms of PMDD that are interfering with your ability to function, it’s important to talk to a therapist or healthcare provider. You don't have to struggle through these intense feelings alone. 
Understanding PMDD and how it uniquely affects you is the first step toward better managing its impact. Therapy provides a supportive space to address not only the emotional challenges of PMDD but also the underlying thoughts, behaviors, and coping strategies that can make all the difference.

If you think PMDD might be affecting your life, don't hesitate to reach out for help. I am here to offer you a safe environment to explore your symptoms and create a plan that works for you.

University of Oxford. (2024, January 30). New data shows prevalence of Premenstrual Dysphoric Disorder. https://www.ox.ac.uk/news/2024-01-30-new-data-shows-prevalence-premenstrual-dysphoric-disorder.

About the Author

Candyce Young, MSEd, MHC-LP is a clinician at Healing & Growth Counseling. As a female clinician she understands the difficulty women face when trying to express what we feel and why. As Candyce works with her clients, she assists them in identifying their feelings, processing them, and gaining confidence in using coping skills to minimize negative self talk and increase self awareness.

Interested in learning more about Candyce? Check out her bio here.

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