PMDD Classified as a Mental Disorder in DSM-V

[Ellipsis]

Link to the NPR story: http://www.npr.org/blogs/health/2013/10/21/223805027/should-disabling-premenstrual-symptoms-be-a-mental-disorder

After a bit of a debate with one of my classmates, I'd like to get some other impressions on this. I think there are severe complications with labeling PMDD as a mental disorder; some are outlined in the NPR piece. My classmate's justification was that only a small percentage of women are even affected and, by having it in the DSM, treatment for it can be covered by health insurance.

While having medicine/treatment fall under a person's health coverage is surely a benefit, should it really go so far as to be labeled a "mental disorder" by the America Psychiatric Association? Are there any other alternatives aside from that?

I'm also a little rankled, given that comments abound about women being "crazy" while they're on their periods. Though I do not have PMDD, the last thing I would want is my feelings/emotions to be devalued because I happen to now suffer from a "mental disorder."

[Bloodied Porcelain]

I think diagnosing it as a mental disorder is fitting. We diagnose depression that coincides with the seasons as Seasonal Affective Disorder (SAD), and depression that comes after the birth of a child  as Post-Partum Depression, why not depression that coincides with a shift in hormones? This isn't all that different from Post-Partum at the core level, except it happens multiple times a year and only lasts a few days to a week at a time, while Post Partum can literally be nonstop for years. I'm bipolar and had Post-Partum, I never felt like my emotions were "devalued" because I had/have a "mental disorder". If anything, people made me feel like my feelings were more valued because they knew it wasn't something I could help.

The idea that you assume that your feelings would be devalued because you were diagnosed with a disorder makes me wonder how you look at everyone who has a disorder and the things that disorder causes in them. =/

[Kythia]

I think diagnosing it as a mental disorder is fitting. We diagnose depression that coincides with the seasons as Seasonal Affective Disorder (SAD), and depression that comes after the birth of a child  as Post-Partum Depression, why not depression that coincides with a shift in hormones? This isn't all that different from Post-Partum at the core level, except it happens multiple times a year and only lasts a few days to a week at a time, while Post Partum can literally be nonstop for years. I'm bipolar and had Post-Partum, I never felt like my emotions were "devalued" because I had/have a "mental disorder". If anything, people made me feel like my feelings were more valued because they knew it wasn't something I could help.

The idea that you assume that your feelings would be devalued because you were diagnosed with a disorder makes me wonder how you look at everyone who has a disorder and the things that disorder causes in them. =/

Ninja's and +1

[Ellipsis]

I think diagnosing it as a mental disorder is fitting. We diagnose depression that coincides with the seasons as Seasonal Affective Disorder (SAD), and depression that comes after the birth of a child  as Post-Partum Depression, why not depression that coincides with a shift in hormones? This isn't all that different from Post-Partum at the core level, except it happens multiple times a year and only lasts a few days to a week at a time, while Post Partum can literally be nonstop for years. I'm bipolar and had Post-Partum, I never felt like my emotions were "devalued" because I had/have a "mental disorder". If anything, people made me feel like my feelings were more valued because they knew it wasn't something I could help.

The idea that you assume that your feelings would be devalued because you were diagnosed with a disorder makes me wonder how you look at everyone who has a disorder and the things that disorder causes in them. =/

Bolded for emphasis.

It's funny because I've had the opposite experience. Mental disorders run rampant on the female side of my family and I try to get an evaluation done every year or so. I've been around it my whole life, namely with my mother. So when she was diagnosed, I saw how the rest of my family treated her. While I agree that having a scientific foundation for a condition can be helpful for some, if not most, the way people treat my mother now has definitely shifted. But that just goes to show how a person's environment can affect the basis of their outlook. Then again, a portion of my older relatives are from a generation where you don't talk about things like that.

The NPR article does raise some good points, most notably about whether or not this will affect things like custody cases.

[Oniya]

Also, to be clear, PMDD is not the same thing as PMS.  Per the Mayo Clinic:

Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships.

[Kythia]

The NPR article does raise some good points, most notably about whether or not this will affect things like custody cases.

Well, that's a separate issue isn't it, to do with custody cases and what's considered to be suitable grounds.  By that logic, you should argue that all mental disorders should be removed from the DSM because they could affect custody cases. 

[Ellipsis]

And due to the severity of PMDD, I wonder if those who are diagnosed could claim disability? I'm not educated enough on the process, so I'm neither advocating it nor saying it's wrong to do so. It's more of an open question/curiosity than anything.

[Ellipsis]

Well, that's a separate issue isn't it, to do with custody cases and what's considered to be suitable grounds.  By that logic, you should argue that all mental disorders should be removed from the DSM because they could affect custody cases.

I wouldn't necessarily say it's a separate issue, but one of several presented by this classification. I also think you're making a broad generalization with regards that I'm conveying "all mental disorders should be removed from the DSM because they could affect custody cases." Not all mental disorders are equal. Some are worse than others.

However, I think it would be extremely damaging if someone claimed their spouse suffers from a "mental disorder," which affects the way the happen to function on a monthly basis. I'm not saying that it should automatically reflect negatively on the sufferers patient, but the phrasing could give way to a knee-jerk reaction.

If anyone happens to suffer from PMDD and is comfortable talking about it, I would honestly like to know more.

[Kythia]

I wouldn't necessarily say it's a separate issue, but one of several presented by this classification. I also think you're making a broad generalization with regards that I'm conveying "all mental disorders should be removed from the DSM because they could affect custody cases." Not all mental disorders are equal. Some are worse than others.

Very well, perhaps my stroke was a little broad.  But you do seem to be saying that mental disorders you don't feel should affect custody cases shouldn't go in the DSM.  Rather than focusing attention on the way mental disorders are treated in custody cases - which would allow women suffering PMDD to get the help they need.

[Ellipsis]

Very well, perhaps my stroke was a little broad.  But you do seem to be saying that mental disorders you don't feel should affect custody cases shouldn't go in the DSM.  Rather than focusing attention on the way mental disorders are treated in custody cases - which would allow women suffering PMDD to get the help they need.

Again, that is not what I'm saying. My statement was that NPR raised some good points and, by that, I mean points to think about, or rather, consequences of labeling PMDD as a mental disorder. I have yet to state whether I am for or against this in any way, only that I see some complications in labeling it in the DSM.

Allowing women to get the coverage they need to treat this disorder is a very good thing, but I'm wary of having this classification be abused by other parties (i.e. the court system).

[Valthazar]

I obviously know nothing about this, so please don't yell at me if this is considered politically incorrect.  But isn't there a slight bias already in favor of women when it comes to custody issues?  I'm just curious why you are focusing on the custody issue.

[Ellipsis]

I obviously know nothing about this, so please don't yell at me if this is considered politically incorrect.  But isn't there a slight bias already in favor of women when it comes to custody issues?  I'm just curious why you are focusing on the custody issue.

I don't know enough to comment on custody bias really and I don't mean to focus entirely on the custody issue as it relates to PMDD in the DSM. It was just one of the questions brought up by the classification. There are others, like healthcare and the overall perception of PMDD (whether or not those will have it or the condition itself will be perceived differently).

So, my apologies for making it seem like custody cases were all I was concerned with. Truthfully, I don't know how I feel one way or another. I'm just curious whether others feel it's good vs. bad, the ends justify the means, etc.

[Valthazar]

This is purely my opinion, but this seems almost like a manufactured controversy.  PMDD affects 1.3% of the population, and the only reason this seems to be getting the limelight is because, as quoted below:

"I think any time a disorder occurs more frequently in women or only in women, there's going to be a group of individuals who have concern that this will diminish women's role in society, their sense of being capable," Epperson says.

The way I look at it, we should absolutely aspire for as much an equal and fair society as possible, but we should also have the sensibility to know that different ailments and conditions can affect men and women, simply due to differences in biology.  As much as we would like men and women to be identical for the purposes of a fair society, sometimes we just have to acknowledge that there are some differences, and accept that it is not always an ethics question. 

There are conditions that affect men more than women, as well.

[littlerooster]

No doubt I will be crucified for this but isn't calling it a mental disorder akin to agreeing with the idea that women are in fact less capable due to being at the mercy of their hormones? It seems there is a cycle when it comes to the formally "oppressed" who once liberated start claiming what they once fought against.

[Serephino]

Not really.  I see having a hormone imbalance as no different than a person having a chemical imbalance in their brain.  It doesn't mean a woman is less than, but that she has a medical disorder that needs to be dealt with.  Hormones effect mood and what not almost as much, maybe as much, as the neurotransmitters in the brain.  I think it's a positive  thing to know what's wrong with you, that it has a name and is a real thing, and you're not crazy.

[Valthazar]

This article should simply have been a medical/science article, but unfortunately, it is has morphed into a gender issue because of total misunderstandings like those held by littlerooster, in assuming that this is broadly referring to PMS symptoms.

But I do think that what littlerooster says provides a look into how the mainstream will tend to view PMDD as simply "diagnosis-worthy-extreme PMS."  The lady in the article, Sarah Gehlert, suggests that it is this misunderstanding of PMDD as a mental disorder that could come back to detrimentally affect women.  For example, while ADHD is a well-documented, confirmed diagnosis in DSM, there are a segment of cases where young kids are inaccurately placed under this diagnosis for simply displaying normal childhood boisterous behavior.  Women like Gehlert are probably concerned that many doctors, in an effort to avoid lawsuits for denial of care, may easily provide this diagnosis for patients displaying normal PMS symptoms that perhaps 'seem' like PMDD to the patient themselves (as is the case with many other mental conditions).

I'm not saying I agree or disagree with that line of reasoning, but I think that's the rationale behind why this article was written.

[Sethala]

Women like Gehlert are probably concerned that many doctors, in an effort to avoid lawsuits for denial of care, may easily provide this diagnosis for patients displaying normal PMS symptoms that perhaps 'seem' like PMDD to the patient themselves (as is the case with many other mental conditions).

I'm not saying I agree or disagree with that line of reasoning, but I think that's the rationale behind why this article was written.

Just to clarify here, but what's stopping them from just doing that now?  Just because PMDD isn't classified as a disorder?  But if that's the case, wouldn't not classifying it make it more difficult for someone who's actually affected by PMDD to get properly diagnosed?

[Valthazar]

Just to clarify here, but what's stopping them from just doing that now?  Just because PMDD isn't classified as a disorder?  But if that's the case, wouldn't not classifying it make it more difficult for someone who's actually affected by PMDD to get properly diagnosed?

As far as what has stopped the doctors from doing that in the past - well, it wasn't even a diagnosis then.  So basically, before this entry into the DSM-5, it wasn't really even an acknowledged condition in the medical community, from what I understand.  Please correct me if I am wrong.  Doctors probably considered it as just "extreme PMS" probably in the same way many doctors probably considered ADHD as just "extreme hyperactivity" in the past.

I agree that it makes it more difficult for someone who's actually affected by PMDD to get the care/treatment they need.  That's why I think they did the right thing by putting it in DSM-5 (and was probably the scientifically accurate thing to do).

Seems like Gehlert, and others like her, are simply trying to brew controversy because of the potential negative social impact of this diagnosis - due to public misinformation.  But that's a poor way to make decisions about medical issues.

[Oniya]

I can't get a full text from where I am, but I've found references in scholarly journals as far back as 1977.

http://www.sciencedirect.com/science/article/pii/0306453077900026