One of the most common things I see as a PMDD therapist is the shame spiral. It’s that familiar self hate/self loathing we feel after a particularly bad luteal episode. We may have yelled at our coworkers, text-dumped our friends, started World War III with our partners, or (in my case), kicked the fridge in a fit of rage in front of my children. After the rage has settled, we end up hating ourselves, and the idea of self-kindness could not be further from our minds.
PMDD (or Premenstrual Dysphoric Disorder) is a severe, debilitating form of PMS that affects millions of menstruating people. It’s a cyclical, hormone-based disorder that results in anger, irritability, anxiety, panic, difficulty sleeping, fatigue and lethargy, depression, and in many cases, suicidal ideation. As anyone who suffers from PMDD or loves someone who suffers, it’s rough.
While there are many tools and skills we advocate here at Impart Therapy to help PMDD, perhaps the most important, and simplest to understand (yet toughest to implement) is self-kindness.
Why Self-Kindness Matters is Important
In the depths of our luteal phase (the space between ovulation and our periods, when our PMDD symptoms typically arise), we tend towards extreme emotions – very deep feelings of depression or big outbursts of anger/irritability. Our brains feel like they are working against us, and when we behave in a way we don’t love, we turn the criticism inward. Thoughts like “I’m the worst mother/partner/employee/etc.” or “Why can’t I hold it together?” take over. Here’s where self-kindness is a vital part of our PMDD management.
Self-kindness includes meeting ourselves where we are (recognizing that we have PMDD, a serious, debilitating condition that is NOT all in our heads) and holding off on the judgment (we are NOT bad people – we are struggling with a serious mental health disorder). Compassion is paramount – talk to yourself in the same way you would talk to your friend or partner when they are struggling: less anger and blame, more empathy. Self-kindness also ensures that we allow for rest and relaxation, rather than pushing through during the worst of our luteal symptoms.
Here’s Some Tips to Help
Practical tips for adding self-kindness into PMDD management include:
- Track Your Cycle
This is the most important step in all PMDD therapy – know your cycle. Keeping a calendar or using a cycle-tracking app can help you anticipate your most vulnerable days. Instead of being blindsided, you can prepare, so you can lessen the likelihood of big PMDD meltdowns.
- Create a PMDD Coping Ahead Plan
As a working mom, this is one of my favourite tools to help – I have a support plan for when my PMDD symptoms are at their worst. I either meal prep, have frozen meals to pop in the oven or rely on the pizza man to help get us through dinner time. I try to lessen my work days. Most importantly, social times are kept at a minimum. For anyone with a demanding work and/or home life, social events can be particularly triggering. I say no to social events and permit myself to have a quiet night or weekend.
- Watch How You Speak to Yourself
That nasty self-talk is likely familiar to us all. Phrases like “Why am I the worst?” can be changed to “I’m going through a tough time right now,” and “It’s okay to feel this way.” Speak to yourself like you would speak to a dear friend or your child.
- For the Love of Goodness, REST
PMDD includes fatigue, and lots of it, particularly as the perimenopausal years set in. Your body and mind want and need rest, so please, give yourself time and space to do so. Take the time you need to simply refresh.
- Forgive Yourself
This is probably the hardest thing to do following a terrible episode. We may have said some very mean things to those we love or had the equivalent of a toddler-style tantrum. We apologize to those we love but still hold onto the self-loathing. We need to forgive ourselves too. When this happens, remind yourself that you’re trying.
We Can Help
PMDD is a medical condition, and it’s okay to seek support. Treatment options include lifestyle changes, therapy, SSRIs, hormonal birth control, and of course, therapy interventions. You’re not overreacting by asking for help—you’re advocating for yourself.
In those moments when PMDD feels like a tidal wave, self-kindness can be your life raft. You deserve tenderness, patience, and support—not because you’re broken, but because you’re human.
About the Author: Nadine Evans
Nadine was diagnosed with PMDD nearly a decade ago and subsequently left her corporate career to become a therapist. She and other therapists at Impart Therapy all focus on PMDD treatment and therapy, and her book, Mastering the Monthly Madness, provides a DBT-focused guide to help with PMDD.
