Isabel first came to me in October complaining about unbearable anxiety. She was in a high-profile corporate job, one that she gave upwards of 60 hours a week. Her relationship was suffering, and at times she felt like she hated her spouse. Earlier that week, she experienced a panic attack while driving – one so severe she had to pull over for 20 minutes to steady her breathing. She couldn’t go on.

Within only a few sessions, she noticed a significant difference. CBT strategies helped, and she began tracking her thoughts and feelings, relating them to her behaviours and situations. By session three she told me she had debated canceling our appointment that day, as she felt so much better. I was elated for her and amazed at her progress in just a short time.

Alas, short-term progress is very encouraging, but often not permanent. Two weeks later, Isabel arrived at our session in tears, frustrated at how she felt. Her anxiety was back, and lately, it felt like her partner couldn’t do anything right. She also noticed how sad she was feeling – as though she was clouded in darkness and plagued by a general sense of hopelessness.

She was still practicing all her CBT homework, including breathing techniques twice daily. “What’s going on?” she pleaded with me. I had an inkling I knew exactly what it was.

Weeks before, she began tracking her periods to determine if there was a link between her anxiety/depression and her cycle. Low and behold, she was five days away from her period. Last month she noticed the same thing: about 10 days before her period, her mood changed considerably.

She felt out of control, overwhelmed, irrationally irate and sad. Then, when her period arrived, she felt so much better. Gone was her sadness and depression, and her relationship with her partner of seven years was again fine.

Isabel very likely has Pre-menstrual dysphoric disorder (PMDD), an endocrine disorder of unknown case, affecting less than 10% of menstruating persons. Like PMS, PMDD arises in the weeks or days leading up to one’s period and disappears typically within a few days of onset of bleeding.

Depending on the severity of PMDD, Treatment can range from antidepressants (SSRIs such as sertraline), birth control pills, diet changes, supplements/vitamins, exercise, and behavioural therapies such as Cognitive Behavioural Therapy and Dialectical Behavioural Therapy (DBT). These types of talk therapies target the recognition of patterns during one’s cycle and aim to redirect these negative patterns into more productive focused thoughts and emotions.

PMDD is not diagnosed by a therapist. While I may believe Isabel is a candidate, only a doctor (GP, Gynecologist, or Psychiatrist) can make this diagnosis, and this is typically not provided until the client has had time to track their cycles for about three months.

Once diagnosed, it is imperative to take this disorder extremely seriously as PMDD sufferers report a significant negative impact in their daily lives with suicide ideation common among severe sufferers.  Treatment types vary, and many report using an integrated approach (a combination of many types of treatments) that help.

Isabel is in the process of tracking her symptoms to obtain more information for a possible diagnosis. In the meantime, she’s paying attention to her body, continuing therapy (incorporating mindfulness into her daily routine), making modifications to her diet, and trying to get a bit more exercise. Whether she is diagnosed or not, she knows that her cycle is playing a role in her mental health, and she will continue to pay attention to her needs.

Think you have PMDD? Impart Therapy specialized in DBT and CBT therapy treatments for PMDD and PMS-related issues. Learn more here: www.imparttherapy.com – Pmdd, Therapy