The Role of Sexual Abuse in PMDD

David R. Rubinow, M.D.

No one needs to be told that abuse is not good for your health.  Recent studies, however, have revealed a new possible consequence of abuse, namely premenstrual dysphoria [1-4].  Further, it looks like PMDD  not only represents an enduring lesson that the body has learned from the stress surrounding abuse, but PMDD also “rewires” the effects of  abuse from those seen in the absence of PMDD [5].

These conclusions emerge from several lines of evidence.  First, decades old studies identified a link between abuse and PMDD, with a greater proportion of PMDD reporting a history of physical or sexual abuse compared with women without PMDD [4].  Second, women with a history of PMDD and abuse have higher pain sensitivities and a significantly increased prevalence of migraine with aura, but women with an abuse history lacking PMDD fail to show these increased rates of pain sensitivity [5].  Third, women with a history of PMDD and abuse have multiple measures of disturbed cardiovascular function both at baseline and after challenge tests, but abuse does not predict these enduring physiological differences in women without a history of PMDD [6].

How can we make sense of the special physiological state that appears to accompany the combination of PMDD and history of abuse?  As inferred from studies showing persistent hormonal consequences of combat in men and abuse in women, genetic vulnerability coupled with severe stress may contribute to these disorders [7].  According to this model,  genetic factors that may influence resilience or stress maladaptation are likely separate from those that cause hormone sensitivity (the source of PMDD), but these genetic “systems” are nonetheless capable of interacting with each other to generate very specific (albeit distributed) biological effects. Thus the enduring biological effects of women with PMDD and a history of abuse are different from those seen in women with solely a history of one condition or the other.  Another possibility would suggest that the recurrent experience of symptoms in PMDD (rather than the genetic predisposition to PMDD) might interact with either the physiological consequences of abuse or the absence of protective, resilience factors to yield the abnormalities observed.

In either case, there are several important take-home messages. First, it is likely that the recurrent symptoms of PMDD are not without enduring, physiological impact, much as has been demonstrated for abuse histories.  And second, understanding the means by which different stress-linked disorders interact – either at the level of susceptibility or recurrent symptom expression – will be critical to our ability to identify and prevent the risks to health that women with abuse and PMDD experience.

  1. Paddison, P. L., Gise, L. H., Lebovits, A., Strain, J. J., Cirasole, D. M., & Levine, J. P. (1990). Sexual abuse and premenstrual syndrome: comparison between a lower and higher socioeconomic group. Psychosomatics31(3), 265-272.
  2. Golding, J. M., Taylor, D. L., Menard, L., & King, M. J. (2000). Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome. Journal of Psychosomatic Obstetrics & Gynecology21(2), 69-80.
  3. Koci, A., & Strickland, O. (2007). Relationship of adolescent physical and sexual abuse to perimenstrual symptoms (PMS) in adulthood. Issues in mental health nursing28(1), 75-87.
  4. Perkonigg, A., Yonkers, K. A., Pfister, H., Lieb, R., & Wittchen, H. U. (2004). Risk factors for premenstrual dysphoric disorder in a community sample of young women: the role of traumatic events and posttraumatic stress disorder.The Journal of clinical psychiatry65(10), 1314-1322.
  5. Fleischman, D. S., Bunevicius, A., Leserman, J., & Girdler, S. S. (2013). Menstrually Related Mood Disorders and a History of Abuse: Moderators of Pain Sensitivity.
  6. Girdler, S. S., Leserman, J., Bunevicius, R., Klatzkin, R., Pedersen, C. A., & Light, K. C. (2007). Persistent alterations in biological profiles in women with abuse histories: influence of premenstrual dysphoric disorder. Health psychology: official journal of the Division of Health Psychology, American Psychological Association26(2), 201.
  7. Heim, C., Newport, D. J., Bonsall, R., Miller, A. H., & Nemeroff, C. B. (2003). Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. FOCUS: The Journal of Lifelong Learning in Psychiatry1(3), 282-289.
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2 Responses to The Role of Sexual Abuse in PMDD

  1. PMDD Sufferer says:

    I am glad someone is finally taking this problem seriously. I had a history of abuse and severe PMDD mood problems (also during pregnancy, so maybe it’s caused by progesterone sensitivity) and it’s downright insulting to be told I have MDD or need to just make “lifestyle changes” such as diet and exercise more, implying that I’m fat and lazy. Do they honestly think I haven’t tried literally everything already? I am in my thirties, and for about two weeks each month I CAN’T FUNCTION and it’s been apparent since I was 11 or 12. How is this fair in modern society with all the additional economic burdens I am expected to carry when just FUNCTIONING is hard enough?

    Also, I have officially deleted the wordpress account that wordpress forced/bullied me into posting from, without allowing me to edit it. Good job with free speech, WordPress.

    • I’m very sorry to hear about your suffering. Abuse is perhaps the most powerful and destructive means of reprogramming the brain. Regrettably, this fact remains hidden among the misplaced values of our political system. I hope you are able to obtain some relief.

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