Are you bipolar or do you have premenstrual dysphoric disorder?
I would normally say I’m a happy person, but the year I was diagnosed with PMDD, nothing was normal.
We weren’t just in a global pandemic. My two children were going through the process of being diagnosed with autism spectrum disorders, and my eldest child was awaiting testing for a genetic disorder. When I started having mood swings, it seemed like a natural by-product of the level of stress I was going through as a single parent under those circumstances.
When the mood swings turned into suicidal ideation, I knew things were bad, but I couldn’t understand why. My impulse control didn’t seem to work, I was crying more than I’ve ever cried in my life, I was forgetting things I should have remembered, and I was exhausted all the time.
Then, without explanation, I was fine. I was better than fine. I was happy and full of energy and I couldn’t even understand what had made me so sad.
Understanding Overlapping Symptoms
With such symptoms, it’s not hard to see why so many people, especially women, are diagnosed with bipolar disorder. There are many similarities.
- Both PMDD and bipolar disorder occur in cycles.
- Both disorders alternate between depressed and manic energy.
- Both even have components of suicidal ideation.
- Both include depression and loss of interest in normal pleasures.
- Both include periods of excessive fatigue and periods of high energy.
- PMDD and bipolar disorder include brain fog and low self-esteem as symptoms during depressive phases.
These overlapping symptoms often lead medical professionals to jump to an immediate conclusion and diagnose patients as bipolar. It is possible for individuals to have one or both disorders with or without premenstrual exacerbation. Imagine being a medical professional trying to decide which symptoms tick which box and which diagnosis is the correct one.
How to tell if you have PMDD
It’s not hard to see how confusing getting the correct diagnosis can be. Yet, there is a key difference that sets PMDD apart and should be ruled out before deciding on a default bipolar diagnosis. It comes down to the cycle itself.
While bipolar disorder is completely unpredictable, PMDD works like clockwork. It begins during the luteal phase of menstruation, about 14 days out of a 28-day cycle. It lasts until the week following the period.
When I was trying to figure out my mood swings, I started using a mood tracker that I got in a subscription box.
Every day I had to color a space to indicate my mood. After mapping my moods for two months, a clear pattern emerged.
Happy colors dotted the calendar until a week or two before my period, then the pattern changed to sad and angry colors until a few days of bleeding. The pattern was so specific that I realized I probably had PMDD.
I had the advantage of being a former therapist. I had a rudimentary knowledge of the PMDD. I didn’t remember much, but I knew of its existence. When I saw the diagram, I immediately made an appointment with a gynecologist to confirm my suspicions.
PMDD is more than a cyclical mood disorder. It is considered a neuroendocrine disorder because the brain is unable to deal with hormonal changes.
It’s as if the body suddenly becomes allergic to normal hormonal fluctuations. Although this disorder is related to hormone fluctuations, it is not a hormonal imbalance. The cyclical nature may initially lead clinicians to consider bipolar, but without tracking symptoms it is impossible to make this decision.
The real reason for bipolar is the default diagnosis
Continued misogyny could cause medical professionals to dismiss symptoms as less severe premenstrual syndrome (PMS) or attribute symptoms to stress or another mental health issue. Although the days when women were formally diagnosed with hysteria are over, gender bias is still very much alive.
In fact, a 2019 article in Biol Psychiatry by Baller and Ross summarizes the problem:
“The real mystery is how we manage to under-screen and under-treat a disease that affects 5% of all women and accounts for 14.5 million disability-adjusted life years lost in the United States. every year. Perhaps we are still attached to our societal values regarding the validity of the condition. Or perhaps women are generally resilient enough to accomplish what they need despite the strain PMDD places on their personal and emotional lives.
Baller and Ross point out that research on PMDD only began in the 1980s and was not included in the Diagnostic and Statistical Manual of Mental Disorders until 2013. Gender bias in the medical industry means that conditions specific to women are underresearched and underfunded. Although erectile dysfunction affects less than 20% of men, it is still five times more researched than PMS, which affects more than 90% of women.
Gender bias is just the tip of the iceberg. Racial prejudice further widens the gap for women of color. Because research is not devoted equally to all genders, disorders like PMDD are often underdiagnosed, dismissed, or ignored. We might as well be labeled hysterical by the seriousness with which many medical professionals take this diagnosis.
What to do if you think you have been misdiagnosed
There’s a reason a bipolar diagnosis won’t treat your PMDD. Treatment for bipolar disorder includes anticonvulsants, antipsychotics, and SSRIs. Treatment for PMDD focuses on SSRIs. Bipolar and PMDD treatment recommends ongoing therapeutic support, but Bipolar recommends support groups and hospitalization as needed.
If you think you’ve been misdiagnosed, here are some steps you can take.
1. Get a second opinion
You have the right to get a second opinion. In fact, it is recommended that you get one if you have any doubts. Find a healthcare professional you feel you can trust. If you feel like your concerns are being dismissed by your current doctor, it may be time to find someone new for treatment. You will need to be your best advocate throughout the diagnostic process.
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2. Track your symptoms
While tracking symptoms daily for at least two months can be tedious, it is one of the defining criteria for the diagnosis of PMDD. It could also help your doctors decide if you might have both bipolar and PMDD or another condition. Be proactive with your health by tracking changes.
3. Find an advisor
If you don’t already see an advisor, it might be time to seek one out. Whether you have PMDD or are bipolar, the support of a mental health professional could be invaluable to your treatment. Learning to manage the symptoms could save your life.
4. Take care of yourself
Whether you are experiencing symptoms of any of these disorders, self-care is essential. Navigating the ups and downs of these troubles is exhausting and often disheartening. Make a plan for how you will handle the tough days.
PMDD and bipolar disorder are not interchangeable. Nor should diagnostics be.
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Crystal Jackson is a former family therapist who writes across genres to encompass blog posts, poetry, short stories, children’s books, and literary fiction.