Christina Bohn was a star: classical singer, pianist, tennis player, high school salutatorian and valedictorian of her university’s college of nursing, a lover of God, a mother of two and a nurse who supported her husband through law school.
She also suffered to a severe degree from premenstrual dysphoric disorder, or PMDD.
Unfortunately, it took years to reach that diagnosis. In what would be the last year of her life, her mental health worsened, and she had to leave her family and move home with her parents while she was in and out of inpatient behavioral health treatment.
It took years and multiple attempts on her own life before Christina’s mother, Marybeth, realized that her daughter’s symptoms coincided with the post-ovulation phase of her menstrual cycle and that as soon as she started bleeding, her symptoms vanished.
But identifying PMDD wasn’t the end of their troubles. In the months that followed, Christina and her family butted up against doctors who were poorly informed or unwilling to take the diagnosis seriously – and at the last, an insurance company denied the hysterectomy with oophorectomy (removal of ovaries) which was her last hope of treatment.
Christina took her life the day after that hope was taken away.
Her parents dedicated the remainder of their lives to increasing awareness of PMDD. Which was how I came to be sitting in the basement at my son’s girlfriend’s birthday party last August, talking with Marybeth Bohn for hours about her daughter, PMDD and their advocacy efforts. I knew that night I wanted to share what I was learning here, in this TOB (theology of the body) community. Because we who believe that our bodies are holy, made to make the invisible visible, also know that our hormonal cycles have a very real impact on how we reflect God in real, concrete ways in the world.
So let’s take a minute to ask: What exactly is premenstrual dysphoric disorder?
It is a hormone-based mood disorder, characterized by a severe negative reaction to the hormone changes over the course of a woman’s menstrual cycle. It is not a hormone imbalance. It can manifest at any time, from the onset of menses to menopause, but major changes can trigger it: pregnancy, birth, miscarriage, perimenopause.
Symptoms for PMDD only appear during the luteal phase (the time between ovulation and the next menstrual period) and are relieved with the onset of bleeding or within a few days after. Some women also have Premenstrual Exacerbation, PME, which causes symptoms of other mental health issues to be exacerbated during the luteal phase. Around 1 in every 20 women are believed to suffer from PMDD. Most are misdiagnosed. On average it takes 12 years to receive a diagnosis. One in three women with PMDD will attempt suicide.
What are the symptoms? They can be legion, but a diagnosis requires the presence of five out of a long list, at least one of which comes from a group of “core” symptoms: mood or emotional changes; irritability, anger, or increased interpersonal conflict; depression or feelings of hopelessness; or anxiety.
I imagine savvy NFP (natural family planning) users among us have already identified the problem with diagnosing PMDD: all of these overlap with PMS (premenstrual syndrome) symptoms, things faced by many – perhaps even most – women.
And therein lies the first problem with PMDD: it ties into negative cultural stereotypes about women and cycles. There will always be people who want to dismiss it as women being dramatic about their cycles.
I’ll dive into this more in Part 2, but for now I want to conclude with the analogy Marybeth Bohn uses to help people understand the difference: PMS is like high tide; PMDD is like a tsunami.
Next week I’ll be back to reflect on PMDD in light of the theology of the body. Until then, check out iapmd.org.