Suicidal thoughts and behaviors are associated with hormone-sensitive brain damage

Summary: A new study shows that 34% of people with premenstrual dysphoric disorder (PMDD) have attempted suicide. Researchers say that PMDD is an independent contributor to suicidal ideation and behavior.

A source: University of Illinois

A new global study published in BMC psychiatry 34% of people with pre-existing dysphoria report attempted suicide.

The study is the largest and most reliable method currently available to study the level of suicidal ideation and behavior among people diagnosed with the disorder by a health care provider based on daily symptom ratings.

Previous research on suicide and suicidal ideation, commonly known as PMDD, relies on less well-reported self-reported measures of premenstrual dysphoria, and the new findings provide the strongest scientific evidence that it is likely to contribute independently to confusion and suicidal thoughts and actions. .

Tori Eisenlohr-Moule, assistant professor of psychiatry at the University of Illinois at Chicago, said: “We have identified a very worrying level of suicidal ideation and behavior among patients with PMDD, which underscores the need to take this issue seriously.” to read.

“These findings provide strong evidence that the link between PMDD and suicide is independent of depression, post-traumatic stress disorder, or other mental health conditions that enhance thought and action.”

Premenstrual dysphoria is a cyclical, hormone-based disorder that affects 1 in 20 women of childbearing age. The condition is usually misdiagnosed, misdiagnosed, or completely ruled out by medical professionals within two weeks, despite patient reports of debilitating anxiety, frustration, and various physical symptoms.

To better understand PMDD, the researchers analyzed data from a global study of premenstrual disorders that included 3,153 people from 56 countries and more than 2,000 responses.

The survey was conducted by the International Association, Me v PMDD and Vicious Cycle to help understand the scale of premenstrual disorders and the effects of PMDD.

Analysis of data provided by 599 respondents showed that 34% of PMDDs reported a diagnosis of PMDD based on a daily rating by a health care provider (23%) attempted suicide during an PMDD episode. On average, patients waited 12 years and saw about six providers before receiving an accurate diagnosis of PMDD.

The data also showed high rates of active suicidal ideation (72%), planning (49%), intention (42%) and preparedness (40%) and suicide (51%) among patients. With a diagnosis of PMDD.

Low- and middle-income, a history of severe depression, or post-traumatic stress disorder and infertility – never having children – predict active suicidal thoughts and actions throughout life. Older age and borderline personality disorder were additional predictors of lifelong effort.

Indicators of self-harming thoughts and behaviors were also differentiated by people with PMDD and those with PMDD, who reported that they had been diagnosed with at least one mental health condition, such as depression.

The rates were also higher among those who had never received another diagnosis of mental health: 67% reported active suicidal ideation, for example, 74% with mental illness.

Eisenlohr-Moule said he would see a much larger difference in rates between categories if only thoughts and behaviors, and even more often other mental health problems, were involved.

Evidence suggests that women who are neurobiologically sensitive to hormonal changes may have a higher risk of suicidal thoughts and behaviors, such as PMDD.

Eisenlohr-Moule, chairman of the IAPMD’s Clinical Advisory Board, said: “One of the big problems with PMDD is that the medical community is not only slow to understand the condition, but even to believe that it exists.”

“Providers and communities often ignore patients’ concerns, partly because women’s complaints are not taken more seriously than men’s, and because of persistent and even sexist stigma and misconceptions about menstruation in general.”

Premenstrual dysphoria is a cyclical, hormone-based disorder that affects 1 in 20 women of childbearing age. Image in public domain

“PMDD is not a hormonal imbalance. It is a neurobiological sensitivity to natural and normal changes in progesterone and estrogen levels,” he said.

“Our research shows how destructive PMDD is,” said Sandy McDonald, founder and executive director of the International Association of Menstrual Disorders.

“This is a women’s health movement. PMDD is #MeToo and #TimesUp, the perfect storm to respond to mental health information and prevent suicide. ”

PMDD has been included in the diagnostic and statistical guidelines for mental disorders since 2013 as a major depressive disorder, and there is still no recommended standard screening for suicidal ideation in patients with this disorder.

Funding: The study was supported by grants from the National Institute of Mental Health (R00MH109667, RF1MH120843, R01MH122446 and K01MH116325). Eugene Washington of the International Association of Menstrual Disorders received funding through the PCCORI Engagement Award (EA20240).

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Author: Jacqueline Carey
A source: University of Illinois
The connection: Jacqueline Carey – University of Illinois
Photo: Image in public domain

Original study: Open access.
“Prospective confirmed diagnosis of premenstrual dysphoric disorder in a global sample of 599 patients with prevalence of lifelong self-harming thoughts and behaviors” by Tori Eisenlohr-Moul. BMC psychiatry


The prevalence of life-threatening thoughts and behaviors in a global sample of 599 patients confirmed the diagnosis of premenstrual dysphoric disorder.


Suicide is the second leading cause of death among Americans aged 10 to 34, and the number of suicides among women who have recently given birth has increased. Evidence suggests that the menstrual cycle affects self-harming thoughts and behaviors (HSS), and that sensitivity to neurobiological hormones, such as premenstrual dysphoric disorder (PMDD), can increase a woman’s risk of suicide.

However, existing PMDD studies on PMDD use cross-sectional self-reporting measures for poorly justified PMDD. As a first step towards accurate estimates of the prevalence of PMDD in PMDD, we identified the lifetime prevalence of PPD in a large global survey of patients diagnosed with PMDD based on daily ratings.


Individuals with self-reported PMDD symptoms were invited to an online survey through online support groups for PMDD and social media messages from PMDD information accounts. Participants reported demographic data, whether they were diagnosed with PMDD by the health service using daily ratings, STBs using the Colombia Suicide Severity Rating Scale, and a history of lifelong psychiatric diagnoses.


Of the 2,689 survey graduates, 599 (23%) reported a diagnosis of PMDD based on two-month daily ratings and included analyzes. We have active lifelong suicidal ideation (72%), planning (49%), intention (42%), preparedness for action (40%) and effort (34%), as well as non-suicidal ideation (51%). .

The majority of samples (70%) reported a psychiatric diagnosis accompanied by at least one lifetime. Predictors of lifelong active suicidal ideation include disability, low-to-average (relative to higher) income, and a diagnosis of severe depression or post-traumatic stress disorder.

Among those who expressed active lifelong ideas, lifelong predictors included old age, disability, low income, and a history of post-traumatic stress disorder or borderline personality disorder.


These data indicate high NDA rates among those who report a promising diagnosis of PMD and the need for further research on the mechanisms and prevention of PMD. Clinical practical guidelines for PMDD should include concomitant disease and recommend frequent screening for STI risk. The SDG should be considered for inclusion in future iterations of the DSM PMDD diagnostic criteria.

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