Health is an important part of every human life. Even disorders such as Premenstrual Dysphoric Disorder (PMDD) affect health. Research regarding PMDD is limited. To help further the understanding of PMDD, two hundred University girls across The United States from ages 19 to 45 that suffered from both Depression and PMDD, PMDD alone, and Depression alone were taken as participants for the study to answer the question of how does comorbidity affect PMDD. The study compared the symptoms of those who had PMDD comorbid with Depression against the symptoms of those who only experienced PMDD every month, for a one-year period. The prediction is that there will be a difference in the expression of symptoms between the two groups. However, one problem that this study faces is separating comorbidity from symptom exacerbation. Further research regarding the exacerbation of Depression symptoms against PMDD comorbid with Depression is needed to strengthen the understanding of PMDD.
Health is an important issue that affects everyone in the world and is widely discussed in the media and even within interpersonal relationships. There are things to help assist humanity in keeping healthy, such as diets, exercising and going to the gym, yoga, seeing the doctor for an examination and getting a flu shot, and medicine. There are supplementary vitamin pills to help a person get the needed daily intake of vitamins, made also accessible for children in chewable form. All of the abundant provisions, program, and routines emphasizes just how important health is. Even the most basic primitive instincts of eating and sleeping aids in health, and there are no human beings alive healthy enough to prove otherwise.
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There are many actions one can take to improve health, as stated above. However, there are times when acting doesn’t seem to help, or at least only help temporarily. When a person develops a disease or contracts a virus, sometimes eating healthy and exercising is not enough to get rid of the disease and virus. Sometimes going to the doctors and getting professional help might not solve the health problem either. An example of this can be Acquired Immune Deficiency Syndrome (AIDS). There are only ways to prevent so done from getting AIDS, but when a person has it, they will always have it. Other than diseases and virus, there are also disorders that pose a threat to health. Disorders are described as psychiatric and affects the mind and body together to the point in which the disorders actually cause a disruption in the daily life (Stein et al., 2010). Some examples include Depression, Anxiety, Bipolar, and Borderline Personality disorder. Although disorders can affect anyone, women are more likely to suffer from mood and anxiety disorders, and men were more likely to suffer from antisocial and substance disorders (Eaton et al., 2012).
There are four different phases within the menstrual cycle (Department of Health and Human Services, 2018). First there is the Menstrual Phase, which lasts on average of five to seven days and is when the uterus sheds (Watson, 2018). Next is the Follicular Phase, which is when the egg cell in the ovaries start to grow and mature (Duchesne, Pruessner 2013). The third phase is the Ovulation Phase, where a female is ready to reproduce (Ryu, Kim, 2015). The final stage is the Luteal Phase, which is when the egg awaits to be fertilized, or dies out, marking the repetition of the menstrual cycle (Department of Health and Human Services, 2018). The Luteal Phase is when the premenstrual syndrome occurs (Epperson, Steiner, Hartlage, et al., 2012). Premenstrual Syndrome (PMS) is something that girls entering the reproductive age go through (Cleveland Clinic, 2018). PMS is categorized by bloating, pain, irritability, hypersomnia/insomnia, a lack of energy, and more (Casper, 2017). Premenstrual Dysphoric Disorder (PMDD), is a more severe form of PMS and is sometimes referred to just a severe PMS. PMDD affects 3% to 5% of girls, where the symptoms are disruptive enough to interfere with work and interpersonal relationships (Cleveland Clinic, 2018).
Research regarding PMS/PMDD is lacking despite the prevalence (Forrester, 2011). The lack of understanding regarding PMS can be explained partly by comorbidity, which is when two or more disorders are present within a patient. All disorders included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) have one important criterion stating that symptoms of a disorder a person is experiencing cannot be influenced by any other disorder. Since symptoms of PMS are similar to the symptoms of Major Depressive Disorder (MDD) and Bipolar Disorder, there are split views regarding the validity of PMDD (Daw, 2002). Some psychologists question if the symptoms of PMDD results directly from PMDD, or if having PMS heightens symptoms of MDD, Bipolar, and other disorders, making the symptoms more noticeable and mistaking and classifying the symptoms as a different disorder (Daw, 2002). This is known as exacerbation.
Symptom expression between PMDD, Bipolar, and Depression
PMS/PMDD share similar symptoms with both Depression and Bipolar disorder and can be difficult to distinguish where the symptoms are resulting from (Daw, 2002). However, to discern the three PMS/PMDD, Depression, and Bipolar apart, one must take into consideration the time in which symptoms occur (Department of Health and Human Services, 2018; Kerr, 2017; Mayo Foundation for Medical Education and Research [MFMER], 2018). When looking at severe PMS, most symptoms occur in the late monthly Luteal Phase, classifying symptoms as cyclical (Department of Health and Human Services, 2018), meaning that the symptoms have a certain time where they are expressed and not expressed and in the case of PMDD, they are expressed monthly during the Luteal phase of the Menstrual cycle. Depression symptoms are more persistent, episodic or having irregular time intervals, and occurs almost every day during episodes (MFMER, 2018). Symptoms of Bipolar disorder also occur in unrelated episodes but is also accompanied with drastic mood changes (Kerr, 2017). To clarify, if a biological female with comorbidity experiences fatigue while being in the Luteal phase of the menstrual timeline and has been occurring during that time monthly, fatigue is most likely caused by PMS/PMDD. On the other hand, if there is no connection or pattern to the expression of fatigue, the symptoms can be a result from either Depression or Bipolar. The same can be said for the other symptoms that the three disorders share.
In order to understand the importance of PMDD comorbid with other disorders, a few psychologists compared the symptoms experienced during the Luteal phase by patients with different levels of PMS, severe being equal to PMDD (Firoozi, Kafi, Salehi & Shirmohammadi, 2012). They found that overall, participants with PMS experienced more symptoms that are usually expressed in psychotic disorders than participants who were healthy and do not experience any kind of PMS (Firoozi et al., 2012). In addition, the number of participants with severe PMS was greater than those who had mild PMS, and rated the psychotic symptoms as having a greater impact in their lives similar to Bipolar Disorder and MDD (Firoozi et al., 2012). Firoozi’s experiment provides support that PMDD comorbid with other disorders should not be overlooked as exacerbation, and that women with PMS should be medically treated with care (Firoozi et al., 2012).
Taking into consideration the relationship between PMDD and Bipolar and Depression, there needs to be research focused PMDD comorbid with Depression, and PMDD comorbid with Bipolar. However, since the Bipolar disorder has a manic and a depressive side, and includes mood swings, it will be difficult to accurately study Bipolar Disorder and how it works alongside PMDD (Kerr, 2017). When looking at PMDD comorbid with Depression, one study finds that 25% of medical students in a sample has experiences PMDD, and of those 25%, some have PMDD comorbid with Depression (Jee, Bara, & Bakhla, 2017). Another experiment shows Depression as being one of the most significant disorder to be comorbid to PMDD, with an odd ratio of 4.70 (Hong et al, 2012). This means that the rate or ratio in which those with PMDD also having depression is high. One component that both studies lacks however, is the fundamental influence depression has on PMDD. Therefore, how must expression of symptom differ within the Luteal phase from those with PMDD alone than those with PMDD comorbid with Depression?
This study is a correlational research in which symptoms of PMDD is measured over a one-year basis.
To gather participants, emails were sent out via college’s and university’s emailing system mentioning the requirements and exclusion. A random sample of 200 from those who responded to the email were chosen as participants via a random number generator, in which each respondent was assigned a number. Factors such as race, ethnicity, weight, height and family background were not taken into consideration.
Two hundred university girls throughout the United States of America were examined for the study. Their ages ranges from 19 to 45 years old. For the exclusion criteria, any girls taking birth control pills or other hormonal pills were excluded from this study. Females who do not experience PMS or a menstrual cycle as well as those who experience an irregular premenstrual cycle were also disqualified from the study.
No technological equipment was used other than the Statistical Package for the Social Sciences (SPSS) to analyze all data in a factorial analysis of variance (ANOVA). To measure the symptoms of Depression and PMDD, a total of three different questionnaires were used. To measure PMDD, the Premenstrual Symptoms Impact Survey (PMSIS) was used which is a survey regarding the different impacts of PMS before the onset of menstruation. The PMSIS survey is accurate in distinguishing the different levels of PMS with a sensitivity and specificity level nearing 0.90 (Wallenstein, et al., 2008). The Mood Disorder Questionnaire (MDQ) was used to detect the presence of other mood symptoms to aid in distinguishing with symptoms were expressed most during the Luteal phase within participants. It is usually used in detecting Bipolar disorder. It’s accuracy in detecting Bipolar within patients was near 0.60 in sensitivity and 0.70 in specificity (Miller, Klugman, Berv, Rosenquist, & Ghaemi, 2004). Another research done to test the accuracy and validity of the MDQ had results of a 0.70 in sensitivity and a 0.90 in specificity (Hirschfeld, et al., 2000) This questionnaire is not recommended to detect those with a mild form of bipolar disorder and so will be used as a general symptom tracker. Depression was measured by The Symptoms of Depression Questionnaire (SDQ) and had a high validity in face and concurrent aspect, as well as high validity, and with a p value of p < .01 in test-retest reliability (Pedrelli, et all., 2014). All three tests are self-reported.
This study is broken down into two sessions. The first session is an online screening to determine eligibility to proceed to the second session and categorize participants. Participants will be required to fill out the PMSIS, MDQ, and SDQ. When taking the PMSIS, participants are asked to think about their most two recent menstrual cycle. Participants will also answer a few demographic questions regarding their age, major in school, race, and ethnicity for sorting and organizational purposes that can also be used for further research. The participants whose score do not show that they have either Depression comorbid with PMDD, Depression alone, or PMDD alone were not sent a continuation letter for session two.
After passing the screening in the first session, participants are emailed with and informed about the second session. Participants were then broken down into three groups. They were not informed of what groups they were put into or about their scores on the three tests during the duration of the study. This is to prevent any biases an individual might have in evaluating themselves. Those who tested positive for PMDD alone via the PMSIS will serve as the control group. Those who tested positive for Depression and PMDD via the PMSIS and SDQ will serve as a different comparison group. Those who tested positive for Depression alone via the SDQ will serve as the third comparison group. All subjects are required to take the PMSIS and the MDQ for their upcoming premenstrual cycles for the duration of twelve months. The data will then be calculated for the average responses between two consecutive months in order to differentiate any cycles that were not as severe to be considered as PMDD for a total of six different cycle assessments. Any participants who did not reach report positive for PMDD at least in three assessment cycles within the year were not taken into consideration when analyzing the data. If participants menstruation occurred during the interval of the first and second session, they are two use that cycle for the first month. If participants menstruation occurred before the start of the first session, they are to use their next cycle for the first month.
It is predicted that participants with PMDD comorbid with Depression will show more psychotic symptoms relating to depression and rating the symptoms as more severe than the other two groups. The lack of control for exacerbation makes this study incomplete, and further research needs to be done in order to understand PMDD comorbid with other disorders against exacerbation
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