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Variations in the Taylor MAS of women with pre-menstrual syndrome
Abstract
The Taylor Manifest Anxiety Scale was administered to 28 women with the Pre-menstrual Syndrome, and to 22 controls. The TMAS was administered four times within three weeks of the menstrual cycle (twice during the pre-menstrual period). It was found that women with PMS had higher scores on the TMAS during the entire cycle. These scores also rose during the pre-menstrual period. It was concluded that: (a) women with PMS are more anxious, (b) the TMAS may not be a reliable instrument for measuring trait anxiety.
... For many women, symptoms are of sufficient severity to cause functional impairment and a good deal of subjective distress (e.g., Harrison, Sharpe, & Endicott, 1985). Women high in these self-reported symptoms have higher scores on trait anxiety (Halbreich & Kas, 1977) and neuroticism scales (Gough, 1975) than women reporting less severe symptoms. ...
Groups of women differing in the severity of reported premenstrual symptoms were compared over two menstrual cycles on a digit-span task, a visual-search task, and a combination of the two. Neither group exhibited large performance changes during the premenstrual phase of the cycle. High-symptom women differed somewhat from low-symptom women in the effect of menstrual phase on digit-span performance, recalling slightly fewer series correctly during the premenstrual phase. The response latency of high-symptom women on the visual-search task was substantially longer than that of the low-symptom women regardless of menstrual phase. These results suggest that there may be stable differences between high-symptom and low-symptom subjects that are greater than the cyclical fluctuation within either group.
... It has been shown that women with severe late-luteai deteriorations score higher on neuroticism as measured by standard personality inventories (Coppen & Kessel, 1963;Rees, 1953). Moreover, trait anxiety has also been found to correlate with the repeated experience of premenstrual dysphoria (Goudsmit, 1983;Halbreich & Kas, 1977;Watts et al., 1985). Evidence is accumulating that women with premenstrual complaints are also more distressed during the rest of their cycle when compared with women without premenstrual complaints (Rosen et al., 1988(Rosen et al., , 1990; Van den Akker & Steptoe, 1985). ...
The relationship between stress and changes in insulin levels, plasma ratio of tryptophan to other large neutral amino acids (LNAAs), mood, and food intake was investigated in women taking monophasic oral contraceptives containing progestagens. Subjects experiencing high levels of stress displayed significant decreases of insulin and tryptophan to other LNAAs ratios, before and after the consumption of a standard meal during the pill-free period as compared with the period of pill use. The decline of the tryptophan to other LNAAs ratio was accompanied by worsening of mood. In a control group of subjects experiencing low levels of stress there was no relationship between insulin and tryptophan to other LNAAs ratio, nor between tryptophan to other LNAAs ratio and mood. These results suggest that the combination of stress and alterations in sex hormones may be responsible for mood changes during the pill-free period in women taking oral contraceptives.
The effect of the menstrual cycle on mood and behavior has been the subject of extensive study. The nature and etiology of physiological and psychological cycle related changes have been widely debated. The assumption that biological explanations are adequate and that the medical model is appropriate for these cyclic disorders has been questioned. Psychologists have been involved in much of the research which has stimulated more flexible thinking and generated a move away from a strictly medical model. With these changes clinical psychologists have gradually become more involved in working with women complaining of cyclic symptoms.
Besonderes Forschungsinteresse hat in den letzten Jahren der Komplex von psychischen und somatischen Symptomen erweckt, der üblicherweise als „prämenstruelles Syndrom“ zusammengefaßt wird, seit Frank (1931) mit seiner Arbeit „Hormonal causes of premenstrual tension“ die diesbezügliche Forschung inspiriert hat. Insbesondere hinsichtlich der Ursachenforschung werden verstärkt Anstrengungen unternommen, wobei sowohl biologische und hormonelle als auch psychodynamische und persönlichkeitsbedingte Faktoren untersucht werden. Eine Konsequenz aus dem verstärkten Interesse am prämenstruellen Syndrom ist die Aufnahme einer Kategorie „Dysphorische Störung der Späten Lutealphase“ im DSM-III-R in der Rubrik „Vorschläge für diagnostische Kategorien, die weiterer Forschung bedürfen“ (APA 1989), womit „weitere systematische klinische Studien und Forschungsarbeiten“ angeregt werden sollen.
Forty–two women seeking a diagnostic evaluation for premenstrual syndrome provided daily symptom ratings for two or more menstrual cycles. The Personality Diagnostic Questionnaire–Revised (PDQ–R) was completed in the follicular phase; 10 women also completed the PDQ–R in the luteal phase of the same menstrual cycle. The follicular PDQ–Rs indicated a high prevalence of personality dysfunction. Although follicular personality dysfunction was correlated with severity of premenstrual symptoms, personality dysfunction was not significantly associated with the diagnosis of either premenstrual syndrome (PMS) or late luteal phase dysphoric disorder (LLPDD). There was no significant change in the severity of personality dysfunction across the menstrual cycle regardless of the diagnosis of either PMS or LLPDD.
For centuries, and still at present, the social history of premenstrual syndrome (PMS) and phenomena is entangled with the social history of gender relations. At of the turn of the 20th century there have been two main approaches to PMS: a biomedical–hormonal school which emphasizes the reproductive‐related biological aspects of PMS, and several psychosocial schools initially influenced by psychoanalytically‐oriented interpretations of phenomena. During the last several decades several feminist writers incorporated PMS, or more precisely denial of its existence, into their agenda. Currently, a biosocial approach to PMS is being shaped integrating genetic preponderance with dynamically evolving vulnerability, internal and external environments, hormonal triggers, brain–body responses and culturally‐sensitive phenomena. Hopefully exponentially accumulating facts and knowledge will overcome opinions and lead to a balanced approach to PMS and women's reproductive‐related disorders in general.
Despite the widespread recommendation of exercise as a treatment for the premenstrual syndrome (PMS), empirical evaluations of the effectiveness of exercise are few and those outcome studies that have been published are vulnerable to serious criticisms. In the present investigation, 19 women who exercised regularly were compared with 20 sedentary women. PMS was measured prospectively, using the Modified Menstrual Distress Questionnaire, across the follicular and luteal phases of the menstrual cycle. Also, trait anxiety was assessed using the State-Trait Anxiety Inventory. Analyses by χ showed that the proportion of women reporting PMS did not differ significantly between the exercise and sedentary groups. However, analysis of variance with post hoc tests showed that for women with PMS, involvement in exercise was linked to significantly reduced anxiety. These findings suggested that the widespread view of exercise as an effective treatment for PMS could stem predominantly from its anxiety-reducing effects.
Subjects complaining of premenstrual symptoms have been reported to vary from control subjects on a number of personality characteristics. Premenstrual symptom reporters have scored more highly on scales measuring neuroticism, trait anxiety and on the General Health Questionnaire (GHQ).
This study reports the scores on the Eysenck Personality Questionnaire (EPQ) N and L scale, the State Trait Anxiety Inventory (STAI) scales and the GHQ in luteal and follicular phase.
Premenstrual symptom sufferers were found to have significantly higher scores on all measures in both luteal and follicular phase. Premenstrual symptom sufferers also score more highly on both the STAI State and Trait Scales in luteal phase than in follicular phase. There were no significant differences in the GHQ or EQP N or L scale between cycle phases. Control subjects showed no significant difference in scores between cycle phases.
Eighty-nine women seeking a diagnostic evaluation for premenstrual syndrome provided daily symptom ratings for two or more menstrual cycles. Three scoring methods were used for assessing symptom change associated with the late luteal phase of the menstrual cycle. Diagnoses of late luteal phase dysphoric disorder (LLPDD) were considered using the DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) criteria. Lifetime mental history data were collected using the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). We sought to determine whether women seeking evaluation for premenstrual complaints, but who did not meet the criteria for LLPDD, in fact displayed a higher incidence of psychiatric disorders or symptomatology. Depending on the criteria for scoring symptom severity, 13–28% of the women met criteria for LLPDD. A present or past episode of a psychiatric disorder was present in 45% of the women. Psychiatric diagnosis was not significantly associated with the presence or absence of LLPDD. Specific symptoms of the various psychiatric disorders were not significantly associated with the report of similar LLPDD symptoms.
Emphasizes theories that are relevant to clinical diagnosis of and treatment for women who complain of dysphoric PMS. The article attempts to answer the following questions: What is the normal menstrual cycle and its associated changes? What can go wrong? Why do not all women have PMS? What is the association between dysphoric PMS and mental disorders? Which menstrually related processes might be related to dysphoric PMS? The main hypotheses concerning the cause of PMS, including the role of the gonadal hormones estrogen and progesterone and the contribution of abnormal serotonergic activity, are discussed as well as the relevance of an integrated psychosocial, hormonal, and brain hypothesis to the clinical management of PMS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The premenstrual syndrome (PMS) includes a regularly occurring increase in psychological and/or somatic symptoms in the days preceding the menstrual flow. Eight hundred and forty-four women responded to a number of questionnaires on days 12, 18, 22 and 26 of their menstrual cycle. Change scores of the four menstrual distress scales pain, water retention, impaired concentration and negative affect served to form subgroups of cases with very clear and moderately clear PMS. Scores for anxiety, anger and depression show a dramatic increase in PMS women over time. The group with a very clear PMS symptomatology consistently experiences a highly significant increase in anxiety, anger and depression. Besides, the relationships between PMS, neuroticism, anxiety, anger and depression are studied. It seems that neuroticism is less powerful in explaining the variation of anxiety, anger and depression than the subgroups derived from PMS change scores. The results suggest, especially for those who view PMS from a ‘biopsychosocial’ perspective, that it might be possible to improve the diagnosis and assessment of PMS by administering anxiety, anger and depression scales at two or more points in time.
This article reviews the literature linking psychological processes with the presence and severity of premenstrual symptoms, identifying the areas of agreement and disagreement. An exploratory study which measured menstrual distress, state and trait anxiety, and depressive mood in women suffering from the premenstrual syndrome (PMS group, n = 15) revealed that their symptoms were restricted to the second half of the menstrual cycle. This cycle-related pattern of responses was not found in women who did not fulfil the criteria for inclusion in the PMS group (MD group, n = 5). Furthermore, the trait-anxiety scores of the MD group were clearly higher than those of the PMS and control groups. The results suggest that women with premenstrual symptoms do not form a homogeneous group, and that further studies should incorporate a strict definition of the premenstrual syndrome in order to distinguish this syndrome from conditions in which the symptoms are not limited to the second half of the menstrual cycle.
The premenstrual syndrome is discussed in relation to prevalence, symptomatology, severity, and time course. Methodologic problems common to the study of the menstrual cycle are presented. The research on psychologic and physiologic etiologies is reviewed, and results of studies on various treatment modes are discussed. Newer theories suggesting a combined psychophysiologic etiology and concomitant nonpharmaceutical treatment modes encompassing self-care and stress management skills are included.
A treatment trial was briefly mentioned in two British publications and women suffering from premenstrual syndrome were invited to write to us. After initial screening, postal questionnaires were sent to all eligible women. Six-hundred and ninety-nine questionnaires were returned and of these 658 were included in the analyses. Although the results of the study need to be considered cautiously because of the unrepresentative nature of the sample, the survey was helpful in ascertaining the views of women who report PMS symptoms and what they had found helpful. The majority of respondents were aged in their 30s and were married with children. Over 60% were chronic sufferers, having had symptoms for 5 years or more. High proportions of the women experienced both psychological and somatic symptoms but it was the psychological symptoms which were perceived as the most distressing. Over 60% of the sample were ascertained as suffering from some degree of psychological distress and the same proportion had one or more social problems. Overall 84% had visited their GP for this problem and many had also visited gynaecologists, family planning clinicians and psychiatrists. Agencies offering alternative medicine were also frequently contacted and often found more helpful. Most women had tried more than one type of medication but no one treatment was found to be particularly helpful.
The premenstrual syndrome includes a regularly occurring increase in psychological and/or somatic symptoms in the second half of the menstrual cycle. Changes in anxiety, anger and depression in a group of 844 women were studied during one menstrual cycle. The women answered a number of questionnaires on 4 days during the study cycle. Anxiety, anger and depression, as states, are on the average lower in women without symptoms of PMS. Scores for the emotional states show a dramatic increase in the second half of the menstrual cycle in the group of women with PMS-symptoms. Besides, some evidence is given that PMS and neuroticism may be correlated constructs.
Groups of women differing in the severity of reported premenstrual symptoms were compared over two menstrual cycles on a digit-span task, a visual-search task, and a combination of the two. Neither group exhibited large performance changes during the premenstrual phase of the cycle. High-symptom women differed somewhat from low-symptom women in the effect of menstrual phase on digit-span performance, recalling slightly fewer series correctly during the premenstrual phase. The response latency of high-symptom women on the visual-search task was substantially longer than that of the low-symptom women regardless of menstrual phase. These results suggest that there may be stable differences between high-symptom and low-symptom subjects that are greater than the cyclical fluctuation within either group.
A large representative sample of women of child bearing age in five urban practices were asked to complete two measures to record premenstrual changes in their health. The first method was a daily health record which sought to disguise the fact that the focus of the study was premenstrual changes while the second method was a conventional, retrospective checklist. In addition, the women completed a personality inventory which allowed them to be allocated to one of two personality subtypes according to level of neuroticism--neurotic or stable. The results suggest that women in the neurotic subgroup are, in general, more likely to report premenstrual changes than stable women and particularly so on the retrospective checklist rather than the daily record of health changes. It was also shown that women in the stable subgroup were less likely to be inconsistent reporters of symptoms on the two questionnaires than neurotic women. Better understanding of the variable nature of the premenstrual syndrome may demand that more attention is paid to the method of collection of data and to how this interacts with the woman's basic personality. In particular, for research purposes, the traditional method of a retrospective checklist introduces an unacceptable level of response bias in favour of the identification of women with high neuroticism scores, and underrepresents more stable women who suffer from premenstrual complaints. Previous treatment trials which have used this method may therefore be invalid and their conclusions should be reappraised.
Seventy-six women completed a three-month prospective evaluation for premenstrual syndrome (PMS). As a part of the evaluation, they completed Rotter's Locus of Control (LOC) form in the follicular phase and premenstrually. It was found that the LOC scores of women meeting criteria for PMS rose significantly (became more "external") premenstrually, while scores of women without PMS did not show significant change. In addition, the premenstrual LOC scores of women meeting criteria for PMS were significantly higher than were scores of the non-PMS women. The results are consistent with the idea that cycle related changes in self-perception occur in women demonstrating PMS symptomatology.
The premenstrual syndrome is discussed in relation to prevalence, symptomatology, severity, and time course. Methodologic problems common to the study of the menstrual cycle are presented. The research on psychologic and physiologic etiologies is reviewed, and results of studies on various treatment modes are discussed. Newer theories suggesting a combined psychophysiologic etiology and concomitant nonpharmaceutical treatment modes encompassing self-care and stress management skills are included.
PIP
This article reviews current knowledge of the symptoms, etiology, and treatment of premenstrual syndrome. The wide variability in symptoms defined as comprising the premenstrual tension syndrome has resulted in variability in reported prevalence rates. Research in this area has been characterized by methodologic flaws such as a lack of a control group. For example, uncontrolled studies have generally shown that oral contraceptive (OC) users have a lesser incidence and severity of premensrual symptoms than nonusers; however, many women who experience an increase in symptoms with OC use discontinue their use, leaving a biased sample of OC users. Most widely accepted at present is the theory that physiologic factors cause premenstrual symptoms, while personality factors and social stresses exacerbate these symptoms. Recent research has focused on the interaction of psychologic and physiologic factors in the etiology of the premenstrual tension syndrome. Nonpharmacologic treatment modes encompassing self-care and stress management skills have proven effective. Such an approach has no undesirable side effects and increases women's sense of control over psychophysiologic processes. Group therapy, aimed at correcting stereotypes about premenstrual tension and modifying perceptions of menstrual pain as degrading, is emerging as a particularly effective treatment modality. Stress management techniques often enable women to break the cycle in which stress leads to sympathoadrenomedullary arousal that precipitates further stress.
The main methodological issues that should be considered in studies of premenstrual changes are discussed. They include: the selection of well-defined groups of subjects who reflect the diversity of subtypes of premenstrual changes (PMC); the confirmation of retrospective reports through daily monitoring of changes by ratings, or by objective procedures when possible; the need to consider the diversity of premenstrual biological changes instead of comparing average levels, since there is a likelihood that different pathophysiological changes are connected with diverse behavioral and mood changes; application of a multivariate, time-related approach to explore the pathophysiology of PMC; the need to exclude placebo responders prior to the active drug phase in treatment trials and the need for such trials to be double-blind, placebo-controlled and, if possible, of a cross-over design. Attention to such issues should lead to increased consistency of findings across studies and eventually to a better understanding of the pathophysiology of PMC and to a rational, effective treatment.
One hundred (100) women who sought evaluation for premenstrual syndrome were administered a battery of standardized psychological tests, including a Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI) and Short Marital Adjustment Scale (MAS), during the follicular phase of the menstrual cycle. A BDI was repeated in the luteal phase of the menstrual cycle. MMPI profiles were classified by code type using Lachar system as follows: 'Normal'--36%; 'Neurotic'--31%; 'Characterological'--11%, 'Psychotic'--5%, 'Unclassified'--17%. A common feature of MMPI profiles was a low Scale 5 (Mf). BDI scores had several patterns; however, a significant group (25%) appeared to have clinically significant continuous depression regardless of superimposed premenstrual changes. About half of the women (42%) reported marital distress (MAS scores less than 100) at the time of evaluation.
A number of fundamental methodological problems exist in the area of premenstrual symptomatology and psychiatric ill-health. In the study described these have all been taken into account. The study has been so designed as to make expressly clear the definition of premenstrual complaint being employed and material gathered by means of a retrospective questionnaire is checked by means of an interview administered to a sub-sample and the use of a menstrual diary (Sampson & Jenner, 1977; Dalton, 1978). The use of an interview also permits a careful check to be made of the accuracy displayed by women asked to estimate their particular position in the menstrual cycle at the time of completion of the questionnaire. The use of the premenstrual interview, together with a standardized, semi-structured psychiatric interview specifically designed for the population under study, and a standardized, semi-structured social maladjustment schedule, permits a detailed assessment of the inter-relationship between premenstrual, psychiatric and social variables. Finally, the use of a general practice sample of women attending their general practitioners for many and varied reasons, together with a sample of women drawn from attenders at a specialized premenstrual tension treatment clinic, permits a comparison to be made between the symptom profiles of women in a general practice population who have not overtly identified themselves to the treatment agencies as premenstrual sufferers with a group of women who have so identified themselves. In this way, a more accurate estimate of the numbers of women in general practice samples who manifest a degree of premenstrual complaint equivalent to that shown by special treatment clinic attenders can be achieved.
The Premenstrual Assessment Form (PAF) is a new self report procedure designed to measure changes in mood, behavior, and physical condition during the premenstrual period. It reflects the great variability of premenstrual syndromes as opposed to the common practice of viewing these changes as a single entity. In comparison to commonly used procedures, the PAF 1) contains a broader variety and more specific descriptions of positive as well as negative changes; 2) provides Unipolar Summary Scales and Bipolar Continua which are sensitive measures for indexing levels of severity on various types of change; and 3) provides specific criteria for Typological Categories descriptive of different syndromes of change, especially those of mood and behavior. The paper describes the development of the PAF and the three scoring systems and illustrates the sensitivity of the individual items and scoring systems in reflecting the great diversity of change manifested during the premenstrual period.
Past research which has been interpreted as support for a psychological etiology of menstrual distress is critically reviewed. This research is analyzed with respect to methodological issues such as the assessment of menstrual distress, the measurement of psychological parameters, and statistical procedures and with respect to experimenter bias apparent in the interpretation of results. It is concluded that the available empirical evidence is inadequate to support psychological causation of menstrual distress.
A predominantly non-student group of sixty-five women volunteers, screened for medication use, prospectively completed the Moos Menstrual Distress Questionnaire (MDQ) and the Temporal Disorganization Scale (TDS) weekly for one month along with a daily calendar of menstrual status. Data analysis revealed that TDS, concentration disturbances, negative affect, pain and water retention were rated as higher premenstrually and menstrually. Women dichotomized into groups based on high and low premenstrual TDS scores demonstrated different symptom patterns across the menstrual cycle. For the high premenstrual TDS group, concentration, behavioral change, negative affect and pain were all rated highest premenstrually; for the low premenstrual TDS and group the TDS score was rated highest menstrually. The relevance of these findings to literature reports of associations between psychopathology and menstrual cycle phase are discussed.
Some biological factors which have been shown to be abnormal in subgroups of women with dysphoric premenstrual syndromes (PMS) have not been limited to the symptomatic late luteal phase of the menstrual cycle, but also existed during the non-symptomatic mid-follicular phase of the cycle. Personality, cognitive functions, alpha 2 and imidazoline binding, sensitivity to inducement of panic attacks, relative hypothyroidism, and some but not all serotonergic functions of women with dysphoric PMS differ from those with no PMS, and also differ during a non-symptomatic phase of the cycle. It is suggested that premenstrual symptoms are an expression of vulnerability traits that might surface in response to a trigger. Such traits are probably diverse, and the nature of the symptoms might depend upon the underlying trait. It is postulated-that some vulnerability traits to specific premenstrual syndromes might also be vulnerability traits to depression or anxiety in general.
Rats with great differences in emotional reactivity, during weighing and handling for vaginal smear screening were examined on diestrus-2 (DE-2), proestrus (PE), and estrus (E). Rats with high emotional reactivity (HR), interpreted as trait anxiety, had different serotonergic and dopaminergic profile in hypothalamus-preoptic area (HY-PA) and striatum (Str) and thymus weight lower than that found in rats with low emotional reactivity (LR). In HY-PA of rats with HR when compared to rats with LR, increased 5-hydroxyindoleacetic acid (5-HIAA), 5-HIAA/serotonin (5-HT) ratio, and 3,4-dihydroxyphenylacetic acid (DOPAC) and in Str increased DOPAC and DOPAC/dopamine (DA) ratio were found only on DE-2, paralleled by increased adrenal weight and decreased thymus weight. In Str, a significant effect of HR on 5-HIAA was found only on E, in parallel with increased 5-HT and decreased DOPAC and DOPAC/DA ratio when compared to rats with LR. The results suggest that activation of 5-HT and DA in HY-PA and DA in Str through HR is apparent only on DE-2 while, conversely, on E suppression of striatal DA it is apparent with 5-HT dysregulation. These findings might have some relevance to the predisposition of women with trait anxiety to premenstrual syndrome.
This study was designed to examine the contribution of plasma lipids to the pathophysiology of cyclic mastopathy, before and after consideration of diet and sex hormones.
Thirty-four women with severe cyclic mastopathy (case patients) and 29 women without cyclic mastopathy (control subjects) recorded their breast symptoms daily during 1 menstrual cycle. During each menstrual phase (follicular, early luteal, late luteal, and menstrual) they prospectively completed 2 24-hour dietary diaries, provided blood for lipid and hormone assays, and underwent anthropometric measurements.
Mean age was 34 years. Premenstrual breast swelling and tenderness were significantly more severe in case patients (P < .0001). Cyclic change (late luteal vs follicular) of high-density lipoprotein cholesterol differed between case patients and control subjects, with case patients having a relative excess of high-density lipoprotein cholesterol in the premenstrual phase (P = .01). Dietary fat intake was greater throughout the cycle in case patients (37.5 vs 33.7% of calories, P = .02), and case patients reported increased appetite in the premenstrual phase (P = .01). In multivariate analyses the contributions of mean dietary fat intake and of cyclic change in high-density lipoprotein cholesterol were independently significant, with odds ratios for upper versus lower quintiles being slightly >5.
Women with cyclic mastopathy had a relative excess of high-density lipoprotein cholesterol during the symptomatic late luteal phase of the menstrual cycle and a higher fat intake throughout the cycle than did control subjects. These observations support the hypothesis that lipids (notably high-density lipoprotein cholesterol) and a high-fat diet play a role in the pathophysiologic characteristics of cyclic mastopathy.
Worldwide, the prevalence of depression in women is significantly greater than in men. Available data suggest that estrogen, or its absence, is strongly implicated in the regulation of mood and behaviour, as well as in the pathobiology of mood disorders.
The multiple effects of estrogens and their complex interactions with the CNS and endocrine system have been well documented, although the specific, multifaceted role of estrogen in each dysphoric state has yet to be elucidated. Several facts suggest that estrogen plays a vital role in the precipitation and course of mood disorders in women. Gender differences in the prevalence of depression first appear after menarche, continue through reproductive age, and dissipate after perimenopause. Periods of hormonal fluctuations or estrogen instability (i.e. premenstrually, postpartum, perimenopausally) have been associated with increased vulnerability to depression among susceptible women. It is plausible that the phenotype of these depressions is distinguishable from those that are not associated with reproductive events or that occur in men.
Based on current knowledge, estrogen treatment for affective disorders may be efficacious in two situations: (i) to stabilise and restore disrupted homeostasis — as occurs in premenstrual, postpartum or perimenopausal conditions; and (ii) to act as a psychomodulator during periods of decreased estrogen levels and increased vulnerability to dysphoric mood, as occurs in postmenopausal women. There is growing evidence suggesting that estrogen may be efficacious as a sole antidepressant for depressed perimenopausal women. It is still unclear whether estrogen is efficacious as an adjunct to selective serotonin reuptake inhibitors or as one of the paradigms to manage treatment-resistance depression in menopausal women, but such efficacy is plausible.
In this article we trace the historical, cultural, political, and economic forces that led to the social construction of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). The popularity of these diagnostic labels among medical professionals, the general public, and women themselves is considered and explored, as is the damage that the labels can do to women in general, as well as those who receive a diagnosis. Suggestions are provided for psychotherapists who might work with women who present with premenstrual symptoms.
Menstrually related symptoms and disorders are multidimensional and affect diverse physiologic systems. Elucidation of the pathophysiologic mechanisms of these disorders should allow for a more precise diagnosis, and provide direction for targeted therapeutic interventions. Several biologic mechanisms that underlie menstrually related symptoms have been proposed. They focus mostly on gonadal hormones, their metabolites and interactions with neurotransmitters and neurohormonal systems, such as serotonin, GABA, cholecystokinin, and the renin-angiotensin-aldosterone system. Altered responses of these systems to gonadal hormone's fluctuations during the menstrual cycle, as well as an increased sensitivity to changes in gonadal hormones may contribute to menstrually related symptoms in vulnerable women. Disrupted homeostasis and deficient adaptation may be core underlying mechanisms. Future directions for clinically-relevant progress include identification of specific subgroups of menstrually-related syndromes, assessment of the genetic vulnerability and changes in vulnerability along the life cycle, the diversified mechanisms by which vulnerability is translated into pathophysiology and symptoms, the normalization process as well as syndromes-based and etiology-based clinical trials.
CONCERNED WITH THE RELATIONSHIPS OF THE TAYLOR MA SCALE WITH THE SCALES AND INDIVIDUAL ITEMS OF THE BRENTWOOD MOOD SCALE IN A GROUP OF 159 HOSPITALIZED CHRONIC PSYCHIATRIC PATIENTS. 3 TYPES OF ANXIETY-SUBJECTIVELY EXPERIENCED FEAR, ANXIETY EXPRESSED IN PHYSICAL TENSION, AND GENERALIZED UNCERTAINTY-WERE FOUND TO BE RELATED TO SCORES ON THE MA, WITH UNCERTAINTY LESS RELATED THAN EITHER SUBJECTIVELY OR PHYSICALLY FELT ANXIETY. THE MA WAS ALSO FOUND TO BE RELATED TO SUBJECTIVE FEELINGS OF DEPRESSION AND TO AN ABSENCE OF POSITIVELY TONED EMOTIONAL REACTIONS. THE MA WAS INVERSELY CORRELATED WITH WORDS CONNOTING DRIVE LEVEL.
This investigation is concerned with the prevalence of dysmenorrhoea and premenstrual symptoms in the general population and with their relationship to personality.
Many authors have expressed the opinion that such relationships exist, but we will confine our review here to those studies which have presented supporting data. Wittkower and Wilson (1940) studied 57 patients with primary dysmenorrhoea and found there was a history of childhood maladjustment four times as often in these patients as in a control group. They considered that patients with dysmenorrhoea could be classified into two main personality types: the first, “characterized by deep resentment of their feminine role”; the second, “obviously immature physically and either shy or shut-in or chronically anxious and complaintive”. Sainsbury (1960) observed a significantly raised neuroticism score on the Maudsley Personality Inventory for patients attending hospital for dysmenorrhoea. Such views as these are not universally held, and would certainly not be shared by many gynaecologists. Nor are they supported by the little evidence forthcoming from population studies.
"The core of what is presented derives… from experimental work on the normal range of personality, some of which has been systematically carried out in our own laboratory over the last twenty years." Chapter 2 reviews premetric theory, Chapter 3 is given to methodology, and Chapters 4-6 are devoted to type and trait definitions of neuroticism and anxiety. Chapters 7 and 8 deal with individual differences and Chapter 10 with somatic and physiological interactions in neuroticism and anxiety. Chapter 9 covers "Anxiety and Neuroticism Distinguished as States Among Malergic States of Stress, Fatigue, and Depression." Chapter 11 discusses the influences of situational stimuli, personal history, and the culture pattern. "Chapters 12 and 13 integrate theoretically the data" of Chapters 4 through 11. Chapters 14 and 15 discuss the use of measuring instruments in diagnosis and "Particulars on the Available Measuring Instruments." From Psyc Abstracts 36:01:1HK35C. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The relationship between premenstrual affective syndrome and psychiatric disorder was investigated, using 81 women presenting to a Neurology Clinic with functional headache. Premenstrual affective syndrome was significantly associated with a history of depressive syndrome in the population studied. Patients judged to have a non-affective psychiatric disorder reported no greater frequency of definite or probable premenstrual affective syndrome than patients considered psychiatrically normal. The premenstrual occurrence or exacerbation of affective symptoms has been noted. This symptom exacerbation maybe sufficient to require hospitalization. Data presented by Coppen indicate that women with affective disorder are more likely to report the premenstrual symptom of depression than women with other psychiatric disorders. These findings suggest that there may be some relationship between depressive disorder and premenstrual affective symptoms. As part of a larger study on the personality and psychiatric correlates of functional headache, data on the relationship between depressive syndrome and premenstrual affective symptoms were obtained.
Twenty five women with normal menstruation showed fluctuations in psychological and physical symptomatology during the menstrual cycle, symptoms being more intense during the premenstrual and menstrual weeks. Seven women who had undergone simple hysterectomy with conservation of the ovaries, and who were shown to have an apparently normal cyclical hormonal pattern, did not demonstrate similar significant changes in symptoms during the various phases of their cycles. The significance of these findings is discussed.
Sixty-four per cent of 874 freshmen and sophomore women sent questionnaires about premenstrual and menstrual symptoms returned them. They differed from those not returning the questionnaires only in year of school. As predicted, women reporting premenstrual affective symptoms were more likely than those who did not report them to seek psychiatric care at the Student Health Service and to be diagnosed as affective disorder at the service.
The magnitude of premenstrual mood changes in 50 parous adult women between the ages of 30 and 45 was assessed using standardized measures of depression and anxiety. Premenstrual test scores were compared with those obtained during the intermenstrual phase of the cycle and with normative data. Premenstrual state anxiety and depression mean scores were significantly higher than those obtained midcycle, but were much lower than those of patients with psychiatric disorders. Trait anxiety scores were low and were not significantly correlated with premenstrual depression and anxiety scores.
A questionnaire survey of 84 Chinese nurses was carried out to assess the presence of premenstrual syndrome. More than half of the respondents reported emotional changes and backache premenstrually. There were significant associations between nausea and breast changes, irritability and depression, body and skin changes, finally between backache and the 3 symptoms of irritability, headache and the necessity to take time off work.
Human plasma prolactin, measured by a homologous radioimmunoassay, has been found to rise significantly in a number of situations associated with stress. The greatest elevations, averaging approximately five-fold, were seen during major surgery with general anesthesia. Absolute levels of prolactin were higher at all times during surgery in women than in men. Smaller but significant elevations were found with gastroscopy, proctoscopy, and exercise. In all situations except exercise the prolactin rise was as high as, or higher than, that of growth hormone. Hypoglycemia induced by 0.2 U/kg of insulin produced significant prolactin elevations in all of seven normal women. Major elevations of prolactin, but not growth hormone, occurred in a minority of normal women following sexual intercourse; prolactin did not rise significantly in their male partners. It is concluded that prolactin in human beings is at least as responsive as growth hormone to release by stress in most situations; the two hormones ...
: Twenty-six female college students aged 19-22 were tested for differences in anxiety level during the menstrual cycle. Ss were asked to talk for 5 min. on "any memorable life experience." These verbal samples were recorded at ovulation and 2-3 days preceding the onset of menses during 2 complete menstrual cycles for each S. The samples were scored according to Gottschalk's (1961) Verbal Anxiety Scale (VAS) for Death, Mutilation, Separation, Guilt, Shame, and Diffuse Anxiety. The verbal samples were also examined for thematic variations. The sensitivity of the VAS was confirmed, as it revealed consistent and significant variations in anxiety level between ovulation and premenstrual samples for each S. The premenstrual anxiety level was found to be significantly higher (p < 0.0005) than that at ovulation over all Ss. Additional findings showed consistent themes of hostility and depression as well as themes of noncoping during the premenstrual phase of the menstrual cycle. In spite of individual differences between Ss, these findings indicate significant and predictable affective fluctuations during the menstrual cycle which correlate with endocrine changes. Qualitative data on "premenstrual syndrome" and psychosomatic aspects of premenstrual symptoms were also presented. Copyright (C) 1968 by American Psychosomatic Society
Fifteen married, nulliparous women were studied longitudinally over two menstrual cycles. Changes in menstrual symptoms (pain, water retention, autonomic reactions), mood (anxiety, aggression, depression, pleasantness, activation), and sexual arousal were measured. Results indicated that these variables changed cyclically in relation to the menstrual cycle; that the 15 women were generally consistent from one cycle to another in their degree of symptomatology; that this consistency was greater for the intermenstrual than for the menstrual and premenstrual phases, suggesting greater variability of symptoms in these latter phases; and, that high and low premenstrual tension women tended to differ consistently from each other on negative affect throughout the cycle, as well as on another symptoms in other phases of the cycle. Consistently high premenstrual tension women may thus constitute an especially important group for endocrinologic studies.
Electroencephalographic, hormonal, and psychiatric investigations of a small number of subjects with and without premenstrual tension have revealed the following :(1) no indication that the behavioral manifestations of premenstrual tension reflect directly alterations in the cerebral neurophysiology so measured, (2) endocrine activity within normal limits in all subjects, with no demonstrable distinction between subjects with premenstrual tension and controls, and (3) no evidence that would substantiate a theory of psychogenic etiology for premenstrual tension.
However, there appeared to be some definable differences in behavior other than the premenstrual manifestations differentiating the 2 groups. The subjects with premenstrual tension showed more marked emotional lability throughout their cycles, and in general were less assertive individuals.
Thesis (Ph. D.)--University of Kansas, Psychology, 1956. Includes bibliographical references.
: The sensitivity of a newly developed method of measuring immediate affect levels from small samples of speech is demonstrated by use of the method (in 5 subjects) to detect the effect on personality of the biological rhythms of the menstrual cycle. The method employs separate scoring scales for each affect to be measured. Psychoanalytic insights and principles are built into the scales, as exemplified by the verbal themes considered relevant to each affect and by the relative weights assigned verbal items. Extensive reliability and validity studies have been reported elswhere. Four of the 5 women showed statistically significant rhythmical changes in the magnitude of at least one of the affects--anxiety, hostility outward, or hostility inward--during the sexual cycle. The changes in these affects were not similar among the women. Those psychophysiological rhythms more statistically significant appeared within women studied during a larger number of menstrual cycles. This suggests that data from more cycles tended to amplify the effects of the sexual cycle on the emotions measured by minimizing and randomizing the effect of transient intrapsychic and interpersonal events. The individual variations in anxiety and hostility levels during the sexual cycle should be accounted for by personality studies focusing on psychosexual development and conflicts. There was a tendency for the levels of tension measured--specifically, anxiety and hostility inward--to decrease transiently around the time of ovulation. The presumed cause is some hormonal change; whether it is ovarian or gonadatropic (luteinizing hormone) or both has yet to be ascertained. Copyright (C) 1962 by American Psychosomatic Society
Age of menarche does not differ from general population nor from controls, but the patients tended to be more disturbed by its occurrence. For menstrual pain, neurotics experienced more and schizophrenics less, with affective patients not differing from controls. For irritability, depression, anxiety, tenseness, symptoms were increased in neurotics and lessened in schizophrenics. For headaches and irregularity of period, neurotics had more headaches, while schizophrenics had more irregularity. All patients had their sexual adjustment affected; 50% of the neurotics were frigid. Neurotics and affective patients had high Neuroticism and low Extraversion scores on the MPI. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Serum prolactin in women with PMS
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