Full text of psychologist Robyn Stein DeLuca’s talk: The Good News About PMS at TED Talk conference.
Listen to the MP3 Audio here: Robyn Stein DeLuca on The good news about PMS at TED
How many people here have heard of PMS? Everybody, right? Everyone knows that women go a little crazy right before they get their period, that the menstrual cycle throws them onto an inevitable hormonal roller coaster of irrationality and irritability. There’s a general assumption that fluctuations in reproductive hormones cause extreme emotions and that the great majority of women are affected by this.
Well, I am here to tell you that scientific evidence says neither of those assumptions is true. I’m here to give you the good news about PMS.
But first, let’s take a look at how firmly the idea of PMS is entrenched in American culture. If you examine newspaper or magazine articles, you’ll see how widely assumed it is that everyone gets PMS. In an article in the magazine Redbook titled “You: PMS Free,” readers were informed that between 80% to 90% of women suffer from PMS. LA Muscle magazine warned its readers that 40% to 50% of women suffer from PMS, and that it plays a major role in women’s mental and physical health.
And a couple of years ago, even the Wall Street Journal ran an article on calcium as a treatment for PMS, asking its female readers, “Do you turn into a witch every month?”
From all these articles, you would think there must be a mountain of research verifying the widespread nature of PMS. However, after five decades of research, there’s no strong consensus on the definition, the cause, the treatment, or even the existence of PMS. As most commonly defined by psychologists, PMS involves negative behavioral, cognitive and physical symptoms from the time of ovulation to menstruation.
But here’s where it gets tricky. Over 150 different symptoms have been used to diagnose PMS, and here are just a few of those.
Now, I want to be clear here. I’m not saying women don’t get some of these symptoms. What I’m saying is that getting some of these symptoms doesn’t amount to a mental disorder, and when psychologists come up with a disorder that’s so vaguely defined, the label eventually becomes meaningless.
With a list of symptoms this long and wide, I could have PMS, you could have PMS, the guy in the third row here could have PMS, my dog could have PMS.
Some researchers said you had to have five symptoms. Some said three. Other researchers said that symptoms were only meaningful if they were highly disturbing to you, but others said minor symptoms were just as important. For many years, because there was no standardization in the definition of PMS, when psychologists tried to report prevalence rates, their estimates ranged from 5% of women to 97% of women, so at the same time almost no one and almost everyone had PMS.
Overall, the weaknesses in the methods of research on PMS have been considerable.
First, many studies asked women to report their symptoms retrospectively, looking to the past and relying on memory, which is known to inflate reporting of PMS compared to what’s called prospective reporting, which involves keeping a daily log of symptoms for at least two months in a row.
Many studies also exclusively focused on white, middle-class women, which makes it problematic to apply study findings to all women. We know there’s a strong cultural component to the belief in PMS because it’s nearly unheard of outside of Western nations.
Third, many studies failed to use control groups. If we want to understand the specific characteristics of women who have PMS, we need to be able to compare them to women who don’t have PMS.
And finally, many different types of questionnaires were used to diagnose PMS, focusing on different symptoms, symptom duration and severity. To do reliable research on any condition, scientists must agree on the specific characteristics that make up that condition so they’re all talking about the same thing, and with PMS, this has not been the case.
However, in 1994, the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, thankfully — it’s also the manual for mental health professionals — they redefined PMS as PMDD, Premenstrual Dysphoric Disorder. And dysphoria refers to a feeling of agitation or unease.
And according to these new DSM guidelines, in most menstrual cycles in the last year, at least five of 11 possible symptoms must appear in the week before menstruation starts; the symptoms must improve once menstruation has begun; and the symptoms must be absent the week after menstruation has ended. One of these symptoms must come from this list of four: marked mood swings, irritability, anxiety, or depression. The other symptoms could come from the first slide or from those on the second slide, including symptoms like feeling out of control and changes in sleep or appetite.
The DSM also required now that the symptoms should be associated with clinically significant distress — there should be some kind of disturbance in work or school or social relationships — and that symptoms and symptom severity should now be documented by keeping a daily log for at least two cycles in a row.
And finally, the DSM required that the emotional disturbance should be more than simply an exacerbation of an already existing disorder. So scientifically speaking, this is an improvement. We now have a limited number of symptoms, and a high impact on functioning that’s required, and the reporting and timing of symptoms have both become very specific.
Well, using this criteria and looking at most recent studies, we see that on average, 3% to 8% of women suffer from PMDD. Not all women, not most women, not the majority of women, not even a lot of women: 3% to 8%. For everyone else, variables like stressful events or happy occasions or even day of the week are more powerful predictors of mood than time of the month, and this is the information the scientific community has had since the 1990s.
In 2002, my colleagues and I published an article describing the PMS and PMDD research, and several similar articles have appeared in psychology journals.
The questions is: Why hasn’t this information trickled down to the public? Why do these myths persist? Well, certainly the onslaught of messages that women receive from books, TV, movies, the Internet, that everyone gets PMS go a long way in convincing them it must be true. Research tells us that the more a woman believes that everyone gets PMS, the more likely she is to erroneously report that she has it. Let me tell you what I mean by “erroneously.” You might ask her, “Do you have PMS?” and she says yes, but then, when you have her keep a daily log of psychological symptoms for two months, no correlation is found between her symptoms and time of the month.