PMDD and Holiday Stress

Offhand, I can think of four good sources of holiday stress: family, food, finances, and expectations.  Each causes its own manner of stress, but like a toxic family with a volatile history, they all intertwine.  For example: Your family has expectations that involve your finances, either via hosting a food-laden event, traveling to a food-laden event, or simply exchanging gifts. 

Funny, but our current culture would have us believe that the more we spend, the more we care.

Is that messed up or what?  Then, of course, there are the guilt purchases.  You know, the sometimes extravagant but almost always expensive gifts you buy to convince someone how much you care when you won't be showing up in person.  Or maybe you will be there, but you'll have to leave early, or it's the only time you've seen this person since whenever, and you feel guilty about that.  Then there's the keeping-up-with-everyone-else spending. Your gift can't possibly come in at a dollar value less that the gifts "the others" are giving, or you'll look bad.  So you either buy something you can't afford, or pony up your share of a gift you didn't choose and can't afford. 

But I digress.  Above are only a few examples of generic holiday stressors.  A PMDD woman doesn't handle stress well to start with, and so when the holiday madness begins....

You can understand why all she wants is for it to be over, or at the very least, to get through it without a meltdown.

So let's stop for a minute, just stop and think.  What are all these holiday gatherings supposed to be about?  Connecting, making memories to hold you through until you see each other again, right? (Or, if you're all local, celebrating another year of life's ups and downs together.) 

But somewhere along the way, everything shifted.  Away from Jesus and family, peace and goodwill, and toward fueling a selling season that accounts for 40% of the year's retail revenue. 

Connecting more deeply with friends and family is not about two months plus of frenzied shopping to see who comes up with the biggest, best, shiniest gift.  It's about coming to the table well-rested and healthy, comfortable and caring.  It's about making eye contact (put those electronics away!!), feeling genuinely happy to see each other, and connecting in a special way...but not a deep and forever-bonding kind of way.  If you come to the party expecting that, you've fallen into the trap of unrealistic expectations, and you'll only be disappointed. 

Holiday gatherings are for having lighthearted fun and making good, positive memories.  If a heart to heart connection happens, consider it a bonus.  But don't go into the event expecting anything more than a good time.

Happy holiday gatherings are about spending time with people who share common interests, values, and beliefs.  And if that doesn't happen—which is most of the time—it's about managing to enjoy the day and company as best as you can.  In a worst case scenario, it's about keeping the peace (and your peace) for as long as you and these spiritual, mental, and emotional strangers spend time together.

Not everyone is blessed enough to have a group to gather with.  If you are, but can't stand to be around them, and absolutely, positively can not escape attending the festivities, the prevailing advice is to limit your visits to a couple of hours at a time.  If you've traveled long distance, take breaks to visit friends in the area, or maybe revisit familiar local haunts, or even show your partner or kids where you grew up.  If you don't want to do that, or don't know anyone else in town, maybe you can visit some sort of tourist attraction in the area for a break between bouts with relatives.  Or you can offer to be the gofer who runs errands.  Somebody always needs something they forgot to bring at these things.  Offer to fetch it, and use the time to regroup.  If you're not from the area, just take a walk or a drive to explore the surroundings and clear your head.  What is it with people acting as if there's something wrong with wanting to spend more than a few minutes alone?  Could it be they envy your independence? Wish they could break away from the herd as well?  Think about it.

If you have no relatives nearby, find some friends and start your own traditions. Traditions are important, but creating new traditions can be equally important.  Families no longer look the same as they did in the past--we've got single moms and dads, same sex moms and dads, bi-racial couples and children, adopted children, foster children, blended families, events where all parties and their current significant other show up, presumably for the sake of the kids—so why should family events always be the same?  Consider incorporating something new into the mix.  Maybe you can all go to church together, or to a restaurant for dinner, or to a movie or bowling after your meal.  Mix up the traditional menu but try adding something new.  Maybe even ditch the whole thing and have a theme party.

Or maybe you can agree to go to the big family shindig only every other year, or only participate on alternate holidays.  Spend one any way you want to, (whether it be by staying home or planning a ski chalet weekend) and the next by attending a family gathering.  Or schedule the family event at a different time than the true holiday.  Think of all the stress you'll avoid, not scrambling out there with all the other holiday travelers. 

But don't go at all if you know the event will only bring more pain and destruction to yourself and the family.  Family gathering time is not the time to resolve family issues, conflicts, or make major family decisions.  The discussion about your cousin's financial woes or addiction or whether or how to move someone into assisted living is NOT one you want to have at a holiday gathering.  Ditto details about selling, renting, or discarding family property.  True, it may be the only time you are all together, but the holiday celebration itself is NOT the forum for such undertakings.  Those require a separate family meeting.

Just as the holidays are stressful for all of us, most of these suggestions could apply to anyone.  To specifically address your PMDD, I'd have to return to the line of "coming to the table well-rested and healthy, comfortable and caring."  If you are feeling none of these things on the date of the event, then you are not wrong in wanting to cancel, and if you do, please do not feel guilty or accept any blame for doing so.  Would you stay home if you had the flu?  Negative moods are just as contagious and can ruin a party just as easily.

Feeling guilt and accepting blame only escalate your PMDD symptoms.  By staying away from the event, you are protecting both the event and taking care of yourself.  Nothing in this world is more important than seeing to your own health and well-being.  Especially when it comes to your mental health.

Because if you don't care enough about yourself to take care of you, believe me, nobody else will either.

Liana Laverentz is the award-winning author of two books on PMDD, PMDD and Relationships, and PMDD: A Handbook for Partners.  Both books are based on the most asked questions by her readers, and therefore the most popular posts on this blog. Both books are also an excellent resource for understanding your PMDD and for starting a meaningful conversation with loved ones who want to know more about this debilitating disorder we live with daily. Both are available in ebook from Amazon and Smashwords (Kobo, ibooks, Nook, and Overdrive), and in print from Amazon, and the International Association for Premenstrual Disorders, or IAPMD.  For more information, please check out Liana's Facebook Page, Living with PMDD.

PMDD, the Holidays, and Relationships

Going into the holiday season, often a time of stress in general, but especially so for PMDD women, who often can not predict how we will feel or how much energy or motivation we will have from day to day, I thought I'd revisit a few posts on relationships to remind us of what's important, what's not, and what we can do about it.

Here are the links to my series of posts about all sorts of relationships, because between now and when life settles down again in January, we'll most likely be dealing with more people than we do the rest of the year combined. So feel free to bookmark this page, and refer to it as needed :)

Relationships Begin With You

Learning to Treat Yourself Like a Friend

HOW to be a Friend to Yourself

Choosing Your Friends Wisely

Choosing Your Family

How to Survive Family Gatherings

It's Not Personal, It's Just Your PMDD

Finding the Right Partner

Dealing with PMDD - Advice for Men

and, as a gentle reminder,

They Only See Our Failures

Take care, God Bless, and may your holidays be happy.

PMDD and Negativity

It may look like I'm just recycling posts, and I am to some extent, but these are really good posts that got shuffled down to the bottom of the popular posts list over time.  It doesn't mean they are any less informative or relevant.  Today's re-post is about the neural pathways we create in our brains, and how we can focus on turning around the negativity that comes with every episode of PMDD. 

In the meantime, I am working on three new posts, the first of which I hope to put up before the month is over.  All went well with my cerebral angiogram, I finally got the *all clear* for a full year, and so now I look forward to getting back into my research and writing, and having even more good posts and information for you to discover here at Living on A Prayer.

Thank you all for your encouragement and support this past year as I dealt with my aneurysms.  What a roller coaster ride it has been. 

Is PMDD Real? : A Psychotherapist with PMDD Shares Her Story

Today we have a guest post from Dr. Chantal Gagnon, who has been kind enough to fill in for me while I continue my research on progestins and progesterone.  Thank you, Dr. Gagnon, and welcome!

IS PMDD Real?

THE SHORT ANSWER: Yes, it's real.

THE LONG ANSWER

PMDD can be thought of as an extreme form of PMS (Pre-Menstrual Syndrome), but with symptoms that are more severe and debilitating. PMDD symptoms can be physical, such as bloating, headaches, breast tenderness, etc., but typically the symptoms that have the greatest impact for women with PMDD are emotional and behavioral symptoms. For up to two weeks near the time of their period (but less time for some women), PMDD sufferers can experience a range of emotions and behaviors, including depression, suicidal thoughts, anxiety, tension, irritability, anger, even to the point of rage, self-loathing, mood swings and feeling overwhelmed. These symptoms can often feel severe or extreme. It's common during this period of time for women to start fights, give people "a piece of their mind" (i.e. become verbally abusive), and perceive their mates negatively. Sometimes women quit a job or end a relationship or scream like a banshee in the midst of an episode.

What causes PMDD is a sudden drop in the neurotransmitter Serotonin following a shift in hormones as a result of the menstrual cycle. The same biochemistry is implicated in PMS, but women with PMDD either are more biologically sensitive to hormonal shifts in general, or the hormonal shifts they experience are bigger. Depending on which study you look at, this disorder affects between 5% to 10% of women, and may get worse with age (30's and early 40's), possibly because stress can make symptoms worse (women report more stress during the years of raising a family and building a career).

How I Discovered I Had PMDD

My first semester as a counseling student I took a course on psychopathology (mental health disorders). The class was focused on learning and understanding the diagnoses listed in the DSM - the Diagnostic and Statistical Manual of Mental of Mental Disorders published by the American Psychiatric Association (APA). We also learned about disorders that the APA was considering adding to the next version of the DSM. PMDD was one of them. I remember thinking at the time: "This is complete BS! These psychiatrists are taking normal PMS and making it a "disorder" so that pharmaceutical companies can sell more drugs." So, for the first several years of my career, I did not believe PMDD was real. I even did a presentation in another class about how the DSM tries to create "disorders" out of normal behavior, and of course, I included PMDD in that presentation.

I was wrong. I discovered my error in judgment when I developed PMDD in myself in my 30's. I noticed that a day or two before my period, I became suddenly and severely depressed - everything in my life seemed hopeless. It was almost as if I was a different person. But the day my period started, I felt completely better. Weird, I thought. But then, the pattern continued and I became more aware of it. Sometimes my symptoms were depression-related, other times it was irritability and anger. When I got married, it got worse because I couldn't isolate myself from people during those few days of my cycle (which had been a fairly effective coping strategy in the past). My husband was always around now :) So, unfortunately for him, he got caught in the PMDD storm!

Finding Resources and Learning to Cope

So, Ken (my husband) and I began looking for answers. I had a hunch PMDD might be the issue, but I had never really believed it was a real disorder. Plus, I wanted to be mindful to not just be making excuses for my bad behavior. Around that time, we found Liana's website and blog: Living with PMDD (www.LivingWithPMDD.com). Wow, what a great resource! Through her site, a book about PMDD, and discussion board posts from other women relating their experiences with this disorder, I discovered that this was indeed what I was living. I later confirmed the diagnosis with a psychologist, and my husband and I have developed coping strategies that are effective for us, and for my particular symptoms. Needless to say, I now know that PMDD is indeed real. I'm one of the lucky ones though, because I only experience severe symptoms two to four times a year. With proper planning, improved stress management, and coping skills most months have been OK, and for the months that aren't Ken and I now know how to surf that wave, instead of getting caught in the rip current.

Every women is different, and PMDD manifests differently in different women. If you suspect (or if you know) that you have PMDD, it's important to find compassionate support people, educate your family on the disorder, and put into practice coping strategies that will work for you.

Dr. Chantal Gagnon is a licensed psychotherapist, author, and life coach in Plantation (Fort Lauderdale), Florida. To read her blog or learn about her services, visit www.LifeCounselor.net or follow her on twitter @DrChantalGagnon

My PMDD Is Not Your PMDD

PMDD is such an individual thing.  What works for me will not necessarily work for you.  What triggers mine will not necessarily trigger yours.  The best I can do is share my research and hope some part of it resonates with enough women that it makes a difference in their lives.  Take caffeine, for instance.  It's been proven to be bad for PMDD.  But is it bad for your PMDD?  Only you can know.  I hardly drink caffeine at all, and I still have PMDD.  I never took birth control pills and I still have PMDD.  I've never experienced trauma of the kinds described in my previous post, and I have PMDD. 

Stress, yes, I have stress in my life.  But my stress is not your stress.  What sets me off might not faze you in the least.  I've only been pregnant once, only had one child.  I've tried HTP-5, Tryptophan, Calcium, Vitamin B Complex and Magnesium.  I've done energy work, meditation, deep breathing exercises, and walking.  Kava kava, evening primrose oil, Omega 3 essential fatty acids, GABA, and various vitamin supplements in cute little packages.  Fluoxetine is as far as I've gone in the drug realm.  I've tried hormone and neurotransmitter balancing diets, cut out sugar and alcohol.  Used bioidentical estrogen and progesterone therapy, both the cream and prescription capsules.  I've faced my emotional issues, cleaned up my life, and taken relationship classes.  I've eaten serotonin boosting foods, made sure I get enough rest, and chart my symptoms.

And still I have PMDD.  But it's not nearly as bad as it used to be.

So what works for me?  I'm not even sure yet.  My symptoms are different from month to month, as are my stressors.  And, as one astute commenter pointed out, stress can come from positive events as well -- it doesn't all have to be negative.  Happy times can cause just as much emotional upheaval as sad ones.

The one thing that has worked the most for me is awareness.  Paying attention to my body, paying attention to my intuition -  listening to how I feel inside.  It's not woo woo.  It's simple wisdom.  For instance, I know a 45 minute walk makes me feel great.  I know certain people and situations make me feel uncomfortable.  I know when something I am doing "just isn't fun" anymore.  I know what makes me feel calm and peaceful, and I know what makes me feel unsettled and angry. 

A lot of women don't know that about themselves.  A lot of women are just so busy running from activity to activity that they simply haven't made the time to get to know themselves. 

There was a time in my life when I thought I wasn't worth getting to know.  Now I am my own best friend.  I look to myself, rely on myself, for every important decision I make.  I go by how it makes me feel inside.  Anxious and edgy?  Cautious?  Bored? Confident? Terrified? Serene?

The body never lies.  If you let it, it will tell you exactly what you need to know...and exactly how you feel about something...anything...going on in your life.

Ever look at a cat, really look at it?  I've used this example before.  Cats just "are."  They know who they are, and what they want, and what they don't want.  And they know how to tell you these things -- without making excuses or apologies. If they want love, they come around.  If they want to be left alone, they go off and be alone.  If they are unhappy, they let you know. 

Why can't we be the same?  Why can't we simply accept or decline whatever is placed before us without going through a whole bunch of angst and/or guilt?  Why can't we live in the moment and deal with situations as they arise?  Why can't we just take a nap in the sun if that's what our bodies indicate we should do?  Why do we have to run around -- do this, do that -- exhausted all the time? 

Why can't we make changes and maybe try something new without upsetting someone else?  I hear this from women all the time.  "He wouldn't want me to..."  "I don't think my (insert friend, relative, co-worker here) would like that."  Or "I don't think (name someone, even your children) would let me do that."

Wouldn't like it?  Wouldn't let you?  I'm talking about things here that would benefit your health and well being.  I'm not talking about women going wild.  I'm talking about basic human needs.  Love, companionship, respect, dignity.  Consideration, concern, compassion, and understanding.  Why wouldn't someone who claims to love you or even just care about you want you to do what you need to do to be the best person you can possibly be?  Why would they want to hold you back from that?  Why would they want you to be "less" of a complete companion, parent, child, sibling, caretaker, employee?

To completely manage your PMDD, you need to take time out for you.  You need to be your own best friend and advocate.  You need to slow down long enough to listen to your body, and listen to your feelings, not the cacophony of demands life puts on us all day long.  You need to take some time to understand your individual quirks and condition, what sets you off and what makes you calm.  You need to stop "reacting" to your life (which leads to that out of control feeling we all know and hate) and become more "proactive".  You need to anticipate when your PMDD is coming, and adjust things around how you feel. 

I'm having a PMDD episode right now.  It's been going on for several days.  My awareness of it has allowed me to adjust for it, and keep my activities calm and low key.  Doing so has also allowed me to put in three slow but steady 18-hour days in a row without snapping at anyone or bursting into tears. 

Amazing. That never would have happened before I became aware of my PMDD.  I can think of at least half a dozen times these past few days where I would have *lost it* in the past.  I may still lose it.  It happens.  But the chance of it happening is a hell of a lot less than it used to be - since I started listening to my body.  Since I started cultivating my awareness of my PMDD.

The body never lies.  When it needs something, it lets you know.  When it senses trouble or danger, it lets you know.  When you meet someone who will be good for you...it lets you know.  The same goes for when you encounter someone or something that is bad for you.  The body knows right from wrong even if your mind is muddled by such things as guilt, pressure, manipulation, deception, negativity, or prevailing social and cultural messages. 

I think a lot of our PMDD crises stem from outside sources.  That's not to say that there's not stuff going on inside that makes us detonate....I'm well aware right now that I could either fall apart or blow up or both at any moment...but if I wasn't able to control my attitude -- and if I wasn't able to be proactive through awareness instead of reactive -- I know my fuse would be a lot shorter. 

Instead I'm listening to my body, taking each moment as it comes, moving from task to task, taking calming breaths, eating healthy, maintaining as positive an attitude as my PMDD brain will let me -- and when I start to get all tense and stressed....I either go for a walk, or lie down and rest. 

The work will wait.  The world can wait.  I'm not that indispensable that my life -- or anyone else's -- will fall apart if I take half an hour to recharge and regroup.

Try it.  What have you got to lose?

Stress and the PMDD Woman

So what causes stress in a PMDD woman?

Well, trauma, for one.   Trauma, (such as a life-threatening accident, war, imprisonment, witnessing or being the victim of a violent crime, including abuse of any sort, a death or major upheaval in the family, especially one over which you feel you have no control) can predispose a woman toward PMDD.  Incidents of trauma like these create neural pathways in the brain that can lead a woman with PMDD to over-react both physiologically and emotionally to normal everyday stressors in her life by producing an excess of "fight or flight" hormones, among other things.  Once this neural pathway has been opened, via trauma, the ruts are established and only get deeper with each new stressor.

 

To top it off, stress can contribute to further chemical imbalances in the brain.

So which came first, the chicken or the egg?  Is it stress that aggravates your PMDD or does your PMDD stress you out? 

 

The answer is both.  Lucky you.

Other sources of stress that work both ways include: 

Addiction

PMDD women are more prone to addictive behaviors, including sexual addiction, relationships addiction, drug addiction, nicotine addiction, alcohol abuse, and emotional eating, all of which bring stress into your life. 

Substance Abuse

This has to do with the reward/pleasure center of the brain, which is basically not working right during an episode of PMDD.  What you think will bring you pleasure or relief from your weepiness and edginess and anger in fact does not, because your brain is not processing information properly to start with.

The following has nothing to do with substance abuse, but is just one example of how my brain doesn't work right during that time...I walk around the track at my local gym.  I time myself.  On a good, comfortable day, I can do one lap in one minute.  Sometimes I can do it in 55 seconds, when I am pushing myself, and sometimes I'm just not feeling up to par and it takes an extra 5 - 10 seconds.  

But on an average day, I do one lap in one minute.

When I am having an episode of PMDD and force myself to go and walk around the track, and I feel like I am moving through molasses and every step is a challenge...imagine my surprise to discover that according to the second hand of the clock, I am actually moving at my normal pace of one lap per minute.

PMDD screws with your perceptions.  Of everything.

This includes what you see, what you hear, what you feel, what you think, and what you reach for to numb the pain.

Depressed people in general like to self-medicate (Remember, the first D in PMDD stands for Dysphoria, or depression) and jumpstart the reward/pleasure center of the brain with external substances, both legal and illegal.  But the PMDD brain does not respond properly to these stimulants, leaving the woman vulnerable to addiction.  Things that only add to the muddle going on in your brain are unresolved conflicts from the past, destructive behavior patterns, cycles of abuse, day to day stress, relationship issues, and cultural conditioning--all of which can lead to substance abuse in non-PMDD women as well.

So not only do the same things that set other women off set PMDD women off, but:

Our brains do not process the information properly during an episode...which leads to all sorts of drama...which only adds to our level of stress...thus leaving PMDD women more prone to substance abuse disorders, whether from the differences in our brain chemistry or the issues and situations that arise as a result of our choices and actions...which are also in part dictated by our abnormal brain chemistry.  

Did you get all that? 

The bottom line is it's a vicious cycle, and no matter which way you look at it, PMDD women lose.

Adolescent Abuse

Briefly, studies have shown that women who have been abused in adolescence are more likely to develop PMDD.

Childhood Abuse

A scientific link has been found between women who were abused as children, and women who develop PMDD.  Again, this has to do with the faulty neural pathways developed in times of trauma, affecting the "fight or flight" response in the brain.

Physical Abuse

Physical abuse has the same effect on the brain as trauma. Women in abusive situations are also more prone to anxiety and depression disorders, which adds to the burden on the brain.

Sexual Abuse

Studies have shown sexual abuse to be a precursor to both Major Depressive Disorder and PMDD, no doubt through the connection to trauma.  A link has been established between sexual abuse, PTSD, elevated thyroid ratios and PMDD.

Next up:  Ideas for reducing the amount of stress in your life.

PMDD and Neural Pathways

In next week's post (which I am already writing today), I'm going to talk about stressors specific to PMDD women.  I'm going to use words you may or may not have heard before.  Like neural pathways.  What does that mean?  Well, let's look at neural.  Neurology. Neurologist.  Having to do with nerves.  Ever have a pinched nerve or experience nerve pain?  Ever say to someone "You're getting on my nerves?"  A neural pathway is like a dirt road.  The more you use it, the more it gets worn down.  If you use it a lot, the road develops ruts.  When a road has ruts in it, you can get stuck in the mud. 

 

On the flip side of that, think of a pair of shoes.  Nothing better than a pair of shoes you've had so long that they feel totally comfortable. 

 

So we have these neural pathways in our brains.  The more we use them, the more they can either develop ruts we get stuck in, or the more comfortable they can become.   Sometimes we can get comfortable with things that are not good for us.  Like addiction and abuse.  But hey, they are familiar.  Better the devil I know than the one I don't.  So in times of stress, we reach for the familiar. Our brain sort of goes on autopilot and says "I know how to react to this" and sticks with the tried and true.

The brain does not distinguish between what is comfortable and what is a rut.  Left to its own devices, the brain just takes the path of least resistance.  To get a different result, or take a different path, you have to consciously choose to do so, and in a sense, give your brain instructions to do something different this time.  Because even while the brain reacts automatically, you are in control of your thoughts, your thoughts are not in control of you.

Hard to believe when you're in the middle of a PMDD episode, but bear with me here.

To take a different path, you have to let your brain know that's what you want to do.  It will be hard, of that there is no doubt.  Your brain has been conditioned to doing things a certain way.  It's quite content to keep doing things this way.  Basically, you have to re-train your brain. 

 

I'd much rather slip into a comfortable pair of shoes than get stuck in a dirt road rut. 

 

Screaming and yelling and crying and creating all sorts of drama is sinking into the rut.  Taking a deep breath, holding your tongue, going for a walk or into a room by yourself to calm down is breaking in a new pair of shoes.  It will feel unfamiliar and tight and pinched at first, but the more you wear those shoes, the more comfortable they will become.  The more you practice self-control, the more familiar and comfortable it will become.  Eventually, you will have created a new rut...one you don't mind being stuck in.  One that helps your relationships instead of hurts them, and one that doesn't leave you feeling destroyed every time you get stressed.

We're talking normal stressors here, the stuff people have to deal with every day.  A meeting with your boss, a new client, your kid's teacher, a presentation you have to give, just dealing with people in retail, or long lines at the grocery store.  Traffic jams, flight delays, spilled milk, and crayons on the wall.  Practice is how you retrain your brain to deal with that stuff.  Because PMDD women have a reputation for being unable to cope with everyday stresses.  But this is because our PMDD brains have been conditioned to over-react to normal everyday stresses.  We have to work hard to get out of those brain ruts and we have to start small.

One moment at a time.

Some think of PMDD women as being weak, but I think the opposite.  I think we are strong.  Stronger than most.  Because we're starting out from deep in the ruts, while everyone else is starting on solid ground.  And still we succeed.  We get the clients, give the presentations, raise our children, maintain our households, keep our families and businesses afloat,  bring home the bacon, create beautiful things, care for our loved ones, and win recognition and respect DESPITE having a brain that does not function properly.

So never put yourself down for having PMDD.  Doing so only creates another rut you have to crawl out of.