Medicalising menstruation: the case of premenstrual dysphoric disorder and DSM 5

The phenomenon of ‘premenstrual syndrome’ has attracted considerable
attention during the early half of the twentieth century. Over the years, medical
researchers and physicians have concluded that premenstrual changes could
cause women severe distress and impair their ability to function at work and at
home. In 1994, the Diagnostic Statistical Manual of Mental Disorders (DSM-IV)
(American Psychiatric Association 1994) used the term ‘premenstrual dysphoric
disorder’ (PMDD) to refer to these premenstrual changes. At present, PMDD is
being proposed for inclusion as a new category in DSM 5, due for release in May
2013. This inclusion means women who experience premenstrual changes could
be classified with a mental disorder. This study aimed to explore how
premenstrual changes evolved from a normal biological fact of life into a
psychiatric disorder.
The study examined the way premenstrual changes have been constructed in
psychiatric and psychological literature. The study was informed by a critical
realist epistemology and adopted a Foucauldian discourse analysis methodology.
The study took a genealogical approach to explore the discursive and nondiscursive
practices that have influenced the medicalisation of premenstrual
changes in DSM.
The study found three interrelated ‘truths’ about women’s premenstrual changes
that have been produced and disseminated by psychiatrists and psychologists to
reify PMDD as a psychiatric problem. Psychiatrist and psychologists have drawn
on the discourses of science and medicine to render these constructions or
‘truths’ intelligible. The literature focused primarily on negative mood changes
and failed to consider positive premenstrual experiences that many women
report. The literature did not consider premenstrual experiences from a nonbiomedical
perspective and neglected the role that relational, social, economic,
cultural and structural factors play in contributing to or exacerbating premenstrual
experiences. This means that the published research has excluded aspects of
premenstrual experiences that could stand in contrast to the dominant accounts
reported throughout the literature. The study found that the construct of PMDD
taps into powerful cultural ideas about what it means to be a woman and what is considered feminine. The study shows that the concept of PMDD is grounded in
a historical tradition of problematizing menstruation. This increased tendency to
view menstruation or aspects of menstruation as problematic does not benefit
women.
We must recognise that the way we construct menstruation or menstrual cycle
experiences has an effect on the way we view women and the way we treat
them. The inclusion of PMDD may devalue women and result in the
discrimination, marginalization, and stigmatization of women. This study
recommends that the category of PMDD be excluded from DSM 5.
Recommendations for clinical practice and further research are suggested.