Q:  Is it possible someone can have PMDD & have it be confused with Bipolar disorder. Does it mean if a person tried a suicide attempt that it strictly classifies he or she as Bipolar? Do people with PMDD attempt suicide?


Dear Mia --

Well, this is one of those "there is a long answer, and a short answer" things. I'm going to try for the short answer. For the long answer, I would recommend that you learn a lot about the idea of the "bipolar spectrum". My website on bipolar II might be a good start there.

The short answer, in my personal opinion -- as there is very little research directly on this question, to my knowledge -- is contained in the following picture (from my separate page on hormones and mood):

The picture is intended to illustrate that there is a continuum from "PMS" (premenstrual syndrome) through "PMDD" (premenstrual dysphoric disorder, the somewhat more official name for severe PMS), to bipolar disorder (shifts of mood and energy severe enough to warrant both treatment and a label, which occurred not just prior to menses but throughout the month).

Considering suicide, or making an attempt, probably probably indicates a condition which is "severe enough to warrant both treatment and a label", wouldn't you say?  I think most people would say yes.

Technically, if a woman has major depression, she should not be diagnosed as having PM DD.  The former "trumps" the latter, diagnostically, in an official terms.  Bipolar disorder includes episodes of major depression.  It is differentiated from major depression by also having other symptoms suggestive of "maniac".  This is getting into the long answer.  Again, I would refer you to a page on my website.

In real life, it is clearly obvious that women can have both: they can have an underlying mood disorder (either major depression or bipolar mood cycling) and also have severe exacerbations of their mood problem just prior to menses.  In this case, technically, they do not have "PMS" or "PMDD", they just have a worsening of their illness that is associated with their reproductive cycles.

We know that people can be suicidal in association with major depression and bipolar disorder.  But can a woman become suicidal from PMDD alone?  In other words, can she have no other symptoms throughout the month, except the last 10 days prior to menses, and then become suicidal during that premenstrual phase?  That's an interesting question.  Not knowing if anyone has even studied this,I've put the words PMDD suicide in the search engine at the national Library medicine (pub med). two articles appear.  They both might be of interest to you, although they both are rather technical -- and the bottom line of each contradicts the other!  One says that suicide is associated with PMS, and the other finds the opposite.^{Wittchen , Baca-Garcia}  Or so I would interpret from reading the abstract alone, which is always a little tricky.  If you are really interested in this, you might want to dig up those articles.

Thank you for an interesting question.

Dr. Phelps