What conditions is PMDD comorbid or confused with?

Key Takeaways

Premenstrual dysphoric disorder (PMDD) is a more intense form of premenstrual syndrome (PMS). People with PMDD experience physical symptoms like bloating, headaches, and breast tenderness, combined with severe anxiety, depression, and mood swings in the one to two weeks before their period.
Doctors can diagnose PMDD on its own, but up to 70% of women with PMDD also have co-existing conditions, like anxiety disorder, post-traumatic stress disorder (PTSD), major depression, and bipolar disorder. PMDD impacts 3% to 9% of women of reproductive age.
Managing PMDD and any other co-existing conditions requires care that addresses both conditions. This typically includes a combination of talk therapy, lifestyle changes, and medication.

Many women experience intense menstrual periods with cramps, heavy bleeding, and mood swings. However, for those with premenstrual dysphoric disorder (PMDD), the symptoms are severe and often include depression, anxiety, and other debilitating side effects during the one to two weeks before their period. While these symptoms usually subside once menstruation begins, PMDD can make half the month feel extremely difficult, often disrupting jobs and relationships.

Adding to the challenges, PMDD is frequently diagnosed alongside other mental health conditions. In fact, nearly half of women with PMDD and PMS also live with depression. Existing mental health conditions may temporarily worsen during a menstrual period.

Addressing both PMDD and co-existing mental health conditions requires a comprehensive treatment approach that can include hormonal therapies, lifestyle changes, medication, and talk therapy.

What other conditions can co-exist with PMDD?

Some physical health conditions and mood disorders can mimic or worsen PMDD symptoms, making an accurate diagnosis more difficult.

Some of the physical conditions include:

Irritable bowel syndrome (IBS)
Chronic fatigue syndrome (CFS)
Migraines
Nutritional deficiencies (vitamin D, B6, and magnesium)

PMDD has a high rate of co-existing with other mental health conditions. These conditions can make PMDD symptoms worse, and vice versa. Some of the conditions that can co-occur with PMDD include:

ADHD: Research suggests PMDD might make ADHD symptoms worse, and vice versa.
Seasonal affective disorder (SAD): Some people with PMDD notice their symptoms become more severe during a certain time of year. Many people with PMDD are also diagnosed with seasonal affective disorder (SAD).
Bipolar disorder: Studies have shown a strong link between PMDD and bipolar disorder. In severe cases of PMDD, women can experience panic attacks, mood shifts, fatigue, and other symptoms, sometimes mirroring symptoms of bipolar disorder.
Depression: Underlying depression and anxiety are common in PMDD. Untreated PMDD can lead to depression and, in some cases, thoughts of suicide.
PTSD: Research indicates that PTSD and PMDD frequently occur together. There seems to be a link between past trauma and PMDD.

Since many of these mental health conditions share symptoms, this can complicate a diagnosis and treatment plan for PMDD.

The key to distinguishing PMDD from other mental health conditions lies in charting your menstrual cycle and symptoms. If your symptoms consistently appear one to two weeks before your period and ease once menstruation begins, this suggests PMDD.

Other mental health conditions, like depression and anxiety, typically cause symptoms that persist throughout the entire month. While these symptoms may intensify around your period, their ongoing nature indicates that it could be more than just PMDD.

Why does PMDD frequently occur with other conditions?

PMDD is a relatively new diagnosis, and many healthcare providers are still unfamiliar with the condition. This can make obtaining a diagnosis challenging — especially if you have a co-existing mental health condition.

PMDD symptoms often overlap with those of other health conditions, like thyroid disorders, clinical depression, or anxiety. PMDD can also co-exist with other mental health conditions due to overlapping factors, including:

Hormonal changes: During the menstrual cycle, shifts in estrogen and progesterone impact serotonin, a key mood regulator.
Genetics: Those with a family history of PMDD, depression, or postpartum depression may be at an increased risk of developing both PMDD and a co-existing mental health condition.

PMDD and other mood disorders like major depressive disorder (MDD), generalized anxiety disorder (GAD), and bipolar disorder also share overlapping symptoms, including depression, anxiety, irritability, and fatigue.

However, what sets PMDD apart is its cyclical pattern. PMDD symptoms only occur in the luteal phase of the menstrual cycle and improve once menstruation begins.

How to uncover the root of your symptoms and start healing

Identifying the root cause of your PMDD and any co-existing mental health conditions is key to avoiding misdiagnosis, receiving personalized treatment, and improving your overall quality of life.

By working with a therapist trained in PMDD and other mood disorders, you can safely explore underlying factors like chronic stress, past trauma, and unresolved grief.

A therapist trained in PMDD and co-existing mental health conditions can help you:

Break the cycle of negative emotions by addressing thought patterns and emotional triggers
Develop tools and self-care strategies for managing your mood disorder effectively
Examine family dynamics, work, and other relationships to assess whether they contribute to stress
Explore past experiences like childhood neglect, abuse, or early loss that may shape your emotional responses
Track and identify symptom patterns by encouraging you to keep a detailed record of your menstrual cycle and triggers

Through this process, you’ll gain greater self-awareness and strategies to manage PMDD and co-existing conditions more effectively.

A therapist can guide you in exploring therapeutic options that address both emotional and physical triggers of PMDD and co-existing mood disorders. These may include:

Cognitive behavioral therapy (CBT): This evidence-based form of talk therapy focuses on identifying and reframing negative thought patterns, managing triggers, and developing effective coping strategies. CBT has proven highly effective in treating PMDD and other mood disorders.
Eye movement desensitization and reprocessing (EMDR): Originally designed for trauma, EMDR is also effective for mood disorders. It helps process unresolved memories and experiences that may contribute to emotional distress.

Find care with Rula

If you experience menstrual periods that go far beyond normal cramps and irritability, you may be experiencing PMDD. Managing this condition can become even more challenging if you have a co-existing mood disorder. Working with a therapist who specializes in PMDD and other mental health conditions can help you minimize the severity and frequency of your symptoms while providing the care and support you need.

Rula connects you with a network of over 10,000 therapists ready to help you manage your mental health. With just a few clicks, you can find a provider that specializes in mood disorders and accepts your insurance, and meet with them as soon as tomorrow.

About the author

Linda Childers

Linda is an award-winning medical writer with experience writing for major media outlets, health companies, hospitals, and both consumer and trade print and digital outlets. Her articles have appeared in the Washington Post, USA Today, WebMD, AARP, Brain+Life, HealthyWomen.org, The Rheumatologist, California Health Report, Everyday Health, HealthCentral, and many other media outlets. While juggling the responsibilities of being part of the “sandwich generation” and caring for both her toddler son and terminally ill mother, a nurse friend encouraged her to seek therapy, which helped her to learn coping strategies and manage her depression. Linda hopes her work will help to destigmatize mental health conditions and encourage others to get the help they need.

Rula's editorial process

Rula's editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness. Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.