Pre-Menstrual Dysphoric Disorder (PMDD): Why It Goes Undiagnosed
There are a multitude of mental health diagnoses that go undiagnosed for various reasons. Pre-Menstrual Dysphoric Disorder (PMDD) is one that not only goes undiagnosed, it often goes unrecognized due to limited research and fairly recent recognition as a diagnosable disorder. Despite its devastating impact, PMDD is often dismissed as "bad PMS" or misdiagnosed as depression, anxiety, or even bipolar disorder due to its cyclical nature.
PMDD was officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Before then, it was considered a provisional diagnosis, meaning there was not enough research to classify it as a distinct disorder. Even today, a significant number of healthcare providers are unfamiliar with PMDD, leading many individuals to struggle without proper diagnosis or treatment.
Defining PMDD
PMDD is a severe, hormone-based mood disorder that follows the menstrual cycle. Symptoms typically emerge during the luteal phase (the two weeks before menstruation) and subside within a few days after the period starts. Unlike PMS, which can cause mild discomfort and mood changes, PMDD is debilitating. It disrupts daily life, relationships, and emotional stability. Research suggests that PMDD has a genetic component and that symptoms can intensify after major reproductive events such as pregnancy, birth, or during perimenopause.
Since PMDD shares such similar core traits as PMS it often goes undetected or unacknowledged and ascribed to “bad PMS,” or a low grade depressive or anxiety disorder that gets worse during menstruation. Needless to say many indivduals are then left to feel shame for their symptoms and go on to be mistreated for an alternative disorder.
Because PMDD symptoms fluctuate with the menstrual cycle, one of the most common and harmful misdiagnoses is bipolar disorder, as both conditions involve severe mood swings.
The Misdiagnosis of PMDD as Bipolar Disorder
One of the key distinctions between bipolar disorder and PMDD is the timing of symptoms. Bipolar disorder is characterized by episodes of mania or hypomania that can last for weeks or months, interspersed with depressive episodes. PMDD, on the other hand, follows a predictable cycle, with symptoms appearing in the luteal phase and disappearing after menstruation begins.
Unfortunately, this cyclical nature leads many medical professionals to mistake PMDD for bipolar disorder, particularly bipolar II disorder, which involves depressive episodes and milder forms of mania (hypomania).
Statistics on PMDD and Misdiagnosis
A 2012 study found that more than half of individuals with PMDD were previously misdiagnosed with bipolar disorder, depression, or an anxiety disorder before receiving the correct diagnosis.
Another study reported that nearly 40% of people with PMDD had been prescribed bipolar medications, such as mood stabilizers or antipsychotics, which may not effectively treat PMDD and can come with significant side effects.
Research indicates that people with PMDD are over 70% more likely to be misdiagnosed with a psychiatric disorder before their hormonal cycle is considered as a root cause.
This pattern of misdiagnosis leads to inappropriate treatment, leaving individuals struggling with symptoms that don’t improve—or even worsen due to the wrong medications.
What PMDD Feels Like
Many people with PMDD describe it as feeling like a stranger in their own body, experiencing drastic shifts in mood and energy that feel completely out of their control. One week, they may feel like themselves, and the next, they are overcome with irritability, rage, despair, or suicidal thoughts.
PMDD symptoms overlap with many mental health conditions and may include:
Intense mood swings
Irritability, anger, or rage
Hopelessness and suicidal ideation
Panic attacks and anxiety
Brain fog and difficulty concentrating
Extreme fatigue
Feelings of worthlessness or guilt
Sensory sensitivity (e.g., noise, light, touch)
Severe bloating, headaches, or joint pain
Because PMDD is still widely misunderstood, many people suffering from it feel alone and invalidated. It is not just bad PMS, and it is not a personality flaw—it’s a legitimate medical condition that requires proper diagnosis and treatment.
Getting the Right Diagnosis and Treatment
If you suspect you have PMDD but have been misdiagnosed or not diagnosed at all, tracking your symptoms in relation to your menstrual cycle is key. Keeping a symptom journal for at least two cycles (preferably 3) can help you and your healthcare provider identify patterns. Bring your tracking log to your appointment with your healthcare provider and advocate for an assessment for PMDD.
There are a multitude of effective treatment options for managing PMDD including but not limited to:
Hormonal treatments, such as birth control or GnRH agonists, to regulate hormonal fluctuations
SSRIs (Selective Serotonin Reuptake Inhibitors), taken continuously or only during the luteal phase
Lifestyle changes, including dietary adjustments, exercise, and stress management
Dialectic-behavioral therapy (DBT) and trauma-informed therapy, which can help with emotional regulation
Nervous system-focused interventions, like somatic therapy or polyvagal work
Hormonal treatments, non-hormonal birth control or GnRH agonists, to regulate hormonal fluctuations, Hormone Replacement Therapy (HRT) for those with underlying hormonal imbalances or those in perimenopause
The hope is that PMDD gains wider recognition in both the medical and mental health communities, leading to earlier diagnoses and effective treatment. No one should have to suffer in silence or be told their symptoms are "just in their head."
Final Thoughts
PMDD is real, and it’s time for healthcare professionals to start recognizing it as a serious condition. By raising awareness and advocating for better education around menstrual-related mood disorders, we can help individuals receive the care they deserve—without years of misdiagnosis, shame, or unnecessary suffering.
If you or someone you know struggles with cyclical mood symptoms, seek out a provider who understands PMDD. You are not alone, and there is help available.
Find support here and connect with other women that suffer from PMDD: PMDD Facebook Support Group
Kimberly Ciardella, Psy.D. is the founder of The Path Wellness Center in El Dorado Hills, CA. She is a licensed marriage and family therapist and specializes in working with couples and individuals experiencing the challenges of infertility and the grief and loss from miscarrying. Dr. Ciardella works with determined individuals to overcome anxiety and low self esteem, along with strengthening relationships and mending old relationship wounds. She works with couples who are facing parenting struggles that are working towards prioritizing their relationship in the midst of the chaos of raising a family. One of her biggest passions is helping women who are struggling with reproductive health challenges including supporting women who are living with Premenstrual Dysphoric Disorder (PMDD). Dr. Ciardella helps clients heal from past traumas in order to lead fulfilling and joy filled lives.
