5 Psychological Factors that may Contribute to PMDD Symptoms

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS), comprising emotional and physical symptoms, including symptoms of depression, anxiety, fatigue, irritability and panic attacks. It happens during the Luteal Phase, approximately two weeks before the menstrual period, and typically ends two to three days after the menses stops.

Research suggests that there are 5 main psychological factors that may exacerbate the emotional symptoms that occur for women with PMDD.


A risk factor that may exacerbate PMDD symptoms is having a negative cognitive style. This involves critically evaluating yourself and the world around you. Many factors can cause us to develop a negative cognitive style, such as receiving harsh feedback from our parents during childhood, or experiencing rejection from people around us.

Sometimes these negative cognitive styles are not obvious and do not impact our everyday lives until they are triggered by a stressful event.

For women with PMDD, having a negative cognitive style may maintain depressive symptoms, including feelings of hopelessness and tearfulness. Research has found that women with PMDD use a higher number of negative adjectives to describe themselves during the Luteal Phase, compared to healthy women.

Having a negative view of yourself, the world around you and the future may also reduce your beliefs about your self-efficacy, namely the beliefs you have about your ability to complete tasks and reach your goals. For women with PMDD, having a reduced self-efficacy can make you feel frustrated with yourself and worsen your depressive and anxious symptoms.


Alexithymia refers to difficulties in recognising and expressing your emotional and physical symptoms, and is a likely factor that contributes to the PMDD experience. Alexithymia may impact women with PMDD for two reasons.

Firstly, difficulty identifying your internal experiences may cause you to experience elevated physical symptoms and pain. Furthermore, high levels of alexithymia may reduce your ability to cope with stressful situations or pain, because it becomes more challenging to find the most beneficial way of managing your symptoms.

Research has also highlighted an association between alexithymia and poor body image. Women with PMDD tend to have lower levels of body satisfaction, and it is likely that this is in part caused by alexithymia, as difficulty in understanding your symptoms can become internalised and associated with your body.


A significant risk factor for developing PMDD is the experience of abuse or trauma. This could be experienced in different ways, such as emotional, physical or sexual abuse. Research has highlighted a relationship between childhood trauma or abuse and the development of PMDD.

Experiencing a trauma may affect your emotional regulation skills, which refers to the ability to influence your emotions. Women who have suffered a trauma at a young age may be ill-equipped to process changes in emotional and physical symptoms. This may be particularly relevant during the Luteal Phase before menstruation, where particularly difficult emotional, cognitive and physical changes occur.

Experiencing abuse or trauma may also increase your sensitivity to negative information in the environment. Taken together, this may mean that women may feel overwhelmed by intense negative symptoms, leading to the development of PMDD.


Neuroticism is one of the Big Five personality traits, and has been associated with PMDD. Neuroticism is characterised by an inclination towards frequent worrying, low mood and sensitivity to negative information. Neuroticism is not always a bad thing – it may be beneficial for survival by making us more sensitive to environmental threats. However, for women with PMDD, this can contribute to the severity of your symptoms.

Furthermore, neuroticism is associated with higher levels of a specific serotonin receptor, which results in altered serotonin levels. These altered levels may worsen feelings of depression and anxiety. Neuroticism may therefore cause intensified experiences of negative emotions and stress in PMDD.


Research suggests that low levels of social support is a strong predictor of PMDD. As PMDD affects a smaller proportion of women compared to PMS, it is less widely spoken about and this can result in feelings of isolation. Feeling that nobody understands your experience and that you have to cope with your symptoms alone can lead to feelings of loneliness and increased stress levels.

Moreover, having low quality relationships can exacerbate PMDD symptoms; feeling unsupported in low quality relationships, especially during the Luteal Phase when symptoms arise, can intensify experiences of anxiety, depression and stress.

Although these emotional experiences may feel overwhelming and difficult to control or change, we are here to support you.

Psychotherapy can help you work on your deep-rooted thinking patterns and unhelpful coping strategies that may be exacerbating your symptoms. Our psychotherapists are available for face-to-face and remote online sessions. We offer a free 30 minute session,

Nutritional therapy can help you improve symptoms that may be caused in part by hormone sensitivities.

Our programme, MindHealth, combines both psychotherapy and nutritional support to help you target both your psychological and somatic symptoms. A holistic approach can help you build a better relationship with your body, mind and emotions. You can find out more about our programme here.

To book a FREE 30 minute session with a therapist, a 15-minute nutrition call with our experienced nutrition team, or to find out more about our MindHealth programme, book a call with our Client Support team.

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