MOOD FLUCTUATIONS

Mood fluctuations in women and men were studied both prospectively and retrospectively to determine whether cyclic changes occur over phases of the menstrual cycle, lunar cycle, and/or days of the week. The participants (15 women using oral contraceptives, 12 normally cycling women, and 15 men), who did not know the purpose of the study, recorded the pleasantness, arousal, and stability of their moods daily for 70 days (concurrent data). Later they recalled (retrospective data) their average mood for each day of the week and phase of the menstrual cycle (women only). The only evidence of mood fluctuation over the menstrual cycle in the concurrent reports was that normally cycling women reported more pleasant moods in the follicular and menstrual phase than did men and women on oral contraceptives. Women's moods fluctuated less over the menstrual cycle than over days of the week. Recollections of menstrual mood changes differed from actual changes: Women recalled more pleasant moods in the follicular phase and more unpleasant moods in the premenstrual and menstrual phases than they had reported concurrently. Bias also was evident in recollections of weekday mood fluctuations: Weekend highs were exaggerated and Monday blues were reported even though they were not reported concurrently. There was no evidence of mood fluctuations over the lunar cycle and the groups did not differ in mood stability. The retrospective reporting bias for both the mensural cycle and days of week suggests the influence of stereotypes about moods. Implications for research and practice are discussed.     

Men's and women's attitudes and beliefs about the menstrual cycle

Recent analyses of menstrual distress have emphasized sociocultural influences. Yet beliefs and attitudes of men—an important socialization force in the lives of women—have received little attention. In the present study, 239 students (156 females and 83 males) from three colleges filled out a survey on expectations for menstrual and premenstrual symptoms, attitudes about mensturation, sources of menstrual-related information, and effects of menstruation upon daily activities. The major findings are as follows: First, although both males and females believed women experience certain cycle-related symptoms, females reported that women experience more severe menstrual and premenstrual symptoms (when compared to intermenstrual ones) than males reported, while males believed women experience more severe menstrual than premenstrual symptoms than females believed. Second, males learned less about menstruation from the majority of possible informational sources and rated most sources as more negative than did the females. Third, males believed that menstruation had more of an effect on women's moods and had a more debilitating effect on women's lives than did females. Fourth, females rated menstruation as more bothersome than did males. Fifth, more males believed their mothers experienced menstrual irritability and moodiness, while more females believed their mothers experienced swelling. The findings are discussed in terms of the role of socialization and the type of information imparted to males and females in America today.     

Women's theories of menstruation and biases in recall of menstrual symptoms

Previous research is consistent with the proposition that people use implicit theories of personal stability or change in remembering the attributes they possessed in the past. However, there has been little systematic investigation of the relation between these implicit theories and memory biases. In this study, the relation between women's theories of menstrual distress and their recollections of physical and affective symptoms was examined. Ss completed daily questionnaires in which they evaluated themselves on several physical and affective symptoms. Later, some Ss were asked to recall the ratings they had made on a day when they were menstruating; others recalled a day when they were not menstruating. At the time of recall, all Ss were in the intermenstrual phase. Finally, Ss completed a measure designed to assess their theories of how they are typically affected by menstruation. The recollections of Ss who recalled the menstrual state were biased so as to be consistent with their theories of menstrual distress: The more a woman believed in the phenomenon of menstrual distress, the more she exaggerated, in recall, the negativity of her symptoms during her last period. The recollections of women asked to recall the intermenstrual state were unrelated to their theories of menstruation. Furthermore, consistent with previous research, the daily questionnaire ratings revealed that physical symptoms varied with menstrual cycle phase, whereas affective symptoms did not. Finally, comparisons between subjects' theories and daily ratings revealed that, on average, women exaggerate the degree to which they experience changes during menstruation.     

Symptom Attributions Across the Menstrual Cycle in Women with Panic Disorder

Women with panic disorder are likely to experience greater menstrual-specific symptoms (e.g., headaches, cramps) as well as more panic/anxiety-related symptoms (e.g., dizziness, faintness, chest pain, heart pounding), and may be more likely to experience these symptoms during the premenstrual phase. This study examines the attributions women make about the somatic and affective symptoms they experience during the menstrual cycle. Using a 30-day prospective design, women with and without panic disorder monitored physical and affective symptoms. Participants reported on severity of various symptoms and a primary cause for each symptom (menstrual cycle-related, panic/anxiety related, stress-related, health-related). Women with panic disorder reported more panic attacks during the premenstrual phase compared to other cycle phases. They also reported more severe affective and panic symptoms during the premenstrual phase compared to other phases, but did not significantly differ from the comparison group in menstrual symptom severity across the three cycle phases. Although women with panic disorder attributed more panic/anxiety-related causes for their symptoms across the menstrual cycle, they were able to discriminate between panic/anxiety causes and menstrual cycle-related causes. Women with panic disorder may benefit for therapy that focuses on their exacerbation of panic symptoms during the premenstrual phase.     

Effects of menstrual cycle phase on aggression measured in the laboratory

This study investigated the effects of menstrual cycle phase on aggression in two groups of women, which differed in the severity of their self-reported perimenstrual symptoms. A low- and a high-symptom group were recruited using the Menstrual Distress Questionnaire (MDQ) to define the groups. Twenty-two subjects (11 low and 11 high symptom) participated across one menstrual cycle: during the premenstrual, menstrual, midfollicular, and ovulatory phases. The Point Subtraction Aggression Paradigm was used to assess aggression on each day of participation. There were three main findings; a) rates of aggressive responding did not vary across phases of the menstrual cycle; b) the high-symptom group emitted higher rates of aggressive responding across the menstrual cycle than did the low-symptom group; and c) rates of aggressive responding correlated with the MDQ's behavioral and psychological scales and not the somatic scales. These findings indicate that the menstrual cycle phase does not differentially affect this laboratory measure of aggression. The differences found between the two symptom groups parallel a few reports indicating that women who differ in retrospectively reported mood and behavioral changes related to their menstrual cycle also differ on a number of other psychometric measures. Aggr. Behav. 24:9–26, 1998. © 1998 Wiley-Liss, Inc.     

Changes in Moods and Activation Levels During the Menstrual Cycle in Experimentally Naive Subjects

Two experiments providing additional validity data on the Profile of Mood States and the Thayer Activation-Deactivation Adjective Check List were per-formed. In the third and main experiment, seven normally menstruating women filled out both questionnaires at the same time every day for 90 days. They were not aware that they were participating in a study of menstruation. Analysis of the time series records of individual women revealed relatively few significant fluctuations in moods and activation levels. Analysis of the group data showed that Fatigue, Confusion, Deactivation/Sleep, and Depression/Dejection were significantly lower in the premenstrual phase than in the periovulatory phase of the cycle, while General Activation was higher. Anger/Hostility and Confusion were both lower in the menstrual phase than in the periovulatory phase. On a retrospective menstrual distress questionnaire, these same subjects say that they experience increases in anxiety, irritability, depression, and tension in the premenstrual phase of the cycle. The differences between individual and group data and the apparent discrepancy between daily self-reports and retrospective questionnaires are discussed.     

Ambivalent sexism,attitudes towards menstruation and menstrual cycle‐related symptoms

The objective of the present study was to investigate the relationship between ambivalent sexism and beliefs and attitudes towards menstruation, and, in turn, to study the influence of these variables on menstrual cycle‐related symptoms. One hundred and six Mexican women completed the Ambivalent Sexism Inventory, the Beliefs about and Attitudes toward Menstruation Questionnaire and the Menstrual Distress Questionnaire. The higher scores on benevolent sexism were associated with the most positive attitudes towards menstruation and also with the belief that a menstruating woman should or should not do some activities and that menstruation keeps women from their daily activities. The higher scores on hostile sexism were associated with rejection of menstruation as well as with feelings of embarrassment about it. Beliefs about and attitudes towards menstruation predicted menstrual cycle‐related symptoms related to negative affect, impaired concentration and behavioural changes, but did not predict somatic symptoms. These results will be useful to health professionals and advocates who want to change the negative expectations and stereotypes of premenstrual and menstrual women and reduce the sexism and negative attitudes towards women that are evident in Mexican culture.     

Premenstrual Syndrome and Misattribution: A Self-Perception,Individual Differences Perspective

Self-perception theory suggests that premenstrual syndrome (PMS) may arise from the misattribution of hormone-induced bodily changes. If so, individual differences in the role of bodily responses in emotional feelings, measured in a separate expression-manipulation procedure, should be related to susceptibility to PMS. In Study 1, women responsive to cues from their bodies showed significant mood changes, both negative and positive, with their cycle, over a 60 day span; whereas women relatively unresponsive to personal, bodily cues showed no consistent cycle effects. PMS was also predicted by a measure of emotional complexity. In Study 2 women whose moods were based on bodily cues also rated their moods as less positive if they were in their premenstrual week, and women unresponsive to their bodies were unaffected by their cycle. A reminder of their cycle-stage prevented PMS in the body cue group, which is a kind of discounting effect. Women who were unresponsive to their bodies also did not show PMS, and were unaffected by the reminder.     

Problem-Solving Appraisal,Oral Contraceptive Use,and Menstrual Pain1

The effects of self-appraisal problem-solving ability and oral contraceptive use on ratings of menstrual pain were studied among 130 undergraduate women. Participants completed the Problem-Solving Inventory (Heppner, 1988) and the Menstrual Distress Questionnaire (Moos, 1984). Regression analyses indicated that oral contraceptives–which are often prescribed to relieve menstrual pain among college women–were not predictive of lower pain ratings. Problem-solving appraisal, however, was significantly predictive of pain. Ratings of effective personal control during problem solving were associated with lower ratings of premenstrual and menstrual pain. Results are discussed as they pertain to the study of psychological factors in menstruation, and to the study of problem solving and behavioral health.     

IS A LITTLE (PSYCHIATRIC) KNOWLEDGE A DANGEROUS THING?

One hundred thirty-four participants completed a revised Menstrual Distress Questionnaire (MDQ), which included criteria for premenstrual dysphoric disorder (PMDD). Two weeks later the participants again completed the revised MDQ after reading either the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for the PMDD or a copy of the same criteria retitled "Episodic Dysphoric Disorder," with all menstrual cycle references removed. Knowledge of the diagnosis did not affect women's perceptions of their own menstrual cycle-related symptoms, but it increased participants' perceptions of premenstrual changes as a problem for women in general. Chi-square analyses revealed that participants were more willing to attach a psychiatric diagnosis to women they know if they believed the diagnosis was related to the menstrual cycle.     

Cyclical variation in digit-span and visual-search performance in women differing in the severity of their premenstrual symptoms.

Groups of women differing in the severity of reported premenstrual symptoms were compared over two menstrual cycles on a digit-span task, a visual-search task, and a combination of the two. Neither group exhibited large performance changes during the premenstrual phase of the cycle. High-symptom women differed somewhat from low-symptom women in the effect of menstrual phase on digit-span performance, recalling slightly fewer series correctly during the premenstrual phase. The response latency of high-symptom women on the visual-search task was substantially longer than that of the low-symptom women regardless of menstrual phase. These results suggest that there may be stable differences between high-symptom and low-symptom subjects that are greater than the cyclical fluctuation within either group.     

PLACING PREMENSTRUAL SYNDROME IN PERSPECTIVE

In a longitudinal prospective study, mood fluctuations were assessed for evidence of premenstrual syndrome (PMS) as well as other menstrual, day of week, and lunar cyclicity. Volunteer participants from the community (60 women and 10 men) provided daily data for 12 to 18 weeks. Significant mood fluctuation was determined by a new nonparametric method using each individual's own standard deviation as a measure of "marked" change. Cyclicity was the norm; two thirds of both the women and men had one or more menstrual or lunar phases or days of the week that were markedly positive and/or negative, relative to their own range, but few experienced stereotypical cyclicity (PMS, Monday blues, full moon). About half the women whose prospective data met conservative criteria for PMS, met liberal criteria, or met neither criteria said they had PMS, and half in each group said they did not.     

Frontal EEG asymmetry and premenstrual dysphoric symptomatology

Resting frontal electroencephalographic (EEG) asymmetry has been hypothesized to tap a diathesis toward depression or other emotion-related psychopathology. Frontal EEG asymmetry was assessed in college women who reported high (n = 12) or low (n = 11) levels of premenstrual negative affect. Participants were assessed during both the follicular and the late luteal phases of the menstrual cycle. Women reporting low premenstrual dysphoric symptomatology exhibited greater relative left frontal activity at rest than did women high in premenstrual dysphoric symptomatology, an effect that was not qualified by phase of cycle. Although women with extreme levels of symptomatology were assessed, the question of whether such symptoms qualified for premenstrual dysphoric disorder criteria was not assessed. These results are consistent with a diathesis-stress model for premenstrual dysphoric symptomatology.     

Mood-related self-schemata and mood-congruity effects in autobiographical memory: A study of women with premenstrual syndrome

Everyday autobiographical memory and mood interactions were explored in a small clinical sample of women with premenstrual syndrome (PMS) and a matched control group. Subjects kept daily records of memorable events for two consecutive menstrual cycles. Two recognition memory tests were given after a one-cycle delay. Mood, or affect, was self-assessed retrospectively over a week, at the end of each day during data collection and at testing, and when events occurred. Women with PMS were more depressed and more negative (angry) than positive (experiencing bursts of energy) in their daily moods than controls. Memory accuracy was poorer overall for PMS than control subjects, although no direct effects of menstrual cycle phase on memory were found. Instead, mood affected memory indirectly through moodrelated self-schemata which subsequently mediated mood-congruity effects. Memory accuracy for events experienced in negative mood states and associated with negative affective reactions was higher for PMS subjects when tested in negative mood states than for controls. No group differences were found on events associated with positive affect or positive daily moods when mood state at the time of testing was also positive. Women with PMS processed information selectively from negative events and events experienced in negative moods compared to controls. Negative events and negative moods appeared to interfere with remembering for control subjects. Women in the control group appeared to be biased towards selectively remembering positive events and events experienced on days when their mood states were relatively positive.     

A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome

We randomized, at two sites, 210 patients with Rome II diagnosed irritable bowel syndrome (IBS), of at least moderate severity, to one of three conditions: group-based cognitive therapy (CT; n=120), psychoeducational support groups (n=46) as an active control, or intensive symptom and daily stress monitoring (n=44). One hundred eighty-eight participants completed the initial treatment. Those in symptom monitoring were then crossed over to CT. For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries, both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition, but the CT and psychoeducational support group did not differ. Among treatment completers on the same composite measure of GI symptoms, again, both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite, or on any other measure. On individual IBS symptoms, both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence. Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity, with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being. Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms, including the McGill Pain Questionnaire. Group CT and psychoeducational support groups continued not to differ on any measure. We thus conclude that group CT is not superior to an attention placebo control condition.     

Pain perception across the menstrual cycle phases in women with chronic pain

The menstrual cycle has been reported to alter pain perception but the patterns differ among studies. It has been reported that estrogens may influence somatic sensory processes. The present aim was to investigate whether the perception of pain varies by phases of the menstrual cycle. 20 women with chronic low pain volunteered to participate and were asked to rate their pain each day during three successive menstrual cycles. The menstrual cycle was divided into four and five phases to be able to compare results. Analysis showed there were phase differences in pain ratings during the menstrual cycle. Regardless of whether the menstrual cycle was divided into four or five phases, women rated pain significantly higher in the menstrual and premenstrual phases than in the midmenstrual and ovulatory phases. This is consistent with other studies showing less pain sensitivity during phases of the menstrual cycle associated with high estrogen. Women with high pain frequency reported more frequently a passive coping style and catastrophizing thoughts.     

Physical Characteristics of the Menstrual Cycle and Premenstrual Depressive Symptoms

ABSTRACT— Little is known about the associations between premenstrual depressive symptoms and specific physical symptoms of the menstrual cycle. In a nonclinical sample of 183 female university students, six physical symptoms of the menstrual cycle (headaches, skin changes, gastrointestinal problems, breast changes, and coagulation and heaviness of menstrual bleeding) were tested for their associations with premenstrual depressive symptoms. The physical symptoms explained nearly 30% of the variance in depressive symptoms. Moreover, when the summed score for all six physical symptoms was used as a predictor of depressive symptoms, a strong linear effect and a moderate curvilinear effect were observed. These results could not be explained by response bias or by the presence of a small group of highly depressed individuals. This study emphasizes the need to consider physical symptoms of the menstrual cycle to better understand premenstrual depressive symptoms, and suggests that the contribution of the menstrual cycle to depressive symptoms in the general population is underrecognized.     

Toward the content validity of premenstrual dysphoric disorder: do anger and irritability more than depressed mood represent treatment-seekers' experiences?

The content validity of Premenstrual Dysphoric Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) has been questioned in the literature. We tested whether mood-related symptoms reported by 26 women seeking treatment for premenstrual disorders were among the proposed criteria. These women were asked to list their premenstrual symptoms and rate the severities of listed symptoms daily for two menstrual cycles before treatment. They completed semistructured interviews to differentiate symptoms of Premenstrual Dysphoric Disorder from those of other psychiatric disorders in women who had other disorders. All participants reported functional interference due to the symptoms. 19 symptoms of or similar to those of Premenstrual Dysphoric Disorder were among the 22 most frequent premenstrual symptoms experienced. Premenstrual depressed mood was less frequent than premenstrual irritability or anger when other psychiatric disorders such as major depression were taken into account. Results suggest that the DSM-IV-TR criteria have generally good content validity but may need revision to represent treatment-seekers experiences more accurately.     

SEXIST DISCRIMINATION MAY ACCOUNT FOR WELL-KNOWN GENDER DIFFERENCES IN PSYCHIATRIC SYMPTOMS

It was hypothesized that women may have more depressive, anxious, and somatic symptoms than men because they experience a deleterious stressor that men do not: sexist treatment. A total of 255 students (180 females, 75 males) at a state university completed an anonymous questionnaire containing measures of these symptoms. Women were found to exhibit significantly greater symptoms than men on all of them. Further, women who experienced frequent sexism had significantly more symptoms than men on all symptom measures, whereas women who experienced little sexism did not differ from men on any symptom measure. These findings suggest that gender-specific stressors not only play a role in psychiatric symptoms among women but may account for well-known gender differences in those symptoms as well.     

Incidence of anovulatory menstrual cycles among dysmenorrheic and non-non-dysmenorrheic [corrected] women: effects on symptomatology and mood

The incidence of spontaneous anovulatory (SA) menstrual cycles among dysmenorrheic and non-dysmenorrheic women and their effects on symptomatology and mood were examined in 52 university students distributed into two groups (18 dysmenorrheic women and 34 non-dysmenorrheic women) according to the presence or absence of symptoms of primary dysmenorrhea. Women were tested in menstrual, ovulatory and premenstrual phases. In order to estimate the proportion of ovulatory and SA cycles the basal body temperature (BBT) method was used. Results indicated that the percentage of SA cycles found in dysmenorrheic women does not confirm that primary dysmenorrhea only occurs in ovulatory cycles. In addition, the ovulatory cycles did not present greater symptomatology than the anovulatory cycles in self-rating of negative affect. In fact, menstrual symptomatology was not associated with ovulatory cycles. These data confirm that primary dysmenorrhea does not only depend on the endocrine factors which regulate the menstrual cycle but also on other factors such as social or psychological ones.