Physiological and psychological reactivity in women with asthma: the effects of anxiety and menstrual cycle phase.

The relation between menstrual cycle timing, panic attacks, and diagnosis of asthma was explored in this study. Women with or without asthma and with or without a history of panic attacks engaged in a psychophysiological task during either the intermenstrual or premenstrual cycle phase and completed self-report measures of menstrual symptoms and attitudes, general psychological symptoms, and attitudes toward illness. No significant differences were identified for psychological or psychophysiological measures with menstrual cycle phase as a factor. However, women with both asthma and a history of panic attacks reported more general psychological distress than women in the other groups, and more state anxiety than controls. Women in the asthma, asthma and panic, and panic groups reported higher anxiety sensitivity than the control group. After listening to asthma-related scenes, women with asthma exhibited a decrease in peak expiratory air flow, and women with asthma and panic exhibited increased skin conductance response magnitude. Implications for the role of anxiety in lung function are discussed, as well as directions for future research with asthma and anxiety populations.     

Menstrual Reactivity: The Role of Gender-Specificity,Anxiety Sensitivity,and Somatic Concerns in Self-Reported Menstrual Distress

To determine the impact of gender roles, anxiety sensitivity, and somatic concerns on self-reported menstrual distress, two studies were conducted. In the first study using 278 primarily Caucasian college females, anxiety-sensitivity level, not current menstrual cycle phase, influenced reports of menstrual symptom severity and depression. Regardless of cycle phase at the time of self-report, women high in anxiety sensitivity reported significantly more depressed mood, trait anxiety, and retrospective menstrual symptoms. In the second study of 158 primarily Caucasian college females varying in anxiety sensitivity levels, adherence to sex role stereotypes, feminist beliefs, and illness attitudes were examined. Participants also completed measures of general premenstrual, most-recent premenstrual, and current menstrual symptoms. Women high in anxiety sensitivity reported the highest levels of sex-specificity, feminist embeddedness, and illness attitudes, with sex-specificity accounting for significant variance in current menstrual symptoms. Results are discussed within the context of the menstrual reactivity hypothesis, which proposes that beliefs surrounding the menstrual cycle and body sensations expectancies contribute to self-reports of greater menstrual distress. Women high in anxiety sensitivity appear to represent one subgroup vulnerable to menstrual reactivity.     

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.     

The influence of the menstrual cycle on reactivity to a CO2 challenge among women with and without premenstrual symptoms

Clinically significant premenstrual symptoms (PMS) is conceptualized as a depressive disorder in DSM-5, however, it may share pathophysiological processes with anxiety- and fear-related disorders. Specifically, women with PMS panic at higher rates during biological challenge procedures. It is unclear if this increased interoceptive sensitivity is a general vulnerability or specific to the premenstrual phase. The current study examined the role of menstrual cycle phase on reactivity to a CO₂ challenge among women with (n = 11) and without (n = 26) clinically significant PMS (N = 37). During the late follicular phase (days 6–12), women with and without PMS responded similarly to the CO₂ challenge, whereas during the premenstrual phase (within 5 days before menses), women with PMS reported significantly more intense panic symptoms in response to the challenge than women without PMS. Vulnerability to panic in women with PMS may be specific to the premenstrual phase. Potential psychological and neurobiological mechanisms underlying this phenomenon are discussed.     

Daily moods and symptoms: effects of awareness of study focus, gender, menstrual-cycle phase, and day of the week

Evaluated changes in daily ratings of moods and symptoms in 30 normally cycling women and 23 men. Women were randomly assigned to two groups for manipulating awareness of the study focus (aware vs. unaware). Principal-components analysis revealed six factors (Dysphoric Moods, Well-being, Physical Symptoms, Personal Space, Food Cravings, Depression) that accounted for 70% of the variance in daily ratings. Repeated-measures analyses revealed cyclic variation on each factor and no significant differences between aware and unaware women during premenstrual or menstrual phases on any measure. Unaware women reported less well-being than men during the premenstrual phase but did not differ on any other measure. Aware women did not differ from men in premenstrual or menstrual ratings on any measure. The way these findings relate to retrospective symptom reports, menstrual attitudes, and changes in moods and symptoms across the week was examined.     

EFFECTS OF EXPECTATIONS AND BODILY SENSATIONS ON SELF-REPORTS OF PREMENSTRUAL SYMPTOMS

Two experiments examined expectations and bodily sensations in premenstrual symptom reports. Women took a fictitious test that indicated they were either "premenstrual" or "intermenstrual." In Experiment 1, 48 women were studied during their premenstrual phase. In Experiment 2, 82 women were studied during either their premenstrual or intermenstrual phase. Individual differences in retrospective premenstrual distess were assessed prior to the experiments. Both experiments revealed that the higher the woman's retrospective reports of premenstrual distress, the more symptoms she reported in the lab during her premenstrual phase, regardless of what the test indicated. However, women who were told they were premenstrual reported greater symptoms than women who were told they were intermenstrual. In summary, although expectations affect women's symptom reports regardless of their actual phase and history of reported symptoms, premenstrual symptom reports cannot be dismissed as simply expectations, because some women do experience greater symptoms as they approach menstruation.     

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.     

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.     

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.     

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.     

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.     

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.     

神经质程度和月经周期对女性主观情绪和生理反应的影响

分别选取两组神经质程度高、低女性16名和25名, 考察两组被试在月经周期不同阶段(经期、卵泡晚期、黄体中晚期)的激素(雌二醇、孕酮)波动以及观看情绪视频(中性、搞笑、悲伤、愤怒)的主观情绪感受和生理反应的差异。结果显示高神经质女性在月经周期中对负性情绪视频的主观情绪和生理反应变化明显, 黄体中晚期对愤怒视频主观情绪体验更低, 对悲伤视频生理反应更小, 而低神经质女性的情绪反应不受月经周期影响。研究表明高神经质女性的情绪反应更易受月经周期影响, 这可能与其对孕酮水平波动的敏感性高有关。     

Avoidant coping in panic disorder: a yohimbine biological challenge study

Few studies have addressed whether the use of avoidance-oriented coping strategies is related to the development of panic in patients with panic disorder(PD). Self-report, clinician-rated, and physiological data were collected from 42 individuals who participated in a yohimbine biological challenge study, performed under double-blind, placebo-controlled conditions. Participants included 20 healthy controls and 22 currently symptomatic patients who met DSM-IV-TR diagnostic criteria for PD. Consistent with prediction, patients with PD who had higher perceived efficacy of avoidance-oriented strategies in reducing anxiety-related thoughts reported increased severity in panic symptoms during the yohimbine challenge condition as compared to the placebo. Further, patients with PD who had more fear of cognitive dyscontrol, cardiovascular symptoms, and publicly observable anxiety also reported increased severity in panic symptoms during the challenge. Healthy controls who had more fear of cardiovascular symptoms similarly reported increased severity in panic symptoms during the challenge. No effects were found for heart rate response to the challenge agent. These results provide support for the role of avoidance-oriented coping strategies and fear of anxiety-related symptoms as risk and maintenance factors in the development of panic symptoms, particularly within a biological challenge model.     

Autobiographical memories of anxiety-related experiences

Ninety-nine undergraduate students retrieved three memories associated with each of the five emotional experiences: panic, trauma, worry, social anxiety, and feeling content. Subsequently, they answered 24 questions assessing properties of each memory, including the vividness and perceived accuracy of the memories and sensory, emotional, and anxiety-related experiences during retrieval. Memories were coded for affective tone and specificity. Results indicated that panic-related and trauma-related memories were rated similarly as content memories, but that they generally were associated with more imagery and emotional experiencing than worry-related or social anxiety-related memories. Participants experienced panic and worry symptoms to the greatest degree when they retrieved panic-related and trauma-related memories. All anxiety-related memories were characterized by more negative tone than content memories. Panic-related and trauma-related memories were more specific than worry-related, social anxiety-related, and content memories. These findings can explain partially why individuals with some, but not all, anxiety disorders experience enhanced memory for threatening material.     

SOCIAL STIMULUS PERCEPTION AND SELF-EVALUATION: EFFECTS OF MENSTRUAL CYCLE PHASE

Women in different phases of the menstrual cycle were compared to each other and to men in their responses to a social interaction stimulus: a videotape depicting a female nurse interacting with a hospitalized patient. Sex differences and cycle-phase differences were found for both affective and cognitive dimensions. Premenstrual women reported feeling more dominant, energetic, indifferent, negative, and somewhat more tense than women menstruating or women in the intermenstrual cycle phase. However, they did not differ from men in their affective ratings. Premenstrual women evaluated the nurse as less attractive than did men and they attributed greater responsibility for the nurse's behavior to the patient than men and intermenstrual women. Women in all groups evaluated the nurse as nicer and more pleasant, interesting, concerned and self-assured than did men. All women also felt more friendly toward the nurse and reported that they would be more comfortable asking her questions than the men did. The implications of these findings are discussed.     

Premenstrual symptoms: the role of irrational thinking.

104 women, between the ages of 18 and 45 years, were surveyed to investigate the relationship between premenstrual symptomatology, as measured by the Modified Menstrual Distress Questionnaire, and irrational thinking, as measured by the General Attitude and Belief Scale. The women who reported greater premenstrual symptomatology also reported significantly higher scores in the "need for comfort" irrationality subscale. This indicated that these women had particular difficulty dealing with hassles and the resulting feelings of tension and irritability in the premenstruum. It was suggested that the absence of significant effects for other rationality-irrationality subscales could be associated with testing at different times during the menstrual cycle. Irrationality, like other conditions (such as anxiety and depression) prevalent in the premenstruum, could change in intensity across phases of the menstrual cycle.     

Avoidant coping in panic disorder: a yohimbine biological challenge study

Abstract

Few studies have addressed whether the use of avoidance-oriented coping strategies is related to the development of panic in patients with panic disorder(PD). Self-report, clinician-rated, and physiological data were collected from 42 individuals who participated in a yohimbine biological challenge study, performed under double-blind, placebo-controlled conditions. Participants included 20 healthy controls and 22 currently symptomatic patients who met DSM-IV-TR diagnostic criteria for PD. Consistent with prediction, patients with PD who had higher perceived efficacy of avoidance-oriented strategies in reducing anxiety-related thoughts reported increased severity in panic symptoms during the yohimbine challenge condition as compared to the placebo. Further, patients with PD who had more fear of cognitive dyscontrol, cardiovascular symptoms, and publicly observable anxiety also reported increased severity in panic symptoms during the challenge. Healthy controls who had more fear of cardiovascular symptoms similarly reported increased severity in panic symptoms during the challenge. No effects were found for heart rate response to the challenge agent. These results provide support for the role of avoidance-oriented coping strategies and fear of anxiety-related symptoms as risk and maintenance factors in the development of panic symptoms, particularly within a biological challenge model.     

Causal attributions in premenstrual syndrome

Abstract

The relationship between causal attributions and symptoms was investigated with self-report inventories in patients with premenstrual syndrome (n=38) and controls (n=26) during the premenstrual as well as the intermenstrual phase of the cycle. Patients with prospectively confirmed premenstrual exacerbations of physical and psychological symptoms more frequently attributed their complaints during premenstruum to the cycle than was the case during the intermenstrual period. Controls showed no differences in types of explanations for complaints in either phase of the cycle. It appeared that patients used not only the menstrual cycle, but also psychological distress and physical exertion, more often then controls as an explanation for complaints during both phases of the cycle. Implications of the finding that patients used medical as well as non-medical explanations for complaints during the cycle are discussed with regard to treatment strategies for PMS.     

Symptom patterns in late luteal-phase dysphoric disorder

The symptom patterns of 180 women with prospectively confirmed late luteal-phase dysphoric disorder (LLPDD) were examined using a careful application of factor and cluster analytic techniques. Factor analysis of premenstrual change scores on 33 common premenstrual syndrome symptoms yielded four orthogonal factors that were consistent across two sets of menstrual cycle data. These were a negative affect dimension with concomitant behavioral changes, physical symptoms, agitation, and positive arousal. Cluster analysis of factor scores grouped patients into one of five symptom patterns, the most common of which is a general distress cluster, characterized by symptoms across all dimensions. The LLPDD symptom groups identified are remarkably consistent with those of earlier studies using both normative and clinic samples, and consideration of symptom pattern differences in future research may greatly increase our understanding of this disorder.