Persistent alterations in biological profiles in women with abuse histories: influence of premenstrual dysphoric disorder.

OBJECTIVE: To examine dysregulation in biological measures associated with histories of abuse in women and whether women with premenstrual dysphoric disorder (PMDD) differ in their dysregulation. DESIGN: Twenty-five women meeting prospective criteria for PMDD and 42 non-PMDD controls underwent structured interview to determine abuse histories and lifetime Axis I diagnoses, excluding those with current Axis I disorders or using medications. MAJOR OUTCOME MEASURES: Plasma cortisol and norepinephrine (NE), heart rate (HR), blood pressure (BP), and vascular resistance index (VRI) were assessed at rest and in response to mental stress. RESULTS: A greater proportion of PMDD women had prior abuse compared with non-PMDD women. Regardless of PMDD status, all abused women had lower plasma NE and higher HRs and tended to have lower plasma cortisol at rest and during stress. Abused women also reported more severe daily emotional and physical symptoms. Greater VRI and BP at rest and during stress were seen only in PMDD women with abuse. CONCLUSION: There is persistent dysregulation in stress-responsive systems in all abused women that cannot be accounted for by current psychiatric illness or medications, and PMDD women may be differentially more vulnerable to the impact of abuse on measures reflecting alpha-adrenergic receptor function.     

ILLUSTRATING FEMINIST THEORY

Feminist theory holds that many of the pathological behaviors observed in patients result from their position in the social hierarchy. The goals of the demonstration detailed in this article are to show the impact of current gender roles on the psychological well-being of women and men and to generate understanding and discussion of the problems that relative status can create in the therapeutic relationship. This teaching demonstration draws parallels between the Zimbardo (1971) prison experiment and the impact that assignment to low-and high-power roles can have on the psychological health of women and men. Students are asked to rate men and women on some of the diagnostic criteria that the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) associates with Axis I and II diagnoses. The students watch a video of Zimbardo's prison study and then rate the prisoners and guards. This demonstration provides another explanation for gender patterns in psychopathology by demonstrating that psychologically healthy White males will develop different patterns of psychopathology depending on whether they are placed in a dominant or subordinate role. When placed in the subordinate role, they exhibit behaviors typically seen in women clients; when placed in a dominant role they exhibit behaviors commonly associated with male clients. This exercise demonstrates the unhealthy nature of the gender roles for both women and men.