Are You Bipolar — Or Do You Have Premenstrual Dysphoric Disorder?

I would normally say that I am a happy person, but the year I was diagnosed with premenstrual dysphoric disorder, nothing was normal.

We weren’t just in a global pandemic. Both of my children were going through the diagnostic process for autism spectrum disorder, and my eldest child was awaiting testing for a genetic disorder. When I began having mood swings, it seemed like a natural byproduct of the amount of stress I was under as a single parent under these circumstances.

When the mood swings slid into suicide ideation, I knew things were bad, but I didn’t understand why. My impulse control didn’t seem to be functioning, I cried more than I’ve ever cried in my life, I kept forgetting things I should have remembered, and I was exhausted all the time.

Then, without explanation, I was fine. I was better than fine. I was happy and energetic and couldn’t even understand what had made me so sad.

Understanding the Overlapping Symptoms

With symptoms like these, it’s not hard to understand why so many people, particularly women, are diagnosed with bipolar disorder. There are many similarities.

Both PMDD and bipolar disorder occur in cycles.
Both disorders alternate between depressed and manic energy.
Both even have components of suicide ideation.
Both include depression and loss of interest in normal pleasures.
Both include periods of excessive fatigue and periods of high energy.
Both PMDD and bipolar disorder include brain fog and low self-esteem as symptoms during the depressive phases.

These overlapping symptoms often have medical professionals drawing an immediate conclusion and diagnosing patients as bipolar. It's possible for individuals to have one or both disorders with or without premenstrual exacerbation. Imagine being a medical professional trying to decide which symptoms check which box and which diagnosis is the correct one.

How to Know if You Have PMDD

It’s not difficult to see how making the correct diagnosis could be confusing. Still, there’s one key difference that sets PMDD apart and should be ruled out before deciding on a default bipolar diagnosis. It comes down to the cycle itself.

While bipolar disorder is completely unpredictable, PMDD runs like clockwork. It begins during the luteal phase of menstruation—around 14 days out of a 28-day cycle. It lasts until the week following menses.

When I was trying to understand my mood changes, I began using a mood tracker I received in a subscription box.

Every day, I was supposed to color a space to indicate my mood. After charting my moods for two months, a clear pattern emerged.

Happy colors dotted the calendar until a week or two before my period, and then the pattern changed to sad and angry colors until a few days into bleeding. The pattern was so specific that I realized I likely had PMDD.

I had the benefit of being a former therapist. I had a rudimentary knowledge of PMDD. I didn’t remember much, but I knew of its existence. When I saw the pattern, I immediately booked an appointment with a gynecologist to confirm my suspicions.

PMDD is more than a cyclical mood disorder. It’s considered a neuroendocrine disorder because the brain is unable to manage hormone changes.

It’s as if the body suddenly becomes allergic to normal hormone fluctuations. While this disorder is linked to the fluctuations of hormones, it is not a hormone imbalance. The cyclical nature may initially have clinicians considering bipolar, but without tracking symptoms, it’s impossible to make that determination.

The Real Reason Bipolar is the Default Diagnosis

Ongoing misogyny could have medical professionals dismissing symptoms as less-severe premenstrual syndrome (PMS) or attributing the symptoms to stress or another mental health concern. Although the times of women being diagnosed formally with hysteria are gone, gender bias is still alive and well.

In fact, a 2019 article in Biol Psychiatry by Baller and Rosssummarize the problem:

“The real mystery is how we manage to under-screen and undertreat a condition that affects 5% of all women and accounts for 14.5 million disability-adjusted life-years lost in the United States each year. Perhaps we are still wedded to our societal values regarding the validity of the condition. Or perhaps women are generally resilient enough to accomplish what they need to despite the toll PMDD takes on their personal and emotional lives.”

Baller and Ross point out that research into PMDD only began in the 1980s and wasn’t included in the Diagnostic and Statistical Manual of Mental Disorders until 2013. Gender bias in the medical industry means that conditions specific to women are under-researched and underfunded. Although erectile dysfunction impacts less than 20% of men, it still gets five times more research than PMS, which impacts over 90% of women.

Gender bias is just the tip of the iceberg. Race bias widens the gap for women of color even further. Because research isn’t dedicated equally to all genders, disorders like PMDD are often underdiagnosed, dismissed, or ignored. We might as well be labeled as hysterical with how seriously many medical professionals take this diagnosis.

What To Do If You Think You’ve Been Misdiagnosed

There’s a reason a bipolar diagnosis won’t treat your PMDD. Treatment for bipolar disorder includes anticonvulsants, antipsychotics, and SSRIs. Treatment for PMDD focuses on SSRIs. Both bipolar and PMDD treatment recommend ongoing therapeutic support, but bipolar recommends support groups and hospitalization as needed.

If you think you’ve been misdiagnosed, here are a few steps you can take.

1. Get a Second Opinion

You are entitled to get a second opinion. In fact, it’s recommended that you get one if you have doubts. Find a medical professional that you feel you can trust. If you feel that your concerns are being dismissed by your current doctor, it may be time to find someone new for treatment. You’ll need to be your strongest advocate throughout the diagnostic process.

2. Track Your Symptoms

While tracking daily symptoms for at least two months can be tedious, it’s one of the determining criteria for the diagnosis of PMDD. It could also help your doctors decide if you could have both bipolar and PMDD or another condition. Be proactive with your health by tracking changes.

3. Find a Counselor

If you’re not already seeing a counselor, it could be time to seek one out. Whether you have PMDD or bipolar, the support of a mental health professional could be invaluable for your treatment. Learning to manage the symptoms could save your life.

4. Practice Self-Care

Whether you are experiencing symptoms of either disorder, self-care is essential. Navigating the ups and downs of these disorders is draining—and often discouraging. Make a plan for how you’ll handle the down days.

PMDD and Bipolar Disorder are not interchangeable. The diagnoses shouldn’t be either.

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Crystal Jackson is a former family therapist who writes across genres to encompass blog posts, poetry, short stories, children's books, and literary fiction.