27/03/2026
How effective is therapy for Premenstrual Dysphoria Disorder aka. PMDD? This was a question posed on a page which piqued my interest.
I’ll get to the point first. If you want to read more about the research and definitions, I’ve added that further down.
Firstly, PMDD is a menstrual disorder that is characterised by severe symptoms of anxiety, depression and suicidal ideation; this is usually in response to sensitive reactions to hormonal fluctuations rather than a hormonal imbalance, although both could arguably contribute to similar symptoms. PMDD can be severely debilitating, leading to relationship breakdowns and employment problems. This can look like being a fully capable person demonstrating insight and emotional resiliency to quickly losing insight, self-awareness and becoming dysregulated and unable to function. This is also compounded by the decline of estrogen during the luteal phase that can impact a person’s executive functioning if their dopamine reserves are low (which they usually are if you have ADHD).
I am an accredited CBT therapist and support many clients who have PMDD (indirectly due this being a common phenomenon in neurodivergent people). I personally believe that you can’t think your way out of a hormonal experience. Many people with PMDD begin to experience intrusive thoughts, rumination and anxiety/self-doubt in their luteal phase. One study identified an incidence of 49% of women /AFAB experiencing a spike in intrusive thoughts around their luteal phase (Vulink et al., 2006). Studies also show that PMDD is more prevalent in up to 82% of women who have endured childhood trauma (Kulkarni, 2021). Trauma also alters the body’s response to stress, making the brain more reactive to hormonal changes.
My approach looks like this:
* Building cycle awareness
* Theoretically you could challenge the negative automatic thoughts that arise in the pre menstrual period, but it would depend on a person’s existing level of understanding about their condition. If they logically understand that the thoughts are illogical, then it is likely better to move towards ‘process’ oriented techniques such as mindful detachment and self-compassion
* Acknowledgement that needs vary on different weeks of the month
* Exploring earlier life traumas that resurface in a cyclical manner; considering trauma-focused CBT or EMDR to treat unresolved trauma
* Providing education about evidence-based pharmacological recommendations for PMDD where appropriate
* Providing psych-education about PMDD
* Helping to identify what themes of memories/thoughts that arise in the worst phases of their cycle alongside recurring themes related to assumptions and beliefs about oneself e.g. ‘I should be able to handle this’, ‘I should be on top of my emotions 100% of the time’ etc.
* This may include different self-care needs on different weeks of the month and communicating those needs to others if/when needed and setting realistic expectations of functioning across the month.
* Compassion Focused Therapy, could arguably help with emotional regulation, overcoming shame and self-criticism (common areas that arise in PMDD). CFT can help to develop a self-compassion, improving your self-talk and relation relationship with yourself, particularly during tricky times of the month.
In summary, CBT can’t cure PMDD but it can help to become more self-aware, whilst learning to build self-compassion and self-advocacy skills along with heal from unresolved traumas. Along with considering lifestyle factors and pharmacological support that could also facilitate symptomatic relief.
The deep dive into the clinical implications:
Research highlights a greater propensity for PMDD in people with ADHD (up to 46%) and/or Autism (up to 92%)(Boughton et al., 2025; Obayi & Puri, 2008). The generalisability of the latter data is questionable as the sample size related to autistic women with a learning disability. Nonetheless, research supports the increased prevalence of PMDD in neurodivergent people and therefore the impact this can have on mental health and wellbeing.
One study identified that almost 1 in 3 autistic females/AFAB are wrongly diagnosed in earlier life with disorders such as Bipolar and Emotionally Unstable Personality Disorder / Borderline Personality Disorder (Kentrou et al., 2024). Similarly, ADHD can lead to misdiagnoses of BPD. Misdiagnosis can clearly have severe implications on access to work, psychological support, medication and incorrect care. This also poses ethical considerations in terms of the psychological harm and consequential risk of ableism. It can be postulated that misdiagnosis is due to traits that relate to hormonal fluctuations and reproductive life stages e.g. puberty.
More info can be found here:
https://neurodivergentinsights.com/borderline-personality-disorder-adhd-and-autism/?srsltid=AfmBOoraqrwTjtYPLggQlMFz3nU7WidC8XDGJL7IsrJw3GWS_7Uxw5-h
https://neurodivergentinsights.com/misdiagnosismonday/?srsltid=AfmBOorH8DFUu5URVLN0n4kIY7u_U0GKjZ-k3iDJw1ec4ti7CzDbHrbs
It is fundamental as clinicians to become more aware of these distinctions and their ramifications.
Equally, as clinicians, we may not be able to cure PMDD, but there are many ways in which we can support people experiencing PMDD. Not only will this promote wellbeing, it may support mood stability, emotional regulation, allow a person to remain in work, heal from trauma and consider remaining in a relationship if this is an area that causes them problems.
