Association of premenstrual syndrome and premenstrual dysphoric disorder with bulimia nervosa and binge-eating disorder in a nationally representative epidemiological sample

Understanding comorbidity between eating disorder and premenstrual symptoms using a network analysis approach

Eating disorder symptoms are associated with ovarian hormones and fluctuate predictably across the menstrual cycle. However, the specific symptoms that underlie these associations remain unclear. The current study aims to examine which specific eating disorder and premenstrual symptoms confer risk and maintain comorbidity using network analysis. Eating disorder and premenstrual symptoms were measured using the Eating Pathology Symptoms Inventory and the Daily Record of Severity of Problems, respectively, in a large sample of young adult females. Network analysis was used to explicate the structure of eating and premenstrual symptom networks separately and together. Eating disorder networks replicated previous literature and identified body dissatisfaction as a core feature, but was unique in identifying monitoring calories as an additional core feature. Central symptoms identified in the premenstrual symptom network were symptoms interference with daily life and activities and negative emotions brought on by hormone changes. Bridge symptoms between networks were identified as relating to eating behaviors, interference with daily activities, joint and muscle pain, and negative emotions brought on by hormone changes. This study suggests that the links between eating disorder and premenstrual symptoms extend past their individual effects on eating behavior and are indicative of a shared underlying mechanism.

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

BACKGROUND

Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders.

METHODS

This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised.

RESULTS

A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED.

CONCLUSIONS

This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder as Centrally Based Disorders

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) encompass a variety of symptoms that occur during the luteal phase of the menstrual cycle and impair daily life activities and relationships. Depending on the type and severity of physical, emotional or behavioral symptoms, women of reproductive age followed for at least two prospective menstrual cycles may receive one of the two diagnoses. PMDD is the most severe form of PMS, predominantly characterized by emotional and behavioral symptoms not due to another psychiatric disorder. PMS and PMDD are common neuro-hormonal gynecological disorders with a multifaceted etiology. Gonadal steroid hormones and their metabolites influence a plethora of biological systems involved in the occurrence of specific symptoms, but there is no doubt that PMS/PMDD are centrally based disorders. A more sensitive neuroendocrine threshold to cyclical variations of estrogens and progesterone under physiological and hormonal therapies is present. Moreover, altered brain sensitivity to allopregnanolone, a metabolite of progesterone produced after ovulation potentiating GABA activity, along with an impairment of opioid and serotoninergic systems, may justify the occurrence of emotional and behavioral symptoms. Even neuro-inflammation expressed via the GABAergic system is under investigation as an etiological factor of PMS/PMDD. Pharmacological management aims to stabilize hormonal fluctuations and to restore the neuroendocrine balance. The rationale of suppressing ovulation supports prescription of combined hormonal contraception (CHC). Its effect on mood is highly variable and depends on biochemical characteristics of exogenous steroids and on type and severity of symptoms. Hormonal regimens reducing the estrogen-free interval or suppressing menstruation seem better choices. Psychoactive agents, such as serotonin reuptake inhibitors (SSRIs), are effective in reducing the symptoms of PMS/PMDD and may be prescribed continuously or only during the luteal phase. Novel therapeutic approaches include inhibition of progesterone receptors in the brain, i.e., with ulipristal acetate, reduced conversion of progesterone with dutasteride, and modulation of the action of allopregnanolone on the brain GABAergic system with sepranolone.

Association Between Childhood Body Size and Premenstrual Disorders in Young Adulthood

Importance

Emerging data suggest that more than two-thirds of premenstrual disorders (PMDs), including premenstrual syndrome and premenstrual dysphoric disorder, have symptom onset during the teen years. Adulthood adiposity has been associated with PMDs; however, the association with childhood and adolescent body size is unknown.

Objective

To examine the association between childhood and adolescent body size and risk of PMDs in young adulthood.

Design, Setting, and Participants

This prospective cohort study included 6524 US female participants from the Growing Up Today Study (1996-2013). Data were analyzed from February 26, 2020, to June 23, 2021.

Exposures

Body mass index (BMI) was estimated using self-reported height and weight through adolescence and converted to BMI for age (z score).

Main Outcomes and Measures

In 2013, premenstrual symptoms and identified PMDs were assessed with a validated scale based on the Calendar of Premenstrual Experiences. The associations of BMI for age with PMDs and premenstrual symptoms were examined using log-binomial and linear regressions, respectively.

Results

Among 6524 participants (mean [SD] age, 26 [3.5] years; 6108 [93.6%] White), 1004 (15.4%) met the criteria for a PMD. Baseline BMI for age reported at a mean (SD) age of 12.7 (1.1) years was associated with increased risk of PMDs (confounding-adjusted relative risk, 1.09 per unit of z score; 95% CI, 1.03-1.15) and higher burden of premenstrual symptoms (β = 0.06; 95% CI, 0.04-0.08). Associations were particularly pronounced for premenstrual dysphoric disorder and for PMDs with symptom onset before 20 years of age and remained in the absence of psychiatric comorbidities, including depression, anxiety, and disordered eating behavior. When analyzing BMI change over time, individuals with high BMI throughout adolescence had a higher burden of premenstrual symptoms (β = 0.17; 95% CI, 0.08-0.27) compared with those with normal BMI throughout adolescence. Individuals with high BMI early followed by a mild decrease later did not report higher premenstrual symptoms (β = 0.06; 95% CI, 0.00-0.12).

Conclusions and Relevance

In this cohort study, childhood body size was associated with PMD risk and premenstrual symptoms in young adulthood. These findings suggest that maintaining a normal body mass in childhood may be considered for lowering the burden of PMDs in adulthood.

Managing the premenstrual body: a body mapping study of women's negotiation of premenstrual food cravings and exercise

BACKGROUND

Women's eating behaviours and exercise patterns have been found to fluctuate across the menstrual cycle, manifested by premenstrual food cravings and reduced exercise. However, the meaning and consequences of premenstrual changes in eating and exercise behaviours remains underexplored. The aim of this qualitative study was to explore how women who feel negatively about their premenstrual bodies construct and experience premenstrual changes to eating and exercise practices, which disrupt their usual patterns of body management.

METHODS

Four hundred and sixty women aged 18-45 completed an online survey in response to a Facebook advertisement targeted at women who feel negatively about their bodies during the premenstrual phase of the cycle. Participants reported moderate premenstrual distress, high body shame and high risk of disordered eating attitudes using standardised measures. Sixteen women reporting rich accounts of premenstrual body dissatisfaction were invited to participate in body-mapping, involving visually illustrating experiences on a life-sized outline of the body, followed by a telephone interview. Thematic analysis was used to explore qualitative survey, interview, and body-mapping data.

RESULTS AND DISCUSSION

Results found that outside of the premenstrual phase these women engaged in restrictive eating and intensive exercise behaviours, which were disrupted by premenstrual cravings, hunger, fatigue, pain and feeling physically uncomfortable. For a minority of the women, this facilitated self-care in reducing the strict management of their bodies during the premenstrual phase. Others experienced feelings of guilt, shame, self-disgust and pushed their bodies physically through increased exercise.

CONCLUSIONS

These findings emphasise the need to acknowledge changes in body management across the menstrual cycle, with implications for women's mental health and feelings about the self. Internalisation of pressures placed on women to manage their bodies through restrictive eating behaviours and rigorous exercise plays a role in women's premenstrual body dissatisfaction and distress. The current study aimed to explore how women who feel negatively about their premenstrual bodies construct and experience premenstrual changes to eating and exercise practices. Outside of the premenstrual phase these women engaged in restrictive eating and intensive exercise behaviours which were disrupted by premenstrual cravings, hunger, fatigue, pain and feeling physically uncomfortable. Some women allowed themselves to take a premenstrual break from their usual strict eating and exercise behaviours, whereas others felt guilt, shame, self-disgust and physically pushed their bodies through increased exercise. These findings emphasise that changes to eating and exercise behaviours across the menstrual cycle and pressures placed on women to manage their eating and exercise behaviours have implications for women's premenstrual distress and body dissatisfaction.

Binge eating symptoms are associated with the severity of premenstrual symptoms among university students, cross sectional study from Palestine

BACKGROUND

Premenstrual syndrome (PMS) is considered one of the most prevailing disorders among childbearing age women that could considerably interfere with daily living activities life. PMS is underrecognized in Palestine. It is reported that binge eating symptoms are significantly related to premenstrual syndrome. In this regard, the study aimed to determine factors linked with premenstrual symptoms and to explore whether binge eating symptoms are linked with premenstrual syndrome.

METHODS

This descriptive study was performed among female undergraduates at Palestine Polytechnic University, using a cross-sectional design. A self-administrated questionnaire was used in order to collect data. Moreover, participants' nutritional status was assessed using anthropometric measurements. Descriptive statistics, independent t-test and Chi-square were performed.

RESULTS

A sum of 289 undergraduate females were involved in the final analysis. The results indicated that nearly half of undergraduates (47.8%) were classified as having binge eating symptoms. The most frequently noted premenstrual symptoms were lethargy, anger feelings, lack of interest, and anxiety. Chi-square analysis showed that moderate and severe psychological symptoms were significantly more prevalent among females with binge eating symptoms. Besides it was found that moderate and severe physical symptoms were significantly more prevalent among females with binge eating symptoms. Moreover, participants who reported no premenstrual syndrome symptoms were significantly less prevalent among females with binge eating symptoms. The findings also reveal that sociodemographic characteristics was not significantly correlated with premenstrual syndrome symptoms. In multiple adjusted models, both smoking (p < 0.05) and binge eating (p < 0.0001) were significantly related to PMS.

CONCLUSION

Findings reveals that moderate and severe psychological and physical symptoms were significantly more prevalent among females with binge eating symptoms. The current research also reported that the severity of PMS was not significantly related to sociodemographic variables.

Association of Premenstrual Dysphoric Disorder and Eating Behaviors Among Nursing Students: A Cross-Sectional Study

STUDY OBJECTIVE

Premenstrual dysphoric disorder (PMDD) is the most severe form for premenstrual distress. This study's objective was to understand the association among PMDD, premenstrual syndrome (PMS), and eating behaviors.

DESIGN

Cross-sectional design. The survey was composed of validated measures.

SETTING AND PARTICIPANTS

Female students at a nursing school.

MAIN OUTCOME MEASURES

PMDD and PMS diagnoses were made using the Premenstrual Symptoms Screening Tool (PSST). Eating behaviors were assessed using the Eating Attitudes Test (EAT-26) and the Three-Factor Eating Questionnaire-Revised 18 (TFEQ-R18).

RESULTS

Of the 504 participants, according to the PSST, 80 (15.9%) met the criteria for PMDD, 222 (44%) had moderate-to-severe PMS, and the remaining 202 (40%) participants showed mild or no premenstrual symptoms. The total EAT-26 scores were significantly higher in the PMDD group than in the other groups (P < .001). According to the cut-off value (20 points) of EAT-26, the total prevalence of disordered eating behaviors was also significantly higher in the PMDD group (45.5%) compared with the moderate-to-severe PMS group (16.5%) and the no/mild PMS group (13.6%) (P < .001). According to the TFEQ-R18 scores, significantly higher scores for emotional eating and uncontrolled eating were found in the PMDD group than in the other groups (P < .001 for each).

CONCLUSIONS

Given that PMDD is defined as a more severe form of PMS with more strict criteria, the findings in this study reflect that as the severity of premenstrual symptoms increase, disordered eating behaviors also increase. To the best of our knowledge, this is the first study to compare eating behaviors among PMDD, moderate-to-severe PMS, and no/mild PMS groups.

Premenstrual symptoms as a marker of ovarian hormone sensitivity in eating disorders

OBJECTIVE

Research indicates a link between ovarian hormones and eating pathology, suggesting that some women with an eating disorder may be ovarian hormone sensitive. Using premenstrual symptoms (PMS) as an indirect measure of ovarian hormone sensitivity, we investigated the association between 11 PMS domains and four core eating disorder symptoms: body dissatisfaction, binge eating, purging, and restriction.

METHOD

Participants were young adult women (N = 455) who completed an online survey. PMS were assessed using the Daily Record of Severity of Problems and eating pathology with the Eating Pathology Symptoms Inventory. Pearson correlations were calculated between PMS domains and eating disorder symptoms followed by a stepwise regression to create a more refined model for each eating disorder symptom, including relevant covariates.

RESULTS

Significant correlations between a majority of eating disorder symptoms and PMS emerged (r's = .13-.37; p < .01). Backward regression revealed significant PMS domain predictors for each symptom. The final models captured a small-to-moderate amount of variance for each eating disorder symptom (R² = 0.06-0.25).

DISCUSSION

Women who experience physical and psychological PMS may be at risk for eating disorder symptoms; PMS could be a marker of ovarian hormone sensitivity in women at risk for an eating disorder. Future studies should address mechanisms underlying this association.

Premenstrual dysphoric disorder in Arab women: Validation and cultural adaptation of the Arabic version of the premenstrual screening tool

Premenstrual dysphoric disorder (PMDD) is not well-studied in Arab populations. The goal of this study was to validate the Arabic version of the Premenstrual Symptoms Screening Tool (PSST) using the DSM diagnosis of PMDD as the gold standard. The PSST was translated and culturally adapted using back translation and the approval of the original author. We recruited 194 adult women (between October 2013 and March 2014) from two primary care centers in Doha, Qatar. A psychiatrist determined the diagnosis using the semi-structured Mini International Neuropsychiatric Interview, and another rater blinded to the diagnosis finalized the Arabic PSST and administered other clinical questionnaires. The data showed that premenstrual symptoms and PMDD were observed in about 37 percent and 15 percent, respectively, of the women enrolled. The mean age of the women with PMDD according to the PSST was about 30 years, and the majority had children. The Arabic PSST showed high specificity of 95.6 percent but low sensitivity of 26.7 percent. A factor analysis of the different items in Arabic PSST showed that the Arabic PSST could detect the cases with definite PMDD and thus can be a useful tool in primary care settings as this treatable disorder is underdiagnosed in the Arab populations.

Prevalence and factors associated with Premenstrual Dysphoric Disorder: A community sample of young adult women

Premenstrual Dysphoric Disorder (PMDD) was recently included in DSM-5 as a full diagnostic category. Few studies have investigated PMDD in a community sample of young adults, especially in Brazil. Thus, the objective of this study was to evaluate the prevalence and the factors associated with PMDD in a community sample of 727 young adult women between the 18 and 24 years of age in southern Brazil. This was a cross-sectional population-based study. The data were collected from 2012 to 2014. PMDD was assessed using the Mini International Neuropsychiatry Interview (M.I.N.I. - Plus). The prevalence of PMDD was 17.6%. PMDD was significantly higher among older women, and in women from lower socio-economic status. A trend towards significance was found for women without a current occupation (study or work). The comorbidities significantly associated with PMDD were current major depression disorder, agoraphobia, bipolar disorder, current suicide risk, generalized anxiety disorder, social phobia, and specific phobia. The high prevalence found in the present study should be interpreted considering a retrospective report. However, our data showed that clinicians should be alert for PMDD symptoms, especially among young adult women.

Perceived Discrimination and Binge Eating Disorder; Gender Difference in African Americans

Environmental stressors, such as perceived discrimination (PD), are linked to Binge Eating Disorder (BED). The current study investigated the association between PD and BED among African Americans, and the variation in such an association based on gender. Data of the National Survey of American Life (NSAL), 2001⁻2003, with a nationally-representative sample of African American adults, were used (n = 3516). The independent variable in the study was PD. The dependent variable was BED, measured using the Composite International Diagnostic Interview (CIDI). Socio-demographics (age, education, employment, and marital status) were covariates, and gender was the moderator variable. Survey logistic regressions with and without gender × PD interaction terms were used for data analysis. In the pooled sample, PD was associated with higher odds of BED, net of socio-demographic factors. Models also showed a significant gender × PD interaction term suggesting a stronger association between PD and BED for women, compared to men. Gender specific models showed an association between PD and BED among female, but not male, African Americans. Although a link may exist between PD and BED among African Americans, the magnitude of this association depends on gender, with a stronger association among females than males. This finding is in line with the literature that has shown gender-specific consequences of environmental stress for African Americans.

Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study

BACKGROUND

The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown.

AIMS

We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD.

MATERIALS & METHODS

A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria.

RESULTS

Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001).

DISCUSSION

The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD.

CONCLUSIONS

The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.

Comparison of serum zinc concentrations and body antioxidant status between young women with premenstrual syndrome and normal controls: A case-control study

BACKGROUND

Premenstrual syndrome (PMS) is one of the important health problems with high incidence in young women. The exact cause of this syndrome is not clear and some theories have been declared from hormonal factors to nutritional disorders.

OBJECTIVE

We investigated the correlation between serum zinc and antioxidant status with PMS.

MATERIALS AND METHODS

In this case-control study, forty eight young girls were selected from a total sample of 110 students residing at university dormitories including PMS (n=23) and healthy (n=25) groups based on PMS questionnaire. Dietary intake questionnaire and blood samples were collected from all participants. Serum total antioxidant capacity (TAC) and zinc concentrations were also measured.

RESULTS

Serum TAC and zinc concentrations were lower in PMS patients compared with healthy groups (p<0.01 and p<0.05, respectively). Healthy controls consumed lower servings of hydrogenated oils (p<0.05). There were significant differences in terms of muscle mass between the PMS and healthy groups (p<0.05). Both serum TAC and zinc levels were negatively correlated to PMS scores (r=-0.39, p<0.05 and r= -0.36; p<0.05, respectively).

CONCLUSION

This study shows that higher TAC and zinc serum levels are associated with lower risk of PMS. PMS cases have more hydrogenated oils than their normal counterparts.