Processes of appraisal and coping in the development and maintenance of Premenstrual Dysphoric Disorder

This article examines the role of appraisal and coping strategies in relation to women's subjective negotiation of premenstrual changes, drawing on a series of narrative interviews conducted with women who met diagnostic criteria for Premenstrual Dysphoric Disorder (PMDD). The major themes that emerged from the interviews were: the PMDD sufferer as split; over-responsibility is linked to PMDD; PMDD = lack of control; methods of coping; attributions for symptoms; and PMDD as a relational issue. This article draws on each of these narrative themes, in order to illustrate three interrelated psychological processes of appraisal and coping central to the development and maintenance of 'PMDD' or 'PMS' (Premenstrual Syndrome). The first process is awareness of changes in psychological or physical experiences, ability to cope, or reactivity to others, premenstrually. The second process involves expectations and perceptions of premenstrual changes. The third is women's response and ways of coping. This study thus stands in contrast to research positioned within a positivist epistemological framework, where PMDD is viewed as a fixed entity; and women's subjective experience of premenstrual changes, is marginalized or negated. It is argued that premenstrual changes evolve in the context of an ongoing interaction between internal experiences, perceptions, reactions, relationships, and cultural expectations, that differ between women, across menstrual cycles, and can shift within a specific cycle: described as a material-discursive-intrapsychic interaction.