Bakgrund: PMDS är en relativt okänd diagnos. Det är en progression av Premenstruellt syndrom (PMS) men allvarligare och är ibland invalidiserande för den som lider utav det. Prevalensen av PMDS är cirka fem procent av alla fertila kvinnor. Syfte: Syftet var att undersöka hur kvinnor med diagnosen PMDS upplevde hur det är att leva med diagnosen, vilken behandling de provat samt bemötandet som de fått i kontakt med vården. Metod: För att kunna besvara syftet så valdes en kvalitativ studie i form av intervjuer. Detta för att få en utökad förståelse kring PMDS och vad sjukdomen innebär. Intervjuerna var semistrukturerade och sju kvinnor inkluderades i studien. Inklusionskriterierna för denna studie var kvinnor med diagnosen PMDS som har varit i kontakt med sjukvården och blivit diagnostiserade med sjukdomen. Intervjuerna analyserades med hjälp av innehållsanalys enligt Graneheim och Lundman (2004). Resultat: PMDS tycks fortfarande vara en relativt okänd diagnos inom sjukvården och en del av informanterna var inte nöjda med vården de mottagit medan andra haft tur och hittat rätt väg på en gång. Det är en svår diagnos att leva med som inkräktar på såväl vardagsliv som arbetsliv och alla mänskliga relationer. Informanterna anser att en utökad förståelse och hjälp från vården skulle underlätta deras leverne. Slutsats: Mer kunskap krävs inom både vården och för samhället i stort då detta är en allvarlig diagnos som behöver upptäckas i tid så dessa kvinnor kan få rätt hjälp. Det är livsavgörande att kvinnor med diagnosen PMDS får de verktyg de behöver för att kunna leva ett fullvärdigt liv. / Background: PMDD is a relatively unknown diagnosis. There is a progression of Premenstrual Syndrome (PMS), but serious and sometimes debilitating for the sufferer out of it. The prevalence of PMDD is about five percent of all women of childbearing potential. Purpose: The purpose of this study was to examine how women diagnosed with PMDD experienced how it is to live with the diagnosis, the treatment they have tried, and the response they got in contact with health services. Method: A qualitative survey based on interviews was made in order to comprehend the diagnosis PMDS and its symptoms. Seven women participated in semi-structured interviews. The terms and conditions in this survey included women diagnosed with PMDS by and in contact with the health care system. The interviews were analyzed in accordance to Graneheim and Lundman’s content analysis. Results: The result indicated that PMDS is a relatively unknown condition within the health care system. Some of the informants were not pleased with the treatment given. Others received efficient treatment straight away. PMDS is burdensome to live with and it affects working life as well as social relations in common life. Conclusion: Acquaintance, both within the health care system and the society as a whole, is crucial for women diagnosed with PMDS. PMDS is a serious diagnosis which has to be discovered early in order to give these women efficient treatment. It is essential that women diagnosed with PMDS get efficient tools to handle their diagnosis in order to live vital lives.

This essay researches current workings of medicine in relation to contested, female diagnoses. This is made by looking at the construction of the new psychological diagnosis Premenstrual Dysphoric Disorder (PMDD) in Swedish media, and relating it to a current trend seen in medicine; to medicalize women’s underperformance. A qualitative content analysis of 19 articles is conducted, showing that PMDD is constructed as; a biomedical fact and individual problem; a serious disease owned by the sufferers; and as something written out of the women’s self-image as a “not me”. These constructions are analysed with a theoretical framework built around the concept biomedicalisation, which we conceptualise as an exertion of biopower that shapes subjects in line with neoliberal ideals. Biopower is a concept from the Foucauldian notion of Governmentality, and describes power working on micro levels, through for example truth discourses, to make individuals understand and work on themselves as biological subjects. Our analysis shows that biopower can be seen to work through the different constructions of PMDD to shape self-managing, healthy subjects that are willing to biomedically change themselves in accordance with an ideological normal, but that this normal differs from that seen in research on other contested female diagnoses. To conclude we suggest that it would be more fruitful to look at biomedicalisation to understand current workings on female contested diagnoses, than to look at the trend on medicalisation of underperformance.

Die Tage vor den Tagen werden in Fach- und Laienkreisen nicht selten als kritische Tage im Menstruationszyklus der Frau wahrgenommen. Die 'Störungsbilder' des Prämenstruellen Syndroms (PMS) und der Prämenstruellen Dysphorischen Störung (PMDS, engl. PMDD) haben sich mittlerweile gesellschaftlich etabliert. Die vorliegende Arbeit nähert sich der Thematik von medizingeschichtlicher Seite, indem sie Darstellungen des Prämenstruums in populärmedizinischen und wissenschaftlichen Texten vom Anfang des 19. Jahrhunderts bis in die Gegenwart untersucht. Sie umfasst einen historischen Überblick über die Entwicklungen vom 19. Jahrhundert bis zur Etablierung des PMS und der PMDD im 20. und 21. Jahrhundert. Auch unterschiedliche Theorien zur Genese prämenstrueller Veränderungen und Beschwerden werden herausgearbeitet. Der Fokus liegt insbesondere auf dem Einfluss medizinischer Lehren und soziokultureller Faktoren (bspw. der Frauenbewegung, der Degenerations-, und Konstitutionslehre) auf die Darstellungen des Prämenstruums in medizinischen Texten. / In professional and lay circles, premenstrual days are frequently perceived as critical days in a woman's menstrual cycle. The 'disorders' premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) have become socially established. This thesis approaches the topic from a medical history perspective by examining representations of the premenstruum in general medical and scientific texts from the 19th century to the present. The thesis includes a historical overview of the development from the 19th century up to the recognition of PMS and PMDD in the 20th and 21st centuries. The change of concepts of genesis over time, which is subject to the influence of different scientific doctrines and body concepts, is also content of the research work. A particular focus is placed on the influence of medical theories and socio-cultural factors on the descriptions of the premenstruum in medical texts (e.g. the women's movement, the degeneration and constitutional theory).

The question this dissertation seeks to address is if the process of disease mongering can be ethically assessed. Chapter one provides a broad scope of the ethical challenge of disease mongering, UNESCO model framework, ADHD and PMDD. Chapter two examines disease mongering and its driving forces in detail. Chapter three provides an overview of the UNESCO model framework. Chapter four ethically examines disease mongering in conjunction with Attention Deficit Hyperactivity Disorder (ADHD). Chapter five examines disease mongering in association with Premenstrual Dysphoric Disorder (PMDD). Chapter six concludes that examined through the UNESCO model ethical framework disease mongering is occurring for both ADHD and PMDD, and provides remarks for the addressing this in the future. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Background. Despite an abundance of clinical research on premenstrual and menstrual symptoms, few epidemiological data provide estimates of the prevalence, incidence, co-morbidity, stability and correlates of premenstrual dysphoric disorder (PMDD) in the community. Aims. To describe the prevalence, incidence, 12 co-morbidity factors and correlates of threshold and subthreshold PMDD in a community sample of young women. Methods. Findings are based on prospective–longitudinal community survey of 1488 women aged 14–24, who were followed-up over a period of 48 months (follow-up, N = 1251) as part of the EDSP sample. Diagnostic assessments were based on the Composite International Diagnostic Interview (CIDI) and its 12-month PMDD diagnostic module administered by clinical interviewers. Diagnoses were calculated using DSM-IV algorithms, but daily ratings of symptoms, as required, were not available. Results. The baseline 12-month prevalence of DSM-IV PMDD was 5·8%. Application of the diagnostic exclusion rules with regard to concurrent major depression and dysthymia decreased the rate only slightly (5·3%). An additional 18·6% were ‘near-threshold’ cases, mostly because they failed to meet the mandatory impairment criterion. Over the follow-up period only few new PMDD cases were observed: cumulative lifetime incidence was 7·4%. PMDD syndrome was stable across 48 months with <10% complete remissions among baseline PMDD cases. The 12-month and lifetime co-morbidity rates were high (anxiety disorders 47·4%, mood disorders 22·9%; somatoform 28·4%), only 26·5% had no other mental disorder. Particularly high odds ratios were found with nicotine dependence and PTSD. In terms of correlates increased rates of 4-weeks impairment days, high use of general health and mental health services, and increased rates of suicide attempts were found. Conclusion. In this sample of adolescents and young adults, premenstrual symptoms were widespread. However, DSM-IV PMDD was considerably less prevalent. PMDD is a relatively stable and impairing condition, with high rates of health service utilization, increased suicidality and substantial co-morbidity.

Purpose and problem statement: The purpose of this study is to identify how PMS/PMDD affects a leaders leadership. Therefore the individual and the experienced symptoms involving PMS/PMDD are studied. This to identify potential connections between the diagnoses and theories about leadership. <ul type="disc">How is leadership affected by PMS and PMDD?  Method: The study is conducted through an inductive reasoning and qualitative interviews with six informants. The informants helped us understand the empirical field, which in order lead us to identify relevant theories for our study.  Conclusion: The study showed that leadership is affected by PMS and PMDD because of changes in the individual’s personal characteristics during the time of their diagnosis. The individual can go from being a good leader for two weeks, to seeing themselves as a bad leader the remaining two weeks. The change can be recognized by seeing positive characteristics that define a good leader change into the opposite.  Through this study it is apparent to us that there is an opportunity for further research in this subject. It can be done by performing a bigger study or by including a co-worker perspective, since a leader needs its co-workers to be able to lead. / Syfte och forskningsfråga: Syftet med denna studie är att identifiera hur PMS/PMDS ger upphov till konsekvenser som påverkar individens ledarskap. Således studeras individens erfarenheter kring de upplevda symptomen till följd av PMS/PMDS. Detta för att identifiera eventuella samband mellan dessa och teorier kring ledarskap. <ul type="disc">Hur kan ledarskap påverkas av PMS och PMDS? Metod: Studien har en induktiv ansats och utgår ifrån kvalitativa intervjuer med sex informanter. Informanterna har hjälpt oss att förstå det empiriska fältet för att vi sedan ska kunna identifiera relevanta teorier för vår studie. Slutsats: Studien visar att ledarskap påverkas av PMS och PMDS genom att individens personliga attribut förändras under perioden för diagnoserna. Individen kan gå från att vara en bra ledare i två veckor till att se sig själv som en sämre ledare resterande två veckor. Det kan visa sig genom att positiva egenskaper som definierar en god ledare istället blir sämre. Vi kan se att det finns möjlighet till vidare forskning genom att utföra större studier eller genom att inkludera ett medarbetarperspektiv, eftersom ledare behöver medarbetare för att kunna leda.

Around 3-8% of all women in reproductive age suffer from premenstrual dysphoric disorder (PMDD) which disenables them to live an ordinary life during the luteal phase (premenstrual phase) of the menstrual cycle. Throughout the premenstrual phase these women experience emotional, cognitive and physiological changes. Hitherto, the etiology of this disorder is unknown. Some consider the source of this state as non-biological, claiming that PMDD is a social construction imbedded in gender roles, that suggests that women should not show aggressive behavior or depressive mood unless it is during the premenstrual stage. Contradictory, research made in cognitive neuroscience claim that the origin is biological. It is assumed that the increased symptoms in women with PMDD is a result from dysfunctional sensitivity for the progesterone metabolite allopregnanolone that has a receptor in the GABAA system, hence, producing an anxious effect from high levels of allopregnanolone instead of the expected sedative, soothing effects. Research suggest that structural and functional changes occur in brain areas such as the hippocampus, parahippocampus, amygdala, cerebellum as well as in brainderived neurotrophic factor which is important for brain plasticity, growth and survival of neurons. Cognitive behaviors such as anticipation for negative stimuli, working memory and lack of cognitive control also seem to be affected by PMDD. Nonetheless, the evidence is inconsistent, the area of research face multiple issues in regards to study designs, hence making generalization at this point difficult. In sum, this essay reviews recent studies conducted in neuroscience of cognitive changes in women with PMDD, with focus on functional, structural and behavioral changes between the phases of the cycle.

Background. Despite an abundance of clinical research on premenstrual and menstrual symptoms, few epidemiological data provide estimates of the prevalence, incidence, co-morbidity, stability and correlates of premenstrual dysphoric disorder (PMDD) in the community. Aims. To describe the prevalence, incidence, 12 co-morbidity factors and correlates of threshold and subthreshold PMDD in a community sample of young women. Methods. Findings are based on prospective–longitudinal community survey of 1488 women aged 14–24, who were followed-up over a period of 48 months (follow-up, N = 1251) as part of the EDSP sample. Diagnostic assessments were based on the Composite International Diagnostic Interview (CIDI) and its 12-month PMDD diagnostic module administered by clinical interviewers. Diagnoses were calculated using DSM-IV algorithms, but daily ratings of symptoms, as required, were not available. Results. The baseline 12-month prevalence of DSM-IV PMDD was 5·8%. Application of the diagnostic exclusion rules with regard to concurrent major depression and dysthymia decreased the rate only slightly (5·3%). An additional 18·6% were ‘near-threshold’ cases, mostly because they failed to meet the mandatory impairment criterion. Over the follow-up period only few new PMDD cases were observed: cumulative lifetime incidence was 7·4%. PMDD syndrome was stable across 48 months with <10% complete remissions among baseline PMDD cases. The 12-month and lifetime co-morbidity rates were high (anxiety disorders 47·4%, mood disorders 22·9%; somatoform 28·4%), only 26·5% had no other mental disorder. Particularly high odds ratios were found with nicotine dependence and PTSD. In terms of correlates increased rates of 4-weeks impairment days, high use of general health and mental health services, and increased rates of suicide attempts were found. Conclusion. In this sample of adolescents and young adults, premenstrual symptoms were widespread. However, DSM-IV PMDD was considerably less prevalent. PMDD is a relatively stable and impairing condition, with high rates of health service utilization, increased suicidality and substantial co-morbidity.

Bakgrund Premenstruellt syndrom (PMS) och premenstruellt dysforiskt syndrom (PMDS) är tillstånd som innebär en samlad mängd psykiska och/eller fysiska premenstruella besvär hos vissa kvinnor. Dessa tillstånd utgör ett stort lidande och kan leda till psykisk ohälsa, långtidssjukskrivningar, somatiska besvär, drabbade relationer samt svårigheter att klara av sin vardag. Omvårdnadsforskning av dessa kvinnor är dock bristfällig. Forskning på området omvårdnad har dock visat att egenvård stärker patientens känsla av kontroll vid såväl psykiatriska som somatiska sjukdomstillstånd. Syfte Att belysa olika egenvårdsstrategier som kan leda till ett minskat lidande för patienter med premenstruellt syndrom eller premenstruellt dysforiskt syndrom. Metod Studien är en litteraturöversikt och inkluderar 17 vetenskapliga artiklar som söktes fram via systematiska databassökningar i PubMed och Cinahl. Valda artiklar var av kvalitativ och kvantitativ metod för att få en ökad förståelse för både upplevelse av egenvård samt objektiva mått för effektiviteten. Resultat Det fanns en mängd olika egenvårdsstrategier som kvinnor använder sig av och kan använda sig av i olika grad. Tre kategorier i form av livsstil, psykosociala aspekter samt komplementära terapier skapades under analysprocessen. De egenvårdsstrategier som visade det starkaste sambandet med minskat lidande vid PMS eller PMDS var stressreducering, regelbunden fysisk aktivitet och ökad medvetenhet kring sin kropp och sitt eget mående. Slutsats I studierna visade det sig att kvinnor använde egenvårdsstrategier i varierande grad och att de upplevde effektiviteten olika. Egenvård kunde lindra symtomen av PMS/PMDS i olika grad, och främjade känslan av kontroll över den egna situationen. Egenvårdsstrategier kan därmed vara ett redskap för att minska lidandet vid PMS/PMDS. / Background Premenstrual syndrome (PMS) and premenstrual dysphoric syndrome (PMDS) are conditions that involve a total amount of mental and / or physical premenstrual disorders for some women. These conditions are a major affliction and can lead to mental illness, long-term sick leave, somatic disorders, affected relationships and difficulties in coping with their everyday lives. However, nursing research of these women is inadequate. Research in the field of nursing has shown that self-care strengthens the patient's sense of control in both psychiatric and somatic disease states. Aim To illuminate different self-care strategies that may lead to reduced suffering for patients with premenstrual syndrome and premenstrual dysphoric syndrome. Method The study is a literature review and includes 17 scientific articles that were searched through systematic database searches in PubMed and Cinahl. Selected articles were of qualitative and quantitative method to gain an increased understanding of both self-care experience and objective measures of efficiency. Results There was a variety of self-care strategies that women use and may use to varying degrees. Three categories in the form of lifestyle, psychosocial aspects and complementary therapies were created during the analysis process. The self-care strategies that has showed the strongest connection with reduced suffering at PMS or PMDS were stress reduction, regular physical activity and increased awareness of their body and their own mood.ConclusionsIn the studies, it was found that women used self-care strategies to varying degrees and that they perceived their effectiveness differently. Self-care was able to relieve the symptoms of PMS / PMDS to varying degrees and promoted the feeling of control over one's own situation. Self-care strategies can thus be a tool for reducing the suffering of PMS / PMDS.

Syftet med vår undersökning är att få en fördjupad förståelse om på vilket sätt PMS/PMDS påverkar kvinnor i arbetslivet. Kvinnokroppen och premenstruella besvär är och har under en lång tid varit tabubelagt. Trots att det är vetenskapligt bevisat att kvinnors arbetsprestation påverkas negativt under sin premenstruella period, är majoriteten av forskningen rörande ämnet daterad. Detta myntade vårt intresse att studera kvinnor med PMS och PMDS arbetssituation. Områden som vi undersöker är arbetssituation, arbetsmiljö samt vilka åtgärder arbetsgivare och fackförbund kan bidra med för att underlätta för kvinnor under den premenstruella perioden. Den teoretiska bakgrunden i studien belyser i stora drag arbetsprestation och arbetsmiljö. Dessutom presenteras relevanta undersökningar samt modeller inom ramen för ämnet. Undersökningens empiriska material samlades in genom 8 intervjuer. Alla intervjupersoner förvärvsarbetar. En av kvinnorna i undersökningen är deltidsanställd. Resultatet visade att samtliga kvinnor upplevde att deras arbetsprestation påverkas negativt under den premenstruella perioden, till exempel genom  humörsvängningar, utmattning och uppskjutande av arbetsuppgifter. Dock strider resultaten mot tidigare forskning, eftersom några av respondenterna även upplevde att arbetsprestationen påverkas positivt under den premenstruella perioden. Sjukfrånvaro var relativt hög bland studiens intervju deltagarna, och det framkom även att de tenderar att uppge andra orsaker vid sjukanmälan och inte PMS/PMDS på grund av skam och rädsla av att bli utpekade. Det diskuteras sällan om premenstruella besvär på arbetsplatser. Kvinnorna i vår undersökning uttryckte behov av mer stöd, medvetenhet och förståelse från arbetsgivare för att underlätta deras arbetsliv under PMS/PMDS perioden.