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Diagnosing PMS/PMDD

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I am writing to address the factual inaccuracies found in the article by Carol Tavris (“You Haven’t Come Very Far, Baby,” Commentary, March 4) on PMS- (premenstrual syndrome) PMDD (premenstrual dysphoric disorder). Her reasons are apparently related to her own personal bias, and she has grossly misrepresented the facts as they stand.

She presents PMS/PMDD as a (male) psychiatric “Establishment” plot to devalue and undermine women and relegate them to second-class status biologically. She seems to be saying that women who believe that they have PMS or PMDD are being sold a bill of goods. Patients benefit from the accurate diagnosis and treatment of disorders that interfere with their lives. Women who have experienced PMS or PMDD describe illnesses that range from mild to highly disruptive of their functioning. To ascribe this to “an excuse to blow off steam” is shockingly demeaning to these women.

She blatantly misrepresents the diagnostic criteria of PMDD by omitting the critical qualifying adjective--making it appear that the psychiatric Establishment is pathologizing a perfectly normal and healthy process. It’s not “depressed mood” as she states--but “markedly depressed mood or hopelessness”--the former being in the range of normal human experience; and the latter being something well out of the norm.

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She further states flat out that there is “no treatment for PMS/PMDD.” This is untrue. There are recognized, frequently successful treatments available, described in the literature and supported by controlled studies which are utilized in my practice on a regular basis with generally good results.

Tavris claims that mood changes caused by other organic causes (thyroid, testosterone, pain) are not given psychiatric diagnoses, implying sexual bias. Again, she has not done her homework. If a male patient has depression due to Cushings disease or hypothyroidism or brain tumor, the diagnosis is organic affective disorder, with a specific cause further described.

Tavris has her own ax to grind and she is doing it at the expense of accuracy and scientific validity--and further, at the expense of the women whose welfare she claims to advocate.

ALICE A. RUDNICK MD

Psychiatrist

UCLA-NPI, Clinical Faculty

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