PMDD or bipolar?
Far too many women with PMDD are being mistakenly diagnosed with bipolar disorder. The results can be catastrophic — I know from experience.
The vast majority of clinicians who make this faulty diagnosis do it out of ignorance. They have, quite simply, no education or training on PMDD. The good news is that getting the right diagnosis can be done— it just takes more work. The most important thing to do is get the data: record your mood everyday for at least 2 to 3 months. Also ask family or friends their observations.
If you do have bipolar that does not mean you don’t have PMDD. Both conditions need treatment. Done right, such treatment can be life changing.
How to know its bipolar
Bipolar II is defined by recurring episodes of major depression plus at least one episode of hypomania (a milder, shorter form of mania), not full-blown mania.
Core features
Clear, repeated episodes of low mood (depression) and higher-than-usual mood/energy (hypomania).
Hypomania causes noticeable changes in behavior and functioning but does not lead to psychosis or require hospitalization the way full mania often does.
People with bipolar II typically spend more time depressed than “up.”
Signs of hypomanic episodes
Hypomania usually lasts at least 4 days and is a distinct change from your usual self, noticeable to others.
Common signs include:
Feeling unusually upbeat, wired, euphoric, or very irritable.
Needing much less sleep but still feeling energetic (e.g., 3–5 hours and not tired)
Talking more than usual, talking very fast, or feeling “pressured” to keep talking.
Racing thoughts, jumping quickly from one idea or task to another.
Increased activity, goal-directed behavior, or restlessness (starting many projects, cleaning at night, intense creativity).
Increased confidence or inflated self-esteem, sometimes feeling unusually capable or “on top of the world.”
More risk-taking or impulsive behaviors (spending sprees, driving fast, risky sex, impulsive travel or business decisions).
These can feel good or productive at first, which is one reason people often don’t see them as a problem.
Signs of depressive episodes
Depressive episodes in bipolar II look very similar to major depressive disorder, but they are part of a mood cycle that also includes hypomania.
Common signs:
Feeling persistently sad, empty, hopeless, or tearful most of the day, nearly every
Marked loss of interest or pleasure in activities or people
Low energy, fatigue
And so much more
The pattern over time matters a lot in bipolar II.
Key patterns clinicians look for:
History of at least one hypomanic episode plus one or more major depressive episodes.
Mood episodes that are cyclical: periods of “low,” periods of “up,” and sometimes periods of feeling relatively normal in between.
If you think you have bipolar, it’s important to talk to a professional. If you don’t have the hypomanic component of bipolar and still have the cyclical depression in the luteal phase, then it’s likely PMDD. Stand your ground and don’t let your doctor give you a false diagnosis.
