The Difference Between Premenstrual Dysphoric Disorder and Bipolar Disorder

Premenstrual Dysphoric Disorder (PMDD) and bipolar disorder (BD) are mood disorders that share many similarities in symptoms. These similarities can lead to confusion and misdiagnosis among women. Further, frequent dismissal of and a lack of information surrounding women’s health issues can make it even harder to find answers.

Learning the differences between these two conditions can help you better understand what you are experiencing, which will help you on the road to receiving an accurate diagnosis. After that, you can explore treatment options that are tailored to your needs and can greatly impact your quality of life.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is an extreme mood disorder that is still under-diagnosed and under-researched to this day. It is often dismissed as regular PMS even when symptoms are debilitating, which can make it difficult for women to receive a diagnosis. 

Many women with PMDD describe their experience as feeling completely normal during certain parts of their cycle, and feeling like a different person during others. It is common to feel depressed, out of control, exhausted, full of rage, and hopeless when symptoms reach their peak, only for those symptoms to cease around the start or after the first few days of the menstrual cycle. 

Symptoms of PMDD

Due to the cyclical nature of the disorder and its link to the menstrual cycle, the symptoms of PMDD show up in the luteal phase. This is the part of the cycle between ovulation and menstruation.

Symptoms typically last for 10-14 days and can include:

• A sense of being overwhelmed 
• Appetite changes
• Anxiety 
• Decreased interest in regular activities
• Depression
• Difficulty concentrating 
• Drastic emotional swings
• Extreme anger, agitation, or irritability
• Feelings of being constantly on edge 
• Feelings of being out of control 
• Hopelessness or worthlessness  
• Increased interpersonal conflicts 
• Isolation from loved ones
• Lethargy or fatigue 
• Physical symptoms, such as weight gain, breast tenderness, headaches, etc.
• Self-deprecating thoughts 
• Sleep issues (insomnia or hypersomnia) 
• Suicidal thoughts 

Bipolar Disorder (BD) 

BD, on the other hand, is a mood disorder marked by clear and drastic shifts in mood, concentration abilities, and energy levels that is not connected to the menstrual cycle. People with BD experience manic episodes (unusually elevated moods), hypomanic episodes (a less severe form of manic episodes), and depressive episodes.

Bipolar disorder can be chronic (constantly recurring) or episodic (happening occasionally at unpredictable intervals). These episodes can also be mixed, which means that someone with BD can experience both manic and depressive symptoms within the same period.

Symptoms of Bipolar Disorder 

Bipolar disorder is characterized by both high mood and low mood symptoms.

High mood symptoms can include:

• Happiness or excitement
• High energy or restlessness
• Impulsiveness 
• Increased libido
• Irritability or aggression
• Overconfidence 
• Racing thoughts/difficulty concentrating 
• Uncharacteristic rudenness 

Low mood symptoms can include:

• Appetite changes
• Decreased interest in regular activities
• Depression
• Difficulty concentrating 
• Hopelessness or worthlessness  
• Isolation from loved ones
• Lethargy or fatigue 
• Low confidence 
• Sadness 
• Sleep issues (insomnia or hypersomnia) 
• Suicidal thoughts 

Similarities

These mood disorders are both cyclical, though each in their own ways. They share many of the same symptoms, with PMDD often presenting very similarly to the depressive stage of BD. Symptoms such as depression, appetite changes, fatigue, low self-esteem, hopelessness, and more are common in both. 

People with PMDD and BD regularly struggle to navigate relationships when symptoms flare up. It is common to self-isolate, push others away, lash out, or experience more conflicts with others through periods of drastic mood swings and feeling out of control. 

Key Differences

Despite these similarities, there are clear differences between PMDD and BD. 

Timing and Episode Duration 

One distinction between PMDD and BD is the duration and timing of episodes. PMDD symptoms occur 10-14 days before menstruation, and they stop immediately or soon after menstruation occurs. 

On the other hand, BD episodes can occur at any time with no clear pattern. Even when BD is experienced chronically, episodes can be unpredictable in their length, lasting for months, weeks, or days. 

Types of Mood Changes

The types of mood changes that occur in each disorder are different as well. Though mood swings can occur, PMDD regularly causes increased emotional sensitivity, anxiety, irritability, and other symptoms for a fairly consistent period of time each month, all of which very quickly reside when the luteal phase has ended.

In BD, on the other hand, mood shifts are more extreme, and symptoms can vary depending on the type of episode. Manic states can be euphoric and include reduced sleep, increased energy, increased impulsivity, and psychosis-like symptoms in some cases. Hypomania is a less intense form of this with an elevated mood but no psychosis. Though depressive symptoms are similar for both disorders, their timing and duration differ.

Underlying Causes 

Though BD causes are still not fully understood, this disorder is associated with the dysregulation of neurotransmitters such as norepinephrine, serotonin, dopamine, glutamate, and GABA. Genetic vulnerability, neurobiological factors, and circadian rhythm disruption are also important factors to consider.

In contrast, PMDD is an abnormal reaction to the monthly hormonal changes in a woman’s body. It is influenced by fluctuations in progesterone and estrogen levels during the luteal phase. Fluctuating levels of estrogen can increase histamine levels as well, which can worsen symptoms further. 

It is important to note that environmental factors, stress, trauma, and other factors can increase a person’s likelihood of developing either disorder. 

Treatment Options

Treatment Options for PMDD

Various treatment options are available for those experiencing PMDD. It is often recommended to combine professional support with lifestyle changes in order to find lasting improvements.

Some options for treating PMDD include: 

• Therapy: Licensed professionals can help you work through symptoms and find strategies to manage them.
• Medication: SSRIs, birth control, and more options are available. You can consult with a professional to determine the best course of action for you.
• Supplements: Magnesium, B-vitamins, chasteberry, calcium, myo-inositol, SAM-e, and more supplements are available to address symptoms. 
• Nutrition: Prioritizing whole foods, reducing sugar and caffeine, and focusing on low-histamine foods can lead to improvements. 
• Exercise: Beyond existing as a healthy outlet, exercises such as yoga and walking can help you boost your mood and reach a calmer headspace.
• Self-management strategies: Having a consistent routine and tracking symptoms can help you manage PMDD as well.
• Acupuncture: This can calm your nervous system and help you regulate your hormones.

Treatment Options for Bipolar Disorder

Bipolar disorder can also be managed through professional and holistic methods.

Examples of treatment options include: 

• Therapy: Various therapeutic options such as cognitive behavioral therapy (CBT) can help you navigate BD.
• Medication: Medications tend to be the most important part of treatment for BD. Mood stabilizers, antipsychotics, and antidepressants can be used under the advice of your doctor. 
• Supplements: Such as NAC, magnesium, and omega-3s, and more can supplement your lifestyle if recommended by a professional.
• Nutrition: Whole foods such as lean protein, fruit, vegetables, and whole grains can help you manage BD. 
• Exercise: This can help with regulation and reduce depressive symptoms. 
• Self-management strategies: Having a routine, tracking sleep, tracking moods, and tracking triggers can be helpful in managing symptoms. 
• Meditation/mindfulness: These strategies can help manage mood and stress and reduce impulsivity. 

Mental Health Support from Jackson House

If you or someone you love is struggling with a mental health condition, Jackson House can help. Our empathetic and highly trained specialists offer support for a wide range of conditions.

Contact us today to learn how we can help.