Let's Dive into Pre-Menstrual Dysphoric Disorder (PMDD)

This episode, I'm joined by Registered Psychologist, Basmah from Sage House Psychology. 

We break down what Pre-menstrual dysphoric disorder is, how to recognise it, get a diagnosis, and manage the condition.

Find Basmah on Instagram at Sage House Psychology: https://www.instagram.com/sagehousepsychology/reels/

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Aliya x

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Transcript

SPEAKER_00 0:00

Welcome to the Dietician Dispatch, hosted by Alia Ghaznavi, registered dietitian specializing in women's health, bringing you clarity with nutrition and evidence-based science. Today we are diving into our mental health with the focus of the episode Premenstrual Dysphoric Disorder. Chatting with me today is registered psychologist Basma from Sage House Psychology. Hello, Basma. Thank you for coming on the podcast. Thank you for having me. Looking forward to it, inshallah. Inshallah, that's so good. And this is the first episode I'll be having with a psychologist. As we know, we love to have different allied health professionals on here and different experts to fill us in. So, Basma, tell me a bit about why you've decided on the psychology as a profession. I'm always intrigued to see why professionals get into this space.

SPEAKER_01 0:50

Yes, that is a very beautiful question. And my story is so not inspirational. So I went into uni with the Bachelor of Science and I had no idea what to do. I took a psychology elective and I did very well in it. And then I was like, you know what, this is probably something I can pursue. Because when you start uni, you actually have no idea. Exactly. Um, you know, what like there's a thousand and one options, you don't even know yourself enough. But you know what, alhamdulillah, I'm so grateful that you know that I landed on my path because it's been such a beautiful journey. I've learned so much about myself and the way that the world is and the way that people work, and I think it's definitely helped inform so many parts of my life. I think that that would be my journey into psychology. It's opened up so many doors, worked with so many people across different presentations.

SPEAKER_00 1:36

And it's good to hear about that because even my own journey as a dietitian, it informs your own relationship with food and your outlook on life, helping people with their physical health, mental health, so important. And it fulfills you in that way as well. I think the audience would love to know about what kind of areas of expertise you work in.

SPEAKER_01 1:58

Yeah, so mainly I see obviously a range of presentations, but I think the most common ones are things around anxiety, trauma, so traumatic incidents, whether it's kind of like a one-off or like trauma. Also, adjustment. I think adjustment is a very, very, very big thing and transitions between different life stages. And I guess like identity and trying to find oneself amongst the chaos of life, and also the intersection of faith and mental health, and again, you know, those different identities and how they can exist together. Exactly. So I think, yeah, those are probably some, you know, depression, but mainly a lot of anxiety, I'd say, and a lot of trauma. And adjustment. Honestly, adjustment is massive. Yeah. Everyone's adjusting because life's always changing.

SPEAKER_00 2:43

But yeah. Exactly. Oh, that's so interesting, yeah, as well. Because I think people typically think like psychology and therapy is mainly for a mental health diagnosis, like anxiety and depression, but it's also to work through things that have happened to us. Yeah, it's so important. What about the intersection of faith? I think that was so interesting because typically, I think within most of our allied health spaces, we're used to seeing, I guess, Western perspectives of medicine and the way that that is presented. Could you expand on how that works in your practice? I find that so interesting.

SPEAKER_01 3:20

Yeah. So within the practice of psychology, I think it definitely, like faith and religious society, I always get mixed up with that word, and spirituality, I think it definitely adds a layer to the worldview, to the person's worldview. It adds a layer to the kind of the individual that we're working with in terms of what makeup is. So we're not only working with the mind as an example and body, but within that, I guess that container, there also is a soul, which we also need to tend to in the I guess the treatment in that regard. So we definitely have to kind of like uh you know tease through a lot of layers to kind of understand what might be happening. Like, is it just a kind of a cognitive problem, or maybe there's something within not like the soul to diagnose the soul? It's not yeah, yeah, we don't we don't do no soul diagnosis, yeah, yeah. But it's just like maybe there's a dissonance between kind of like what the heart wants and what the mind is, you know, and we try to bring the mind, body, and soul back into a balance. Um, kind of like this, yeah, I'd say more a balance to feel more centered, more grounded in order to face life from that place. Because again, life's gonna throw so many things at you, but we always want to try and reflect on what place are we working from as we go through it.

SPEAKER_00 4:39

100%. And I think it's so important to have practitioners who understand your whole perspective and lifestyle. So I was like I've seen I've done therapy as well. Having someone who understands your cultural and religious background is so important. You don't have to exactly go through everything in your life trying to explain it to them. So it's so important to have that basis when you're going to therapy. Yeah, absolutely.

SPEAKER_01 5:04

Yeah, just those little things, you know, where you makes a difference. Oh, you know, it might be a comment like, oh Ramadan, and then something about Ramadan. And you're like, Yeah, I get it. You know, I you know, don't have to ask, do you just fast from you know, can you have water or whatever? Exactly. There's a lot of unspeakable that's that's understood, or when you know, when a client comes in and has concerns for Akhira, it's not like all right, you know, that's a bit crazy cuckoo. It's like, no, I get it, and that that's a very, very fair concern kind of thing. So yeah, so it's it's a nice holistic approach in that regard. 100%. Where can people find you currently just on Instagram? They which is not active because life behind apparently social media is just a world on its own, and you have that is just a lot, which I'm sure you know. It's it's a lot, yeah. It is it is a lot. So yeah, I do have Instagram, which I've I'm also trying to change my relationship with social media. So there's you know, there's a page there, and there's also an email address if anyone wants to reach out, and I just kind of like post updates on events that you know that might that we run. Um and I'm a telehealth, so SageLC is a telehealth-based clinic. Um, so there's no actual physical space, but it's from the comfort of your own home or wherever safe space you feel. So most all of our sessions are through Zoom.

SPEAKER_00 6:21

Love that, and I think because of COVID, a lot of people have already transitioned to doing telehealth as a my own practice is telehealth, and it's so good because you can reach people wherever they are, and it's always lovely to meet fellow Muslim practitioners. So I love using this platform as an avenue to network and meet other people, and I love how Islam is integrated into your practice. And let's go into the question. So premenstrual dysphoric disorder, what is that all about? That's a that's a tough one.

SPEAKER_01 6:59

That's a tricky one. So premenstrual dysphoric disorder, usually it's it's kind of like an intense, uh, I would say an intense version of PMS. So we all know PMS. Yes. Menstrual, what is that, premenstrual syndrome? Yeah, premenstrual syndrome. And it's kind of like I think it's that thing that we all we all know about it, we all talk about it, you know, that that week before we get our periods, and we're like, you know, you we can smell it, it's coming because of the way that we're acting. Um PMDD is a more extreme version of PMS where it's not it's no longer cute. You know how PMS is like, uh yeah, PMS, you know, it's not. No, no, no, it is not, it is not a cute version at all. So it's it's in the name. So premenstrual, dysphoric disorder. So the keyword here is obviously premenstrual, so it's before you get your period, and dysphoric. So dysphoria here is the opposite of euphoria. So we know euphoria is when you're on this really on this high dysphoria is the opposite, same same intensity, but different direction. So euphoria were up here, dysphoria were all the way at the bottom. So it's like this profound state of unease, of unhappiness, of dissatisfaction, and it impacts so many parts of your life. So it impacts obviously work, it impacts your relationships, it impacts how you see the world across so many domains within your life. So when we look at PMD days, subhanAllah, we want to look out for certain signs and symptoms. And again, like when we say we it's kind of like PMS but more intense, but really it's kind of like this emotional instability that you feel. It's the mood swings, it's where you suddenly feel like tearful or feel super angry, a heightened sensitivity to rejection, or feeling like people are very, very irritating. Irritating. Yes, absolutely. And like we were saying, the increased interpersonal conflict. So people that you usually are like okay with all of a sudden we find ourselves having less tolerance to that, you know, depressive moods, feelings of hopelessness, self-deprecating thoughts. A lot of people also experience perhaps like suicidal ideations and suicidal thoughts, or just feelings of not wanting to be here, um, and anxiety and feeling on edge. So, really, I've literally like, you know, it it's a whole it's a cluster of experience, but the key thing with PMDD is that it has to happen before you get your periods, so within one to two weeks before your periods, and it typically subsides a few days after, and then it should technically no longer exist a week after your periods.

SPEAKER_00 9:38

That kind of yeah, so and that's like half of your life when you think about it, because it's half of the month, exactly, exactly yeah, it's so important, or it's so important to diagnose, and even like I didn't know what it was a few years ago, but I was like, I'm feeling really anxious and um you know upset before my period. And my doctor literally like laughed at me. She was like, You don't have PMDD, like do you even know what that is? And I'm like, I'm like, why are you saying that though? Because like I don't know if I have it, I'm not a psychologist when you're when you're self-diagnosing when you have no answers, that's what people do. Um so yeah, I find it so important. We'll talk about the practitioner side of it and getting a proper diagnosis as well. Um but yeah, what are some I guess for our listeners, how would they determine if it was a normal feeling of anxiety or if it's like you're saying, very severe?

SPEAKER_01 10:42

Yeah, I think a good way is to actually know yourself, come to know yourself because if you can know your baseline and you typically see in terms of anxiety, yes, you start to notice that increase, and then now you can start getting curious about what might be happening here. I find anxiety it's very interesting because um obviously it gets a bad rap, and understandably so it's not fun, it's very debilitating for a lot of people. But at the same time, I think we have to sometimes adjust our relationship with it because anxiety in and of itself is not bad. Um if we didn't have anxiety, the human species would not not be existing right now. Yes, so it's kind of like our bodies' alarm bells. Um, it's normal for our alarm bells to go off when there's a particular threat, like when there's you know, and it could be a real threat, it could be a social threat, it could be a physical one. It's normal to have little bouts of anxiety here and there, but then when it starts to take over, where most days of your week or of your month are riddled with anxiety, um, and it's quite intense where you're not able to do the things that you usually do, you can't enjoy like the little moments, you can't be present every time you're sitting down, your mind is just kind of like tick, tick, tick, tick, tick, ticking away constantly. So we want to look at the duration of it, the intensity and the severity of it. Then those kind of a telltale signs that we need to do something about it, and it's not normal to have that much of it. And it's not to say not normal, like as in ah, I'm abnormal, but like as in there's a more adaptive way to live, a more healthy way to live that we'd like to work towards, of course.

SPEAKER_00 12:21

And we know that obviously, as we're going back to BMDD, when we're in our lithial phase or that phase the two weeks before our period, our hormones drop right before our period. So progesterone and estrogen, and that plays into our feeling as well. If we look into the signs and symptoms of PMDD for our listeners, which we kind of went through already, what are some things for people to look out for in particular? Um, in regards to PMDD? In regards to PMDD, yeah.

SPEAKER_01 12:53

But I guess perhaps the um again going back to the severity of the the symptoms, so the severity of the irritability or the severity of the dip. So remember we're going to dip. So how deep is that dysphoria? Is it like I feel sad, but it's kind of like a passing thought, like a passing feeling, a passing experience, and I'm like, I'll be okay, or have in that in that phase, have I completely lost interest in everything that you know once I I used to look forward to? Do I absolutely roar at everyone um that speaks to me, or I'm hypersensitive when things don't go according to plans? So it's kind of and it I will say with PMDD, sometimes it's hard to be an observer of your own, um, I guess the like the own your own manifestation because you're going through it, it's not until retrospectively you look back and you're like, oh, okay, that's quite chaotic. And in the moment, because you're going, you're going through it, yeah. So don't um like we tend to judge ourselves in the moment. We have our outbursts, we have our it's it's the chaotic, but then we also get annoyed from ourselves that we that it's happening, like we get angry at ourselves. But what we want to try and do is just observe, become like a bit observers in our own life. And I know it's hard to do, exactly, but it's it's kind of like you because you want to understand, you know what I mean? Like a bit of you know, PMDD, whether it's diagnosis or treatment, you need to understand your pattern. In order to understand your pattern, you need to look and be again have your detective hat on, and um, and just and and see, and then ask yourself, okay, is this over the top? Am I usually like this? Do I feel like I can't control it? Yeah, do I feel like I've fallen so deep into this pit and I know that it happens around this time, which is why I highly recommend people to do it alongside a trained, you know, like a psychologist or a doctor that specializes in that area. Exactly. Because yeah, it's it's very hard to feel like you have to do it on your own. Because again, when it's happening to yourself, you don't realize these things, you know what exactly. Um, so you can't sometimes need an extra eye or an extra ear.

SPEAKER_00 15:06

100%. It's so important to go to trained professionals for the information, for the therapy, for the management of PMDD. And if we look at the statistics, it might seem like a small amount, but in Australia, PMDD affects an estimated three to eight percent of menstruating women. But because it's underdiagnosed, this number is obviously going to undershoot the actual number. Another thing that was interesting, it says studies indicate high rates of early life trauma, 83% among sufferers, and an average diagnosis delay of 12 years. That is a lot. Yeah. And another thing was seeing six different health professionals before actually getting that diagnosis. Like that is a lot of people that they're going through. And then it says over half of the individuals reported misdiagnosis, commonly depression, anxiety, or bipolar, which is very obviously not in general, but it's missing the mark significantly. And that goes back to what we're talking about professionals, um, and actually getting a proper diagnosis. People will just get you get brushed off. I think that also goes to GP consults being so quick. Yeah. You sit there for like sometimes a few minutes and then you're gone.

SPEAKER_01 16:23

Yeah. And you also feel sometimes like an inconvenience because there's like a line, and you're like, okay, let me just get in and quickly say my thing, and I need to quickly get out.

SPEAKER_00 16:31

So I I don't have PMD, but I did have anxiety, and um, this was largely due to my own, I guess, health-related problems. And this was before I got diagnosed with the endometriosis. So I was kind of going into what is what's what's causing the anxiety, probably life stuff, and then as well having a condition that is it's a hormonal condition and it's an inflammatory condition, and it's also causing you a lot of physical symptoms. And so my doctor obviously missed a monk with endo. So I had to go to a different doctor finding different specialists, but it's like I could have very much have had PMDD and not known, but that's the problem is that some of these GPs don't spend enough time with their patients and they miss stuff. Yes. So that's why I had to change GPs and find someone who was more proactive, and find someone who invests into women's health and actually and knows what they're talking about in that situation.

SPEAKER_01 17:38

Yeah. Because if you look at, for example, the symptoms of PMDD, like the depressive mood, okay, you it can very, very easily be diagnosed as a major depressive disorder. Yes. Or like if someone is highly anxious or on edge, again, they it can very easily be diagnosed as generalized anxiety. Yes. Like subhanAllah, the I guess the symptoms, like there's a cluster of symptoms, and that cluster also overlaps with other diagnoses as well, which is why it's very, very important to like give it some time because you do have to, I guess, observe yourself over a period of time because with every period, that's the one moment of observation. Exactly. You know, but with periods because they you know become monthly, whatever, it has to happen a few times in order to understand, as opposed to someone coming in and saying, Yeah, I feel this one, two, and three, and then it's like, all right, let's let's give you a diagnosis of anxiety or depression or whatever, whatever it might be. Um, it does take a bit of time, but I'm definitely worth it in order to to move through it.

SPEAKER_00 18:42

Um 100% because then you're kind of going into it with a oh, it's just anxiety, it happens all the time, where it is it's only happening half of the time. And then it's also to do with the hormonal imbalances that's happening during that period. Maybe it's linked to another condition like we're talking about.

SPEAKER_01 19:03

Yeah, it's there has been uh research to show that if you're feeling more stressful, so if there's kind of stressful life events happening, you are more likely to develop PMTD. So it's definitely linked to kind of like that's why I was saying it's an interesting one because it is a very holistic disorder. So obviously at the surface level, it's all of this kind of the emotional stuff, it's the mood swings, it's the irritability, it's all of that stuff. But what's happening underneath the surface is actually your body doing its very natural kind of um you know thing of going through these different phases. But subhanAllah, the individual, again, maybe depending on external context and situations, they are more sensitive to those hormonal shifts and changes, and then their body is not not coping with that. And then it could be exacerbated by stress, it could be exacerbated by traumatic experiences because the default things are there, but when you have the hormonal shifts underneath, they are amplified. So women have it tough. They do, they really do. Well uh it's it's yeah, it's a lot. It is a lot, yeah.

SPEAKER_00 20:12

And that's why they support yeah, that's why they support. Um, but yeah, it's such a shame when you think about it because it's like people probably think, Oh, I just have depression or something, but it's it's linked to your to your monthlies, and it's just something that yeah, I guess get mi gets missed because people are not looking in the right place. Yes. But yeah, in regards to actually getting a diagnosis, is there a specific like questionnaire or something that people use?

SPEAKER_01 20:43

So, in regards to a diagnosis, there's kind of like two things that you'd want to be doing. Our tools and screenings that you can use online, which are very, very helpful. But the first one is a daily record of severity of problems. So the DRSP. And the DRSP basically is kind of like a logging sheet where it has different symptoms of PMDD, and then you log those symptoms across your month. So every day you would kind of like say, Okay, I felt this, I felt that, I you know, I didn't have that, and then you just kind of keep track of it, and then you do that over, you know, a few months, three months, six months, and then just again going back and looking at when these symptoms start to show up more. If they're consistently there, so throughout your month, yes, then it probably wouldn't be PMDD.

SPEAKER_00 21:33

Yes.

SPEAKER_01 21:34

If they if it's there, for example, two weeks out of the month, or they're kind of like around the time of your of your period, and then you decide and you feel great in the remaining two weeks, then it probably would be PMDD. However, you it would you would have to do it with a again a trained professional just to teach out and go through like the clinical interview. Yeah. They ask you more questions and then they probe and again tease to see what what is exactly happening. I think in terms of like trying to get to know yours, I think they're great tools. Um I wouldn't use them as an individual on your own as a diagnostic thing. So if you do it and you're like oh my god I have PMDD but no one no professional told you you did no professional told you. Please don't do that. Yeah no self-diagnosing people it's it's not great.

SPEAKER_00 22:20

Yeah.

SPEAKER_01 22:21

Yeah because self-diagnosing look I can understand and respect it and I do it I I understand why a lot of people do it. But it's not like you know to give yourself a diagnosis because of what it means. Like there's a lot of thinking when it comes to giving a giving a diagnosis. And you're like yeah I knew it alhamdulillah that's fantastic or exactly if you're not being you're like oh well I thought it was PMDD. It wasn't exactly and the other tool is the premenstrual symptoms screening tool so the PSST I love all these acronyms. So that basically is a screening tool where you cross check your symptoms yes across the DSM you cross check the symptoms that are in the DSM give you a diagnosis. So like what we were saying do you feel irritable a lot of the time and then you rate the severity or do you feel hopeless hopelessness and then you drate that it's interesting because one of them is retrospective where you have to ask where you think back to those moments. Yes. Right and the other one is in the now so the DR DRSP that's in the now and I like that one because you want to log it because you to un to understand what's happening and it gives you real time data as opposed to retrospective data. Which is also handy you know exactly yeah yeah um but for the PMDD I think real time real yeah real time data is better. 100% I like that one because like you're saying it's more reliable as well and I think tracking in the now then you actually understand how you feel that day whereas if you ask people like oh how did you feel two months ago they're not going to remember they're not going to remember no they're actually not no ask people what they had for dinner last night what I don't know and like what do you eat normally they're like I don't know food and I'm like yeah that's not helpful but okay thank you I know sometimes you have to tease it out of people then you'd also ask questions around other things so for example life stresses if there's any potential trauma um and that's the that's I guess the root of the psychologist but you know there's also evidence because again PMD D is like body and emotion emotions there's also a layer there that the doctors need attend to um there has been evidence to show that medication does help yeah with it so you know the doctors can can do that part and also lifestyle changes again like because it's like we were saying body based there's it's you really have to take a holistic approach for it as opposed to this is the only way we are only going to do do psychology.

SPEAKER_00 25:06

Yeah it does help yes but you really want to do a holistic you want to do lifestyle changes you want to see a doctor you want to see psychology to to tackle it from all of its different angles 100% because if someone's not eating well or they're staying indoors all the time very isolated that's gonna make a huge difference to how they're feeling 100%. I guess in regards to diagnosis are there any things because I know we're talking about the delays do you know if there are any things that people are trying to put in place to actually improve those timelines or if you don't know the answer that's fine.

SPEAKER_01 25:41

Yeah because you know what I was actually looking into that but I didn't really I didn't really find anything that was significantly significantly more research. Yeah I mean more research yes but no even within that no I didn't I mean I did find research so yeah but I didn't find like anything significant.

SPEAKER_00 26:02

I think the main one actually was the real life tracking yeah the real time tracking as opposed to the reflecting one yeah retrospective that makes that makes sense because then you actually can have the data and see whether this person is having those symptoms across the whole month or it's not because I think when you see the GP and they do that quick questionnaire where it's just like how you're feeling right now that is going to be so general.

SPEAKER_01 26:31

Because most likely they'll be coming like after the fact. Exactly you know it's like after they've gone through it after they've gone through it and they come to the doctor and they're like I just I go through you know um you know these really bad mood swings when I have my proof but it's not like a real time of that. Also the acknowledgement that it actually is a thing. Ah okay I think that's a big thing as well because a lot of women have kind of been brushed off as like oh it's just PMS you know it's normal it happens to everyone and their experience is downplayed. Yeah. Whereas the lady knows that she is actually having suicidal ideations and she doesn't want to exist on this earth because and the issue is in that moment there's no cause like there's no thing where she's like that's why I feel like that yes yeah but when we're like okay hang on you feel like that because you're getting your periods and it's something called PMDD and yes like okay and then that like you know just that that is why because it's not just depression or it's not just I have really bad anxiety it's a serious problem. Yeah exactly that needs to be tended to as opposed to just leaving it on its own and just and and just like continuing life as normal because the thing is you can't continue for a lot of women it's very hard to continue life as normal when you have going through it. Because again it affects it affects your mood it affects how you interact with your world it affects your relationships it affects your ability to go and function properly at work tend to your family and it affects again different domains of your life.

SPEAKER_00 28:04

Exactly and we're saying it's in it's its own disorder like you were saying it's not just a one-off at all yeah it's not and like you're saying about just acknowledging it and I think educating everyone about this men and women is so important because sometimes periods and PMS is just still taboo in some cultures but it's about normalizing it and acknowledging hey this is actually a serious experience that I'm having and you need to understand that if I'm lashing out or you're being irritable or you have a significant mood swing you don't feel like doing things there's a reason why I'm not just moody. I guess in your experience have you seen women across different age groups come in with PMDD so interestingly I only have a handful of PMDD clients. I wouldn't say like a lot but yeah definitely and I actually have some some clients where they just like say I have really really intense a bad bad PMS I have really bad bad PMS and I'm like okay maybe we should look into this you know maybe it's something more but definitely like from what we found is that like understanding I think is is very very powerful you know understanding that this is an actual thing yeah I think removes a very big burden on the experience of the individual 100% and I can speak from personal experience with just with my endo knowing what it is makes a huge difference. It's not just oh it's in my head I made it up like how can you make up physical symptoms you know what I mean and um that's the same for any mental health condition depression anxiety you're not making it up just because you can't see something doesn't mean it's not there.

SPEAKER_01 29:57

Yeah so that's for all of you listeners out there if you feel you know something's going on it's not right you should speak to someone yeah absolutely and I think again with exactly within that that statement is come to know yourself because when you know yourself you know when you're feeling a bit extra off. I think a lot of people struggle with that because they can't differentiate between like you know and like how they would normally feel as opposed to um when they don't feel okay at all. And it's because they're not in tune with their own bodies they're not in tune with their own minds. They're just going through the motion of these things. I think it's really important to just understand your own patterns, your own cycles and how you respond to these things because it gives you an indicator when things start to when it becomes like outside of your norm and regular way of doing things then you can kind of like flag it and it's so important just generally to understand your physical and mental health because like you're saying you can't flag something if you don't know or if you don't understand if it's normal or not.

SPEAKER_00 31:01

Just being able to ask someone questions like I'll have people ask me oh um you know they might not know okay uh oh I don't only drink like one glass of water a day and I'm like you know that's not normal you need to drink more or you know they're going to the bathroom like five times a day for number two and I'm like bruh that's not normal. Yeah yeah and then I'm like yeah there's like a a spectrum of what's normal and then they're like okay I'm existing outside that but they won't know unless they have the knowledge. Yeah absolutely yeah yeah and no shame around it either like exactly you know blackest go you know black sorry on the contrary like go and and ask you know ask and talk to talk to people it might be like you you might book him with a therapist as an example and just talk about your concerns and then you just kind of like hear their you know the response and then that in and of itself can be so like you know just having a second ear like we were saying yes reassuring yeah where it's like oh you know what that actually sounds you know it makes sense to be super angry at that thing and it was like you know oh that was probably a disproportionate response no yeah like I want you to validate means but also it's not always gonna be like that no it's not after yes yeah 100% I've had that too right yeah okay this is not my therapy session but yes I've had that too but also it's this is just a disclaimer don't always vent to your family and friends they're not your therapists as well going to a therapist is so much better like a psychologist because they're an outside ear to your life they're not biased.

SPEAKER_01 32:43

Yeah no no no they are so outside we always you know one thing that I always I guess start the first session with it's like you know I come into your life for this one hour and I go back into my life and you continue yours. So it's like we are very not in your life you know we are part of your life but we're not there. So we are very very objective on the outside but obviously we make space and we hear things out and you know we tend to what's in front of us. But yeah absolutely like you're saying we are on the outside then yeah a hundred percent and then I guess that's the same for any practitioner it's kind of like recognizing that people have different capacities people have different life experiences and perspectives and biases that are going to inform the words that come out of their mouth. Yes. So whilst you kind of go into something and have a conversation with someone wanting a particular thing yes it might work for them it might not work for you again going depending on context if you have good people in your life where you feel like alhamdulillah they give great advice alhamdulillah that's that's amazing. Yes I don't think that happens with everyone and you have to just be mindful you know when when you do talk about these things with others um and it could be something like you know I think like asking people you know is that normal for example with PMDD you can ask women around you guys is that normal to to feel so angry before you get your periods um is it normal that you just feel like you just want to bash everyone you know and then they can that kind of might give you an indication where they're like oh not really or some might say yeah that happens to me so I guess yeah that is is okay um but I I would say for a more personalized and tailored treatment to unpack what's happening um you need yeah I'd really encourage you to see us like at that point um because what might be triggering to you might not be triggering to others and vice versa so again they'll be talking from their perspective and then sometimes you can't apply that onto you because your experience is quite unique.

SPEAKER_00 34:41

And it's not objective yeah no no no it's not it's not which we need. Objective I'm trying to remember you want objective yes you want objective outside one yes and and more more on the treatment side of things so the the treatment options we're talking about so we've got obviously medication um is that I I find um actually I can't remember but like I have anxiety so medication is one of the avenues but I can't remember if we did it first if the doctor's like okay medicate first and see how you feel and then therapy after yeah so is it often in that order yeah it really depends and again the there's like I don't know how many billion people on this earth so really there's like 7.6 billion experiences you know so basically the idea here is that it's very very different for everyone.

SPEAKER_01 35:45

Yes um and some people do therapy first and they feel like they're not able to absorb the strategies or they're not able to kind of like put them into practice because they're so overwhelmed or whatever you might be so anxious. So for them they might feel like it's better for them to go on medication first and then be more receptive to treatment. Yes 100% and for sometimes we like to explain because a lot of people do come in with hesitations around medication yes which is very understandable and we always say that it is a personal choice. For some people where we feel like it is somewhat necessary because of whatever might be happening in a context a situation where it's better obviously we give that's for the doctor to decide but we like to describe sometimes medication as like a life jacket. And then once you learn the skills once you understand what needs to be done once you understand yourself a little bit better then you can slowly off not always some people they need to be on it for long periods of time for others they need it for a short period until they understand the way to do and then they they come off it. So in terms of order there's no there's no necessarily like right way or wrong way around it. Obviously the doctor will talk from their perspective because it's what they know and they medicine and they know a medication that's what they would speak to whereas as as psych we would be talking from a different place because we don't do we don't deal with medications.

SPEAKER_00 37:14

You know medications and at all um and it can help you get to a baseline where you feel you're able to have like a like we were saying a retrospective look at what's going on and you're not feeling so overwhelmed where you're like I can't do anything. It actually helps you get back to a balance.

SPEAKER_01 37:34

I can speak from my perspective when you get to some times where a stage where you feel like there's no highs or lows you just feel like neutral sometimes and other times you're like okay I can feel oh I don't feel like you know if there's a really happy event you don't you don't feel like wow you just feel like yeah it's nice yes yes yes yes yes it can be like that sometimes yeah and I think that's why some people you know I've heard people say I don't want to be a zombie you know when it's not it's not zombie but yeah yeah it is you know what I mean so yeah exactly you know it kind of like um people feel a bit numb and I think again this is why it's a very personal decision you have to do your research speak to professionals that you trust because they'll you know I would like to hope that the professionals that you trust will give you a kind of like a whole an overview of the real side effects that you might experience and as opposed to just kind of like administering and saying all right yellow just take it exactly and and let's move on from this so you want I think you you mentioned earlier you want someone that's that cares and that is attuned and genuinely does have concern for you. And subhanAllah whether it's with the doctor or with a it's with a therapist or any allied health professional that therapeutic relationship is very very important because you want to feel as though you have people in your corner 100% and that that helps.

SPEAKER_00 38:57

Having someone in tune with you because we go back to like my iron was so low to a point where it's affecting my life and then my GP was like your anxiety to get this like to get injections I would faint getting blood drawn or anything and she's like she looked at me she's like you need to see a psychologist she's she told me she's like I think you have anxiety you need to say psychologist and then I did fix that problem but the main issue was obviously the underlying medical condition and but it was causing so many other issues that's why you need someone who can get down to the bottom of things and actually address all the other issues that are going on yes and I think that would come from a few a few yes again we are like we're not just mind we're mind body soul so you want to find the people that tend to those parts I would also argue that a massive part of treatment in regards to PMDD is the self-compassion is the radical kind I guess self-acceptance self-compassion because I think it brings in a lot of shame and a lot of guilt when the cycle when you move through the cycle for a lot of people they turn into someone that they really really don't want to be and I think you know like with the damage of that usually come off the damage of it they look back and they're like oh that's really really bad because there's real life people around them I think a lot of people carry shame and guilt sorry around um so a big part of that self-compassion is trying to be a bit kinder to ourselves in the moments of PMDD in the cycle in when it does kind of um appear sorry yeah in that week um because if we can practice being compassionate in that time then we won't be as um it's not foolproof so I'm not saying like you're when you're compassionate you're gonna like be okay and you're not gonna have it no subhanallah it's it's gonna happen because those you know it's a part of it but what what we do with the self-compassion is that like in those moments we recognize that we're actually having a hard time as opposed to I am a bad person like this is my week um and like we were saying we want to track the cycle so we know what to expect so we know that it's coming so when we know that it's coming then we can kind of put a treatment plan and when we know that when we're in it then we can kind of be like okay I'm in you know I'm in my I'm in my mean week um I need to practice for example as an example um being you know having a degree of mindfulness in in my work I say these things easier said than done right the theory is always easier than the actual practice but it does it does help because what usually remember what usually happens um before any diagnosis or anything you go through the motions of it so you feel irritable and you act on that irritation you feel angry and you act on that anger which we're not denying that there isn't there is the irritability and there is that extra anger there right but when you're not aware of what's happening it pulls you and you go you go into it.

SPEAKER_01 42:01

So when we have that diagnosis when we keep track of what's happening when we know all right you know my cycle usually it's happening the week before I've tracked it I know now I'm gonna go into that it's kind of like knowing all right I'm gonna open this door what are the you know I what tools that I have that I've practiced that I can now like carry with me as I enter enter this door um so it helps have that have that degree and in terms of the tools again it's gonna look so different for everyone depending on your particular trigger depending on what specifically comes up for you so some people might not feel anxious at all they might feel extremely um aggressive or they might feel extremely depressed so you will do different um you know different strategies according to that but really it's kind of like observing like you know we go back to that knowing knowing yourself having a degree of separation between you and your you know you and your thoughts reminding yourself that you are not your thoughts reminding yourself that this is a a time that you know it's a moment that it's going to pass um when you feel that anger knowing for example all right I might need to you know um take some time out you know away during during this week um in whatever way I can um so it's kind of again going back to that that self-awareness and then certain you get I guess strategies to implement in that in that particular week um so yeah sorry like we were saying the CBT definitely um also things like dialect behavior therapy so dbt and that helps with um you know interpersonal conflict it helps with um emotional regulation that one a lot of it you it's like this you practice a lot of mindfulness in it so you become more mindful of your of what of what's happening in your body and what happens is that we feel the feeling and then we usually act on that. Yes I feel irritable and then I'm like Pam I'm you know I do this you know because I'm irritable but when we start to feel it in our body it gives us Like a little bit of time to regulate that before it becomes a behavior. So a bit of that, um, a bit of that mindfulness and being more attuned um in your own self. I don't know if yeah, does that kind of make sense? Sorry. Yeah, yeah, of course. As for specific things, I think it's a bit hard to say because like exactly, you know, depends depends on what it is.

SPEAKER_00 44:21

No, that that's understandable as well. Because in in mind practice, it's very personalized to the situation, to the person's experience and the context around it. Um so that makes 100% make sense. Um okay, well, let's think. Is there anything else that you would like our listeners to know about PMDZ? Is there anything else? We haven't covered I'm trying to think.

SPEAKER_01 44:58

Not really. I think it's just that you know, life obviously and I keep saying this, but really well, life is not um, it's not easy. There's like a thousand and one things happening constantly all the time around different again parts in our life. Um, and if you know you were able to just kind of understand that a little bit, you know, understand this thing about yourself a little bit more and do something about it, then that's one less thing to worry about per se. So seek support, don't feel embarrassed. It's nothing to be embarrassed about. This is, you know, it's normal to have these, um, it's normal to have ups and downs in life. Um, but then what are we gonna do about them?

SPEAKER_00 45:44

I think that's yeah, that's that's the thing. And that's what I say to people about any anything that happens, invest in your health, in your mental health is so important. Um if you don't take care of your mind, you can't you can't function. No, you can't you can't function and you you won't be happy either about it. But thank you, Basma. This has been such an enlightening conversation, even just for myself. And I know so many of our listeners will find it helpful because it's something that I haven't seen much content about, really. Even in our media, they don't really talk about it. Like I was saying, you can find Busma on SageHow Psychology on Insta if you need any services. Thank you so much.

SPEAKER_01 46:27

No worries, and thank you for creating this space.