PMDD is an interesting addition to the DSM-V. I still meet criteria for this, but it isn’t on the disorder level because I don’t let it interfere with my ability to function. I’m able to do this because I can say “this anhedonia and irritability is just PMDD.” I also think it has lessened since my implementation of several lifestyle changes that have allowed my periods to become regulated.
It’s my guess that irregular periods have a high comorbidity with PMDD because you can’t be sure if the psychological symptoms are soon to end or not. I used to have a 12 day sway in when my period might start. Add to that uncertainty over whether you might be pregnant if you are married or otherwise sexually active. An additional irritant would be if you’ve spent any length of time wanting to get pregnant.
But assuming things are otherwise normal and you’re just grumpy up to two weeks a month. Well, that’s like the oldest personality test, is the glass half empty or half full? It means you feel okay about half the time. But what happened with me is the PMDD would mean I didn’t enjoy things I should enjoy, which is disconcerting and starts that script about what’s wrong with me.
About the only thing that could break through the flatness was eating. And ironically, this response to food may propagate cyclic instability and prolong the premenstrual phase. Self medication with alcohol is another possibility. Self medication may then build a priming and trigger cycle that turns into abuse. The physiology of bloat is another interesting topic. Eating that 700 calorie dessert may seem to cause an instant 3 pound weight gain because both had a common root: lowered progesterone. Ideally women would not take such gains as measures of worth, and maybe that constitutes another risk factor.
So to answer the question of whether this is real, the physiologic effects are real. And while I can choose to dismiss them at this time in my life, I only get it for 1 or 2 days. It used to cover much more of my time (ovulation brought separate challenges). There was a few years when I used the cognitive strategy but I still had pronounced distress, where I was essentially white knuckling through. That was still preferable to the unaware reactivity of my teens and twenties. If things had never gotten better than that, I think I would still count myself ahead.