Author: Georgia Macdonald-DanversThis article is for all of my neurodivergent friends who menstruate. 'Aunt Flow' is notoriously the least favourite visitor of every month, with the cramping and the PMS. But for people with ADHD, it is a whole other problem. PMS is often not an experience people with ADHD have, instead it usually manifests as premenstrual dysphoric disorder (PMDD). PMS and PMDD share symptoms of; breast tenderness, bloating, change in appetite, mood swings, low concentration, and over 150 others. Where PMS and PMDD differ is that PMDD is a bit more strict in the diagnostic criteria. While it is separate from other mental disorders as it is directly linked to menstruation, PMDD specifically is distinguished by an abundance of symptoms, one of which has to involve mood dysregulation. Aside from symptoms, the intensity of them must be causing functional impairment. So, when we think of PMS, that is the typical light cramping and hormonal moodiness that can come before your period. PMDD is a hormone-related mood disorder (another example of a hormone-related mood disorder is postpartum depression). To begin, mood-related symptoms are already more common for women with ADHD (often experiencing more anxiety & depression). This puts neurodivergent women at especially high risk for this disorder. In a study, they found that 45.5% of women with ADHD experience PMDD versus the 28.7% prevalence rate in the general population. The symptoms of PMDD spread beyond the week of a period. Often symptoms are between weeks 2-4 of your menstrual cycle, making it an incredibly overwhelming and somewhat long-term problem almost if not every single month. The diagnosis process of PMDD is simple but long. To be able to accurately diagnose this hormonal mood disorder you need to have a very complete examination of your mental and physical health. For diagnoses, it is important to have recorded medical history, lab assessment, and pelvic examination. The medical history should be detailed and also should include any previous or current medications to be able to take substance abuse into account. In the lab, your hormone levels, blood chemistry, and cell count can be looked at to give more insight into your patterns and symptoms. Along with these, a pelvic exam is required as it is important to look for and rule out any other physical illness. There are many ways to treat or more so manage PMDD symptoms. SSRIs like Zoloft can be used to treat the issues with mood associated with the disorder. Professionals recommend lifestyle changes to assist in being able to cope with PMDD. These include; dietary changes and supplements, regular exercise, and keeping stress levels as low as possible. Sources: Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: The Role of SSRIs by Meir Steiner, Teri Pearlstein, Lee S. Cohen, Jean Endicott, Susan G. Kornstein, Carla Roberts, David L. Roberts, & Kimberly Yonkers Prevalence of hormone-related mood disorder symptoms in women with ADHD Farangis Dorani, Denise Bijleng, Aartjan T.F. Beekman, Eus J.W. van Someren, J.J. Sandra Kooij Understanding and treating PMS/PMDD by Penelope M. Bosarge Author: Allison Cooke // CW: Disordered Eating Unfortunate as I was to discover that commonality of comorbidity of mental illnesses, the relation in symptoms leads to a relation in treatment, meaning although one problem may be presented in different ways, the aid is also found in one way but can be applied to a variety of symptoms. Personally, I survive through a diagnosis of Bipolar II disorder and generalized anxiety, as well as ADHD which this article pertains to, however an illness I have not been officially diagnosed in is Anorexia Nervosa. The concept of diagnosis in the mental health field as a way of validation of sickness is privileged in the simplest of terms. The accessibility of a doctor capable of diagnosis is not universal even within a singular country or in my case the particular province I live in. I identify as surviving through both ADHD and Anorexia Nervosa. I do not need a doctor to tell me, and validate that I have significant problems with eating. Due to the physical ramifications of an eating disorder, a self-diagnosis is accepted as fact. In general, studies have suggested that there is a significant gendered factor to Eating Disorders, including the entire spectrum from Bulimia Nervosa to my own self-diagnosis of Anorexia Nervosa. On the topic of gender and following the topic of diagnosis is the matter of a huge population of girls and women who remain undiagnosed with ADHD due to the DSM-5 criteria and its bias towards symptoms that fall more on the male side of the disorder. Studies have shown the current levels of ones ADHD, recognizing that symptoms can at times be much more prevalent than other times, are fasting related. Furthermore, the concept of a peak in ADHD behaviours can be related to feelings of impulsivity and a general lack of control that can come to prevalence regarding food and consumption. Binge eating, which is characterized as consuming a large quantity of food in a short period of time, is closely related to the impulsivity that is so recognized as a part of ADHD. The logic behind this relates to the hyper-focus on a particular topic that accompanies a lack of concentration of a subject unrelated to the particular fixation, resulting in an intended or unintended fast; the body responds when finally given the fuel it was deprived of by consuming all within sight. From my personal perspective, I understand that controlling my impulsivity plays a role in my eating disorder. I find peace in the control I take over my ADHD mindset and predisposition to binge eating by starving myself of not only nutrients by joyous foods and food-related activities. Generally speaking, the activity of eating is a break for most people, with their lunch break signifying a rest time during the workday. My mind has two functions; stop and go, meaning I have a hard time stopping an activity for a break to eat, and fall into holes of restricting and bingeing. On the eating disorder side of this comorbid combination is a dreadful shame that accompanies the binges, and fuels my desire to prolong the restriction phases. This is a spiral that the longer you restrict, the less control you have when you finally binge, and then the eating disorder voices tell you to compensate by restricting longer and harder, only to inevitably trigger another binge. This may look grim, but one of the benefits of comorbid illnesses is the treatment is also comorbid, or occurring at once. With treatment of my impulse control, I can target both the ADHD and ED behaviours. Furthermore, in relation to eating disorders, there is no medication that will cure you, however in my opinion eating disorders are commonly a symptom, or better phrased a coping mechanism to another illness, meaning that the impulsivity that enables binge eating can be treated on its own, and thus have a positive effect on the binges, although not directly treating. It is important to remember that eating disorders are mental illnesses and cannot be treated through physical means alone, meaning treating the psychological symptoms will result in physical benefits, like better coping strategies than starving yourself for control. Sources: Ptacek, Radek et al. “Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced.”Dove Press Journal Neuropsychiatric Disease and Treatment. 2016. Sala, L et al. “Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients.” Eat Weight Disord. 2018. Yao, Shuyang et al. “Associations Between Attention-Deficit/ Hyperactivity Disorder and Various Eating Disorders: A Swedish Nationwide Population Study Using Multiple Genetically Informative Approaches.” Society of Biological Psychiatry. 2019. Author: Georgia Macdonald-Danvers "You should try yoga!" ... "you might be able to do more if you practice self-care." If you're like me, these is the most frustrating phrases to hear when speaking about mental challenges. But, I will give credit where credit is due, mindfulness is a wonderful tool when combatting the symptoms of ADHD... especially for women! There have been studies that suggest that women are actually more interested in and find more success in mindfulness techniques in treating the mood and emotional irregularity symptoms associated with the disorder. Mindfulness is rooted in Buddhism and focuses on observation and being present. In the context of mental illness/disorders (us!) mindfulness focuses on non-judgement and being present to be able to regulate our emotions and other symptoms or sensations we may feel (yes, mindfulness can help with hyperactive, impulsive, and emotional symptoms alike). The point is presence and awareness can allow you to, in simple language, separate yourself from your symptoms and work through them. Now that we have the basics, here are a few techniques you can use to practice mindfulness on your own! Square/Box Breathing: This technique is a personal favourite of mine. Square breathing uses guided, deep, slow breaths to bring down stress levels and heighten your concentration. Begin by taking a deep breath out, trying your best to empty your lungs, this is always where you start with controlled breathing. To begin the 'box' style of breathing that makes this technique all it is; inhale to a count of four focusing on how the breath is filling your lungs and expanding your belly, next hold that breath for a count of four, finally release for a count of four and continue. While doing this 4x4x4 breathing technique pay attention to the decrease in your heart rate as well as the rise and fall that comes with each step. Body Scanning: This technique is perfect for my sisters that struggle with physical and mental hypersensitivity (I feel you!). The goal here is to be aware of the sensations in your body, become familiar with them, and learn to manage them, so practice is key (I recommend practicing it as much as you can throughout your day). Start by getting in whatever position and environment that is most comfortable for you, next take some deep breaths (maybe even some square breaths?), start at the tips of your toes and slowly start becoming aware of the sensations that may arise, breathe into any that are uncomfortable and continue to bring your attention to higher points throughout your body. Focus on breathing through tension and uncomfortable sensations and becoming aware of them to be better equipped when dealing with these things overtime. Yoga: The one you've been waiting for... the one your "Karen" of an Aunt keeps sharing with you on Facebook... the only form of excise I like... it's yoga! Although that introduction may have felt negative, yoga has been a powerhouse of favourite as far as mindfulness and Western culture and wellness, and with good reason. Yoga brings forth my favourite parts of exercise and meditation to create this holistic experience that can be so amazing for people with ADHD. Combining stretches, movements, and deep breathing the hyperactive and scattered mind of a women with ADHD gets a workout. Whether you're utilizing video style guided yoga on YouTube or Apps, going to classes, or making up your own poses and practices yoga can be a beneficial way to become in tune with your body and work off some of that excess energy you may be feeling throughout the day all at once! When it comes to being mindful... you can be your own guide! Practicing new techniques and expanding your "big book of strategies" is a great way to learn what ways work for you and what does not (plus, we both know doing the same breathing technique day-in and day-out gets boring). So developing your own set of strategies to be mindful is a great step at becoming better friends with your ADHD. Sources: Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial by Hoxhaj, Sadohara, Borel, Amelio, Sobanski, Muller, Feige, Mathhies, & Philipsen (2018) The Effectiveness of Mindfulness-Based Therapies for ADHD: A Meta-Analytic Review by Cairncross & Carlin (2016) Author: Georgia Macdonald-Danvers Welcome to the first post on ADH-She, a blog dedicated to providing women and girls of all ages accurate and impactful information in terms of their Attention Deficit Hyperactivity Disorder (ADHD). I believe the first place to start is here; "Do I have ADHD?" I think this is generally how most peoples journey begins. The complication for women is that many professionals do not have the right answer to this question! Entering the 21 century, research indicated that there is about an equal amount of men and women with ADHD. If that is the case, why is majority of research done on boys and men? (see Sexism & Mental Health) Here is where we can start, the basics. The DSM-5, an outline of diagnostic criteria for mental illness and disorders. Their criteria for ADHD is as follows: Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level
To break it down even further we have to ask; "What type of ADHD classification do I fit under?" ADHD has 3 sub-classifications to which you can fit under, which fit nicely into the DSM-5 criteria. First being Predominantly Inattentive, as you can assume, that would suggest that you exhibit majorly the inattentive symptoms as described above. Next would be Predominantly Hyperactive, again, suggesting you fit more into the hyperactive criteria. Last, there is Combined Type, suggesting that you express a combination of both types of symptoms more equally. Now, the information that is important to females would be that most female patients fall into the Predominantly Inattentive category. Why is this important you may ask? Because often, in research and diagnoses, professionals are looking for hyperactive symptoms (i.e. the symptoms that are most common in men). This can often leave women being misdiagnosed with various other disorders (such as mood or personality disorders) that may leave women with inadequate support. Last, I have to guide you to "What can I do with this new found knowledge?" Well everyone, with knowledge is power. Knowing what symptoms you may be exhibiting as well as what type you may fall under can be a helpful tool in your diagnoses journey. Express your concerns and what specific problems you may be having and make that direct connection to ADHD to your doctor or mental health professional to allow an accurate assessment. Sources: ADHD and Female Specific Concerns: A Review of the Literature and Clinical Implications by Nancy L. Nussbaum (2011) Diagnostic and statistical manual of mental disorders (5th ed.) by American Psychiatric Association (2013) |