Nobody likes PMSing, or all the bloating, cramping, and mood changes that accompany it. But for some people who live with mental illness, the hormones your body releases during your period can exacerbate the symptoms of mental illness. A new study has found that that's exactly what happens for people with borderline personality disorder: Symptoms of borderline personality disorder worsen right before and during your period, and understanding this relationship may be key to preventing dangerous manifestations of those symptoms.
The National Alliance of Mental Illness (NAMI) estimates between 1.6 and 5.9 percent of U.S. adults have borderline personality disorder — a mental illness characterized by emotional dysregulation, impulsivity, fear of abandonment, intense moods, bursts of anger, and an unstable sense of self. The new study, which was conducted at the University of Illinois at Chicago (UIC), examined the ways in which menstruation can impact these symptoms. Dr. Tory Eisenlohr-Moul, an assistant professor of psychiatry at the University of Illinois at Chicago, and the lead author of the study, said in a press release, “Our study provides the first evidence that females with borderline personality disorder are at risk for worsened symptoms during the perimenstrual window of their menstrual cycle — the week before and during menses."
At the beginning of the study, 17 women with borderline personality disorder were asked to fill out questionnaires surrounding their mental health symptoms, any past traumas, and other personal details. Then, they each kept a daily journal about the symptoms they were experiencing, as well as the their menstrual symptoms, for thirty-five consecutive days. (Only 15 of the women completed the study.) Interestingly, when Dr. Eisenlohr-Moul and the researchers evaluated the participants with borderline personality disorder using the Carolina Premenstrual Assessment Scoring System — a worksheet that determine how severely your period impacts your mood — they found their mental health symptoms worsened an average of 30 percent in the days immediately before, and during menstruation. “This is equivalent to going from moderate depression to extreme depression on the rating scale,” said Dr. Eisenlohr-Moul.
Further, she explained that the researchers did not expect their participants with borderline personality disorder to have fluctuating or abnormal hormone levels during menstruation. Rather, she suggested that, “similar to [people] who suffer from severe premenstrual syndrome, [people] with BPD may simply be more sensitive to normal hormone changes, which we do know have an effect on mood.”
Considering borderline personality disorder is already marked by an inability to regulate emotions, a 30 percent increase in symptoms associated with the disorder is drastic. Dr. Eisenlohr-Moul said the findings are “particularly important, since people with borderline personality disorder are at a high risk of suicide, so anything that can help patients and clinicians reliably predict changes in their symptoms is very useful.”
In fact, a 2006 article in Psychiatric Times reported that studies have found that people with borderline personality disorder attempt suicide an average of three times throughout their lifetime, but that the frequency of suicide attempts is largely determined by impulsive symptoms.
“Because this group is at such a high risk for suicide, knowing that things get even worse for them during this time of the month around onset of their period, is a piece of information that we can work with to help prepare patients for a time when we know, based on solid research, that things could get worse,” Dr. Eisenlohr-Moul said. “If we can smooth out the hormonal peaks and valleys over the course of the month, it would be interesting to see if we can reduce emotional symptoms by eliminating those hormonal triggers.”
Though more research needs to be done, this study provides crucial insight into how menstruation can trigger mood changes in people with borderline personality disorder. The more we understand about the risk factors associated with this complex disorder, the better equipped mental health professionals will be to support and treat their patients.
If you or someone you know are experiencing suicidal thoughts, call 911, or call the National Suicide Prevention Hotline at 1-800-273-8255. You can find more resources about suicide prevention at the National Suicide Prevention Lifeline or the American Foundation for Suicide Prevention.