The Honesty Debate – Authenticity While Living With P.M.D.D.

Within the last 3 months I have changed jobs, gone through a breakup and moved to a new city. My last post was me trying to stay above water. This one is to let those who read this know that I made it through to the other side.

A few friends of mine have partners with mental health issues or with disabilities. We often have conversations about their feeling the need to be a less authentic version of themselves in order to hold space for the individual they love. My friends feel the need to go out less or speak and hold themselves differently to properly convey their ideas in a safe way.

I outwardly encourage autonomy but I know what it is to want to perpetuate a relationship with someone who is not carrying their share of the emotional labor. When those of us with mental health complexities are our most authentic selves, do we then require those around us to be less so?

I am 30 years old and have been married (and divorced) twice. I am officially THAT person. Obviously I find myself questioning the losses in my life. Can we have life long relationships when our mental health creates controversy? Asking the people in our lives to hold space for the somewhat volatile nature associated with PMDD feels like a lot. My symptoms often mimic Borderline Personality Disorder or essentially crippling panic that every partner I have will leave. There also seem to be some somewhat abrasive problem solving techniques when I’m feeling vulnerable. I’m working on the last part, but the first (crippling panic) feels well founded most days given the circumstances.

It takes a reasonable amount of emotional labor to maintain a relationship with people like me. We need partners who are capable of establishing and kindly asserting safe boundaries for themselves. Boundaries are useless if you do not communicate them effectively. Self-care is something that our partners must learn but do individuals who have their shit together genuinely want to engage in a relationship that they have to have more aggressive boundaries?

I have come to the conclusion that until I figure out what I need, it is important that my romantic interactions maintain a certain fluidity. Whatever form that takes.

Have a partner with mental health issues? Leave a comment and let me know how you and your partner manage your dynamic.


xo Sarah

Mental Health- My FAQ’s

I was in the middle of research for another post when PMDD hit… so I’m going to grab some sour patch kids, put on some pop music and share something I wrote a few months ago that resonates with me today.

Mental Health. – My Frequently Asked Questions. 

Is poor mental health self-absorption?

Or lack of self-care?

Am I really sick?

Or could I just work harder at being sane?

Can you work at being sane?

Are feelings pliable under the influence of a strong hand?

When you brain lies to you, what feelings do you trust?

Can you put each thought into a box, wrap it tightly and open it at will?

Someone forgot to teach me about boxes.

My heart is a pile of al dente pasta.

Messy. Messy. Messy.

If a thought is understood I can clean it up.

If I can put all of my feelings into those boxes maybe people will stay.

People like predictable and compartmentalized people.

Is anyone predictable and compartmentalized?

Are we all just big piles of emotional pasta?

Are some people just better at keeping the red sauce off of their white shirts than I am?

“Is there no way out of the mind?”**

**Quote by Sylvia Plath


Things Your Partner With PMDD Wants You to Know

Have you ever seen one of the tv episodes where the evil doppelgänger traps the protagonist in a closet and walks around doing and saying horrible things to everyone in the town? PMDD feels like that. No one can understand why the person is acting so weird. They probably have a reputation for instability,  not finishing what they start or periodically saying somewhat outlandish things.  If you love someone who suffers from PMDD, here are a few things that you need to know:

1. We Have Just as Hard of a Time Figuring This Out As You Do: 

The idea of a chronic illness is foreign for most. What is it to never be able to slam a door shut on something that brings you pain? If you’re a control freak like me, this part of the diagnosis seems to be the most difficult to swallow. It’s the idea of the perpetual cycle of instability-> pain-> guilt I afflict on my family and friends that often leads me into my spiral of suicidal ideations.

I’ve spent the majority of my life trying to explain my dysphoria. I blamed my religion, my family ,myself, and even my choice to have kids. I was blaming everyone around me and when it came down to it, nothing ever really seemed to fit. When the PMDD diagnosis fell into place like the final number on a life long Sudoku puzzle, it was like I could breathe again. If you’ve chosen to be a part of our lives, we ask a little patience.

2. We Don’t Hate You. We Need Love.

You know all of those things your partner or friend said when they were in the middle of their dysphoria? That’s their insecurities talking. What is your partner’s love language? Learn it. I know it sounds impossible, but something you’ll need to do to make this work is to show them love when they’re dysphoric. Even if that means giving them some personal space or taking some for yourself.

They’re more than likely terrified that this disease is making you hate them. An actual symptom of this disease is broken relationships. You wouldn’t get angry at someone with arthritis in their knees for walking slowly. PMDD is a chronic disorder with no known cure. Learning to separate your friend or partner’s dysphoria from their personality by using a period tracker or keeping a watch on their symptoms can help you understand their words and actions as what they are. Symptoms of a disorder they’re trying to figure out. When I asked a group of PMDD sufferers what they want most from their friends and family,  many wanted to be remembered as they truly are during their dysphoria. Help your friend or partner by remembering the person you love, and looking past their dysphoria

3. Anxiety and Depression Exist Outside of Ovulation

PMDD is a cyclical prison that sufferers are subjected to without their consent.

Orange is the New Black protagonist, Piper Kernan said,

“You spend a lot of time thinking about how awful the prison is rather than envisioning your future.”

During ovulation, those who suffer with it do and say things that aren’t natural to their personalities. They know that these actions are hurtful or frustrating and they see the effects on the people around them. Because of this, there is typically a significant amount of guilt. This causes insecurities and anxiety between their period and ovulation. It gives sufferers a feeling like we can never quite meet societal expectations. We worry about committing to outside engagements like parties for fear that we’ll end up in the bathroom trying to calm down. I’ve put off going back to school for years in fear that I’d make it through a semester or two and then have yet another really bad month and stop everything.

Like many others with chronic diseases, PMDD can be debilitating. Encouraging your friend or partner that you’ll be there during the bathroom crying at parties or will help them stay on target in school will help them live a more fulfilling life. This confidence will help them maintain stability when suicidal ideations are strongest.

4. A PMDD Sufferers Biggest Fear Is that You’ll Get Tired and Leave

No want wants to hear about how getting out of bed every single day is a purposeful maneuver. No one wants to know how hard it is for you to hold down a job because of your panic attacks in the bathroom at work. Pain makes people cringe. People with chronic disorders do too.

Divorce is incredibly common for people with PMDD. Often we struggle with vulnerability and trust. I’m so aware of my mood swings that most of my humor is self-deprecating. I would rather put myself down before you have the chance to. I’ve had a few friends get so fed up with it that they stopped me mid-sentence and told me to say something nice about myself.

If you’re in a relationship with someone who suffers from PMDD, they will most likely need more consistent and purposeful affirmation than other people you’ve dated. Your partner or friend knows that this is hard for you. They may not demand diamonds or spend hours on their makeup but most are high maintenance in the emotion department and that can be a lot of work for partners. If you choose to maintain a relationship with a person with PMDD, let your partner or friend know that you’re in this for the long haul by actively making an effort to understand this about them. I hold most friends at arms length for fear that they will hit their capacity for crazy and disconnect. Feeling like there is something consistent and stable to anchor to during the storms will help lessen the monthly damage. I promise.

Dietrich Bonhoeffer said, “We must learn to regard people less in the light of what they do or omit to do, and more in the light of what they suffer.”

A personal dealing with PMDD must decide every single month if their life is worth living. A stable support system can help them make the right choice one month at a time.

PMDD and Suicidality – You Are Not Alone

As open as I am about my experiences with PMDD, the one topic I find most difficult to talk about is my tendency to not want to exist anymore. I worry that my transparency will be misconstrued as attention seeking. This is the furthest from the truth.

Judy Collins, a musician, writer and mother of a suicide victim said, “For many centuries, suicides were treated like criminals by the society. That is part of the terrible legacy that has come down into society’s method of handling suicide recovery. Now we have to fight off the demons that have been hanging around suicide for centuries.” It is National Suicide Prevention Month and although this is a year-round issue, I think it is timely to touch on something that kills 15% of women with PMDD.

This percentage does not include the women who make unsuccessful attempts.  I was hospitalized for active suicidal ideations four years ago. After that, the natural hesitancy or self-preservation instinct that comes with a suicidal thought was negated by an anxiety medication that the hospital had put me on. My husband found me in the bathroom. Shortly after, I was diagnosed with PMDD, and taken off of all medications. My daughter could have these symptoms one day and that is what fuels me to keep this balanced. I have not tried to hurt myself again but I still experience low points that psychologists call passive suicidality.

Passive Suicidality, a symptom commonly associated with Borderline Personality Disorder (people with PMDD are often misdiagnosed), is the relatively persistent wish to no longer exist. Active Suicidality is planning how you are going to make it happen. When I refer to myself as having suicidal ideations in these posts, I am referring to the fact that I often (3-4 times a month) wish to no longer be alive. When I have these thoughts I am not actively planning to make that happen. The opposite in fact.  I have to come up with ways to work through my lackluster enthusiasm for existence on a monthly basis by acknowledging the source(s). My unhealthy thoughts are often triggered by three things:

  1. Excessive alcohol consumption during ovulation in combination with interacting with large groups or just new people. – I have relatively intense post-interaction social anxiety. The entire way home from any social gathering I reel in all of the “complete nonsense” that came out of my mouth and convince myself that everyone hates me. If I consume excessive amounts of alcohol in tandem I will typically wake up the next morning in an emotional hurricane.
  2. The breaking down of a relationship that I care about. – Knowing that this disease causes intense and sometimes crude reactions to stressful circumstances has me beating myself up for weeks after a relationship goes through turmoil. What am I subjecting the people in my life to? What kind of awful person says these things? I tell myself that I am doomed to destroy all relationships in an emotional ball of flames and that I should just stop.
  3. The idea that I am only 29 and that for the rest of my ovulating days, THIS is my fate. – The cyclical nature of this disorder perpetuates an idea of hopelessness. Prayers for menopause circulate the Facebook groups I am a part of. Many people with uteruses dread the physical implications of being in their late 40’s and early 50’s. Individuals with PMDD see it as the light at the end of the 30+ year tunnel.


I have found that if I have chosen to eat poorly (i.e.: Lots of carbs, red meat and sugar) for consecutive days or consume too much caffeine or alcohol that I can count on having an overall poor demeanor the between ovulation and starting my period. This makes the aforementioned triggers more significant and causes the spiral that if not circumvented can end in more “active” thoughts. I make occasional statements about being “tired,” but not tired physically. An emotional exhaustion permeates my every waking moment. This is my clue to make some life changes.

Like what you ask? I know you asked. Let me tell you. Wait for it…… aaaaand a cure has not been found. Consistent treatment is spotty. Not everyone has access to a hysterectomy. I know what you are thinking. “This is not helping, Sarah.” Reality bites my friend… but we have to keep moving forward.  A few things seem to offer relief for most sufferers:

    • Cognitive Behavioral Therapy– This is simply defined as looking at your symptoms objectively and finding triggers. Therapists are a wonderful resource for you, your partner and your kids as you explore PMDD and what it means for your day to day life. When you are choosing a therapist, consider how you communicate, and how you prefer to receive information. Try different people until you find someone who you connect with. I have spoken to so many people who have gone to a therapist once, have a bad experience and never try again.

        • THIS INCLUDES SYSTEM TRACKING- I cannot emphasize how important system tracking is to your ability to be aware of what is happening in your own body. There are so many apps you can use. Click here for GAF’s suggested trackers.
    • Medications– Everyone has a different chemical makeup. It is important that you talk to your doctor about your options. The link takes you to the Gia Allemand Foundation’s Clinical Care Help sheet. This can help someone educate themselves prior to finding a physician and prepare for talking to them about a disease that is not widely known.


    • Self-Care:  The guilt that is triggered by our actions needs to be quieted occasionally. I have a difficult time just doing something for myself when I know I have been a lackluster parent, friend or partner. I am constantly working to compensate for my bad days though exhausting myself on my good ones. If you are like me and have a hard time coming up with things to do for yourself, the link will take you to a page where someone else has put a lot of thought into it for you.

For some, doing all of these things will not work. Do not give up. You are not a burden. People WILL miss you. Your life is not too messed up to have value. The more you talk about it, the less likely you are to act on it. Having a rough time finding someone to talk to? Gia Allemand has peer counselors available for you! Click here and schedule an appointment today!

You can also call the National Suicide Prevention Lifeline 24 hours a Day: 1-800-273-8255.