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Title: Medicalising menstruation : the case of premenstrual dysphoric disorder and DSM 5
Author: Khamlichi, Shimu
Awarding Body: University of East London
Current Institution: University of East London
Date of Award: 2013
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The phenomenon of ‘premenstrual syndrome’ has attracted considerable attention during the early half of the twentieth century. Over the years, medical researchers and physicians have concluded that premenstrual changes could cause women severe distress and impair their ability to function at work and at home. In 1994, the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association 1994) used the term ‘premenstrual dysphoric disorder’ (PMDD) to refer to these premenstrual changes. At present, PMDD is being proposed for inclusion as a new category in DSM 5, due for release in May 2013. This inclusion means women who experience premenstrual changes could be classified with a mental disorder. This study aimed to explore how premenstrual changes evolved from a normal biological fact of life into a psychiatric disorder. The study examined the way premenstrual changes have been constructed in psychiatric and psychological literature. The study was informed by a critical realist epistemology and adopted a Foucauldian discourse analysis methodology. The study took a genealogical approach to explore the discursive and nondiscursive practices that have influenced the medicalisation of premenstrual changes in DSM. The study found three interrelated ‘truths’ about women’s premenstrual changes that have been produced and disseminated by psychiatrists and psychologists to reify PMDD as a psychiatric problem. Psychiatrist and psychologists have drawn on the discourses of science and medicine to render these constructions or ‘truths’ intelligible. The literature focused primarily on negative mood changes and failed to consider positive premenstrual experiences that many women report. The literature did not consider premenstrual experiences from a nonbiomedical perspective and neglected the role that relational, social, economic, cultural and structural factors play in contributing to or exacerbating premenstrual experiences. This means that the published research has excluded aspects of premenstrual experiences that could stand in contrast to the dominant accounts reported throughout the literature. The study found that the construct of PMDD taps into powerful cultural ideas about what it means to be a woman and what is considered feminine. The study shows that the concept of PMDD is grounded in a historical tradition of problematizing menstruation. This increased tendency to view menstruation or aspects of menstruation as problematic does not benefit women. We must recognise that the way we construct menstruation or menstrual cycle experiences has an effect on the way we view women and the way we treat them. The inclusion of PMDD may devalue women and result in the discrimination, marginalization, and stigmatization of women. This study recommends that the category of PMDD be excluded from DSM 5. Recommendations for clinical practice and further research are suggested.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psych.) Qualification Level: Doctoral