PMDD and Autism: Sensory Overload by Laura Mullen

I’m Laura, a 34 year old, neurodiverse mother of two beautiful neurodiverse girls and wife to a wonderful neurodiverse man. I have struggled with PMDD, Post-partum Depression and Psychosis, and Menstrual Psychosis in my life. I’m passionate about learning and advocating for others who are suffering menstrual related disorders and advocating for the autistic/neurodiverse population. I talk openly about my own experiences through out my life, including my suicide attempts due to my menstrual related disorders.

I have two passions in life, which both relate to myself and my kids: autism and menstrual mood disorders.

I’ve been part of the Premenstrual Dysphoric Disorder scene longer than I have been part of the autism scene, but both felt like home immediately. We talk about finding our tribes, our homes, with people who immediately understand us without questioning what we are going through, without invalidating our thoughts and feelings. Imagine my surprise when upon finding my autism crowd that many struggled with PMDD or other menstrual/hormone related disorders too. See, in the neurotypical world, PMDD is little known and talked about. However, in my autism support group, it’s not uncommon to see it in discussions. 

I’m not formally diagnosed autistic. I self-identify and after a few years of research (which started because of my daughter’s diagnosis) quickly became a special interest of my own when I started to relate so much myself. 

Women and AFAB individuals often experience autism differently than male/AMAB counterparts. We are often discounted or ignored because we are more social, and we tend to mask our struggles.

Women as a whole are expected to mask their struggles in life, neurodiverse or not. 

Classic theories of emotion posit that awareness of one's internal bodily states (interoception) is a key component of emotional experience (Jamil Zaki, 2012).There is talk in some autistic groups I participate in of PMDD or hormonal mood disorders being more prevalent in those that are autistic. This leads me to believe that this sensitivity to hormone fluctuation may be part of the interoceptive sense. When a person has a sensory disorder, we think most commonly of touch, auditory, taste, sight, and smells. Sometimes vestibular and proprioceptive sense is included.

What is rarely discussed in sensory disorders is interoception sensory issues/processing and just how it can affect a person and what it can actually mean for mental/emotional health when its processing is disordered. Yes, for a sensory avoidant person such as myself who shies away from bright light because it hurts or loud noisy areas because those too are painful and overwhelming, my interoception sense is also avoidant and extra sensitive to overwhelm.

But what is interoceptive sense and why in the world would there be a connection to PMDD?

For a long, medical definition of interoception you can read more here. For a simpler definition I am borrowing a passage from www.inspiredtreehouse.com:

Interoception refers to our perception of what is going on inside our bodies and is responsible for feelings of hunger, thirst, sickness, pain, having to go to the bathroom, tiredness, temperature, itch, and other internal sensations. What’s even more interesting about interoception is that it goes deeper than physical sensations because – as with all of our sensory systems – when our brains receive these internal signals, we interpret, attend to, and analyze them. So interoception is also associated with our sense of well-being, mood, and emotional regulation. (Heffron, 2017)

We know that the interoception sense is often part of a sensory processing disorder. We also know that under stress or overwhelm that our interoception is affected, often greatly. Think of our heart rate increasing during a panic attack or irritable bowel issues due to anxiety. And these also affect our emotions, maybe our heart rate is faster than normal, so we become anxious, creating a more rapid heart rate.

”Influential theories suggest emotional feeling states arise from physiological changes from within the body.” (Hugo D Critchley, 2017). Now, we know that PMDD has a physiological response system. The rise and fall of hormones within the body triggers a physical response from several systems in our body, not just ovaries and uterus, but deep within our gut, adrenergic systems, our cardiovascular system, and our brain. 

Compare the response of a sudden surge of progesterone in the late luteal phase to that of an individual with sensory processing disorder being overwhelmed by a sudden shove into a noisy gymnasium, with bright lights, many bodies, smells and a cacophony of sounds. Said individual would likely go into either shutdown or meltdown mode, as they were unprepared for such an assault on their system and may even have difficulty regulating their emotions; in fact their temper may become frayed quickly, they may find themselves having a panic attacks, anxiety may overwhelm them, their body may start producing pain signals to the overloaded senses, they may even collapse under the weight of it all.

A person without the sensory issue may find this environment exhilarating. I would certainly be huddled in a corner until I felt that I could safely slip away unnoticed. Or, I would start to snap at those around me because of a desperate need to get away.

During the monthly cycle, my sensory system would be overwhelmed by the rise and fall of hormones and I felt completely out of control, emotionally.

Because I was out of control. My sensory processing could not keep up with both the physical and emotional toll of what my body was going through. I see so many sad stories of young girls starting menses and the emotional outbursts and meltdowns make absolute sense if you think of hormones as overwhelming a sensory system that just cannot handle it. Any homeostasis change in our environment is difficult to cope with, especially drastic hormone fluctuations during the menstrual cycle.

It’s not that there is anything abnormal about the menstrual cycle itself, but rather how our body processes the sensations and systems that cause a rise and fall outside of the comfort zone.

I believe that this can explain why women are affected by PMDD and how it all works. We found out in the last couple of years that there is a genetic link to PMDD. We also know that it is a sensitivity to hormone fluctuations, not the hormones themselves. Putting two and two together is what led me to this thought process, that it is part of the sensory systems and a processing disorder that causes a severe response, or meltdown, to our hormonal cycle. Obviously, not every woman who experiences PMDD or PME or other menstrual related disorders is autistic or has a sensory processing disorder; however, many are highly sensitive, both physically and emotionally. 

Sources

Heffron, C. (2017, February 27). What is Interoception. Retrieved from The Inspired Treehouse: https://theinspiredtreehouse.com/what-is-interoception/

Hugo D Critchley, S. N. (2017, October). Interoception and emotion. Retrieved from Science Direct: https://www.sciencedirect.com/science/article/pii/S2352250X17300106

Jamil Zaki, J. I. (2012, 05 12). Overlapping acitivity in anterior insula during interoception and emotional experience. Retrieved from Science Direct: https://www.sciencedirect.com/science/article/pii/S1053811912005009