This study investigated fluctuations in anxiety and menstrual distress across the menstrual cycle. Female college students (N = 318) completed self-report measures of symptoms across the menstrual cycle and measures of general psychological adjustment. A subgroup (n = 56) of Anxious participants who reported high levels of anxiety was identified. Results indicated that anxiety and menstrual symptoms were equally severe during premenstrual and menstrual phases and then dropped off during the remaining two phases. Twenty-five of the 56 Anxious subjects met PMS criteria and also reported high anxiety, whereas 31 Anxious subjects reported high levels of anxiety without PMS. These results suggest that some women, and possibly practitioners, may mislabels fluctuations in anxiety as PMS. The findings also suggest a need to attend to the entire menstrual cycle in the assessment of anxiety in women.
There has been an increase in research and clinical attention to menstrually related symptoms in women during the past decade (e.g., Halbreich et al., 1993). However, this interest in psychological problems related to the female reproductive cycle has been limited to the premenstrual phase of the menstrual cycle and to distress prior to the onset of menstruation, popularly known as "PMS". Yet, some of the extant literature, as well as our clinical experience, suggest that many of these menstrually related symptoms may be more than PMS and actually be manifestations of underlying anxiety.
Exacerbations of both medical illnesses and psychiatric disorders during the premenstrual phase have been widely reported (e.g., Endicott, Halbreich, Schacht, & Nee, 1981; Stein, Schmidt, Rubinow, & Uhde, 1989; Stanton & Gallant, 1995) and are also discussed extensively in the appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (4th ed., revised; American Psychiatric Association, 1994) under the diagnostic category of Premenstrual Dysphoric Disorder (PDD). However, systematic research on fluctuations of psychological symptoms over the entire menstrual cycle has been limited. For example, recent reviews on women's health and the reproductive cycle (Gallant & Derry, 1995; Johnson, 1995) focus primarily on PMS and, to a lesser extent, on affective disorders. A few studies have investigated anxiety and anxiety disorders within the context of the menstrual cycle, mostly emphasizing the premenstrual phase. Some of these (e.g., Cook et al., 1990; McLeod, Hoehn-Saric, Foster, & Hipsley, 1993; Veeninga, Ruiter, & Kraaimaat, 1994; Gallant & Derry, 1995) reported a premenstrual magnification of anxiety symptoms in women with diagnosed anxiety disorders (such as panic disorder). In a separate line of study, McLeod et al. (1993) reported that assessment of anxiety symptoms in women who received both the diagnosis of generalized anxiety disorder and PMS may be complicated by cyclical fluctuations of symptom severity. Finally, Halbreich (1993) and Hamilton and Gallant (1993) reported that many women experience menses at least as distressing as the premenstrual phase, suggesting that examination of more than the premenstrual phase is needed.
A series of studies by Sigmon and her colleagues (e.g., Sigmon, Fink, Rohan & Hotovy, 1996; Sigmon, Dorhofer, Rohan & Boulard, 2000; Sigmon et al., 2000; Sigmon, Rohan, Boulard, Dorhofer & Whitcomb, 2000; Dorhofer & Sigmon, 2002) examined fluctuations across the entire menstrual cycle by assessing coping and anxiety experiences in university women. Their findings included that subjects with high anxiety sensitivity, as well as those diagnosed with panic disorder, were more likely to report distress and use maladaptive coping strategies. Furthermore, young women with asthma and those with panic disorder exhibited symptom fluctuations across the cycle.
As the above research indicates, the extent and magnitude of fluctuations in anxiety and menstrual distress across the entire cycle has been examined in clinical populations, including those with diagnosed with PMS, generalized anxiety disorder, and panic disorder, etc. …