How to tell someone their behavior is hurtful and also mention PMDD
May 14, 2020 2:33 PM   Subscribe

I'm tired, exhausted really, of this, seemingly eternal, spiral of behavior that includes regular and predictable symptoms that absolutely meet those outlined by DSM-V PMDD diagnosis criteria. What is the best way to bring that up in a sensitive and effective fashion to someone who is perhaps less than receptive and is also intensely self depreciating, not just during the impacted timeframe but also in general?

I don't know. I'm tired.

I tend to be a overly non-emotional, sometimes to a fault, individual and this is just something that is so foreign to me that I know when I'm out of my depth but the extremes have to level out or... I don't even know what. This person has made improvements in mental well being of late and I don't want that to go unrecognized, and I bring it up as frequently as I can when mentioning positive things, but this aspect continues to be a very large stumbling block. Current coping mechanisms are limited to me swallowing all emotions, even when met with what I call very confusing/conflicting behavior, and giving space for the person to, at best, suffer alone or, at worst, slowly come down from the place of raging emotions (usually anger or insecurity to the tenth power).

Also please note that this PMDD talk isn't coming from a place of ignorance. A close mutual friend of many years who is a licensed professional in the mental health field said it's a really clear case of such.

I'm tired.

Also this is revealing enough, please forgive me for posting this anonymously and will ask your permission to reply to any of your direct questions or pointed replies via memail rather than lay more of this out into the open, well more than I already have anyway. I hesitated to utilize anonymous because it does feel unfair and I hope the answers given will give me the benefit of the doubt that I'm not being a misogynistic, kneejerk asshole here. Maybe I'm making a misstep.
posted by anonymous to Health & Fitness (23 answers total)
To address the self-deprecation part of your question, what works well for me is to straight-forwardly explain that people belittling people isn't something I want to be around - not even as self-deprecation. Sometimes I have to repeat myself a few times for it to sink in.
posted by aniola at 2:46 PM on May 14, 2020 [4 favorites]

So, no matter how certain you are that someone you care about has a DSM diagnosis, it is definitely an overstep to tell them “I think you have X.” I have actually done this once (with my sister), and in retrospect, it was absolutely wrong of me to express my concerns in that way (and it went over like a lead balloon, which is reasonable).

What you can do, at a time when you are both calm, is to bring up the behavior that is affecting you, explain how it makes you feel, express your concern for their wellbeing, and set up boundaries for how you will respond to the behavior. And then give space for them to talk.

They may make no changes, but you will have said, for example, “When you yell, I’m going to go into another room until you have calmed down.” And then it’s up to you to enforce your boundary.
posted by ocherdraco at 2:58 PM on May 14, 2020 [24 favorites]

It's hard to advise you when you don't clarify the relationship. Is this a partner you live with? Someone you're dating? Co-worker? Close relative? The relationship really determines the response.

I would not offer anyone a clinical diagnosis unless I was actually qualified and directly asked to provide one. No matter how sure you are and who confirmed it, it's unlikely that your "diagnosis" will be received in the manner intended or have the desired effect.

I would not focus that much on telling this person how their behavior makes you feel. It doesn't sound like they have much capacity or maybe willingness to alter their behavior even if they know it's upsetting you.

I would focus on setting boundaries of what you will accept and sticking to them. You are under no (or little, again depending on the relationship) obligation to tolerate disrespectful actions, listen to endless complaints, rude/racist/demeaning language. When someone tries to engage you while doing these things stop and respectfully remove yourself from the situation.

"I appreciate what you're saying/how you feel, but I cannot talk about this now/in this manner..." then politely hang-up, leave, change the subject.

Now if this is a roommate situation, then work on finding new living arrangement. Relationship therapy or time to move on. Work, possibly HR, transfer, or new job.
posted by brookeb at 3:01 PM on May 14, 2020 [3 favorites]

A close mutual friend of many years who is a licensed professional in the mental health field said it's a really clear case of such.

It really doesn't matter. You are not a mental health professional, and it is not your place to try and play one and diagnose those around you. And while your mutual friend may have the same belief, they would likely also acknowledge that they have not assessed the person as their profession expects of them before making and delivering a mental health diagnosis.
posted by NotMyselfRightNow at 3:04 PM on May 14, 2020 [17 favorites]

Is this a partner or a close family member?

I think I'd separate these into two different conversations. Honestly if the close mutual friend is that close, maybe they could have the PMDD conversation. But it's not really appropriate to provide a diagnosis - something more like "You seem to be having a hard time, specifically (high-level observations). Have you considered talking to your doctor?" Obviously this varies based on the relationship, but the key thing is to keep it simple and convey your compassion and support. And preferably to have the conversation when the other person is calm and not in the middle of a spiral.

The other is less a single conversation and more about setting boundaries: deciding what you will and won't do and being consistent over time. Honestly that's something I would discuss with a therapist with whom you can share your own background and the details of the relationship.
posted by bunderful at 3:10 PM on May 14, 2020

You should not tell them you think they have PMDD or any other specific diagnosis, and you *definitely* should not say “our mutual friend thinks you have X.”

You have every right to talk about how their behavior is affecting you, and to set and enforce boundaries in refusing to interact with them. Depending on how that goes you may be able to say that you know sometimes medical issues can underlie some kinds of behavior, and encourage them to see a professional. But start with your own boundaries and responses, and see how that goes. If they’re receptive, great; if not, asking them to get help may actually make them dig in their heels and not do it. You’ll have to judge that on the fly.

I see you’ve tagged this “spouse” and so I think you have standing to push for couples therapy. Perhaps that could be a wedge in the door toward individual treatment, and even if not, it could be helpful to have a third party guide you through the boundaries discussions.
posted by Stacey at 3:13 PM on May 14, 2020 [3 favorites]

The reason why you are setting boundaries doesn't matter as much as the fact that you are setting a boundary. You can set boundaries in the moment, as they happen, and you don't need to have a big discussion about it (in fact, it's usually best to not). Captain Awkward has lots of good advice about setting boundaries if you need scripts or language. Be generous and redirect while setting the boundaries you need.

I do think you should ask yourself why it's important for you that this behavior stems from PMDD. Sometimes, especially with gendered interpersonal communication, it's easier to blame a diagnosis than it is for people to sit with or witness women's emotional truth, especially anger. Something to think about.
posted by stellaluna at 3:15 PM on May 14, 2020 [21 favorites]

You can't diagnose people without the proper credentials.
A person with the proper credentials cannot diagnose remotely or 2nd-hand or without being asked, for the most part.
You can't fix other people; you can only use your own behavior to elicit a response and to define boundaries that protect you.

Friend, this is hard to discuss because it's a sensitive topic, and I might come off as judge-y and/or jerk-ish, which is not my intent. Sometimes your behavior is Example of Irritable, Example of Very Sensitive, Example of Other Stuff. It's difficult for me to be around when that's happening, because Define Reasons. It seems like it's correlated with your periods. Have you ever considered pursuing medical care for that? Is there a way can help you with this? I believe you might be able to feel better. Various honest expressions of appropriate love, affection, support.

You can choose not to be around someone who is hair-trigger emotional, irritable, whatever, or to develop useful coping strategies. On re-read, I realize I glossed over the part where you describe the behavior as hurtful. You deserve respect and support, too.
posted by theora55 at 3:21 PM on May 14, 2020 [3 favorites]

It seems like it's correlated with your periods.

I honestly think this would send me into a rage in itself, PMDD or not. There’s something intensely personal and hurtful about suggesting a woman‘s emotions or behaviour are in thrall to unstoppable hormonal forces* and I’m not sure bringing it up that way is going to help anything. I mean, if it is, she very likely knows already at some level, even if she doesn’t want to discuss it. I’d go with one of the other suggestions above, around boundary setting, or at most, a more general suggestion that she seems to be having a hard time and there can sometimes be medical causes, maybe a check-up is in order.

*That’s not to say it’s never the case, but having other people draw that conclusion about you can feel incredibly demeaning.
posted by penguin pie at 3:43 PM on May 14, 2020 [29 favorites]

Generically, you can do two things:

- You can set and enforce boundaries. That can be really hard when the problem is behavior you just don't want to be around, especially if it's in your home. It may mean you need to reconsider the living arrangement. If you intend to communicate this boundary to this person, I'd suggest doing it when they're generally on the up side of the cycle you have observed.

- You can tell someone once, assuming you're willing to piss them off because you think it's important enough that someone say it out loud, that you think they have a medical problem and should see a doctor. If they don't agree, there's not much you can do.

You can certainly say, "I can't continue to live with the extraordinary lows you are regularly going through unless there's some kind of ongoing attempt to figure out/manage them. To my observation, it seems to come and go very distinctly and I wonder if you have discussed this with a GP in case it is a medical issue. I am worried about you, and I am worried about me, and this is reaching a point of unsustainability so something needs to happen."

Unfortunately, diagnoses like PMDD get super weaponized in anti-treatment ways and you're better off approaching the doctor like "is this diabetes??" than "please ignore everything I say and put me on the pill."

This person may decide they don't want to talk to a doctor. If so, you'll need to figure out what you're going to do next.
posted by Lyn Never at 3:49 PM on May 14, 2020 [4 favorites]

I am so sorry, that sounds awful.

I suffered from PMDD for years & years. It took me an astonishingly long time to recognize it and even longer to get treatment.

My symptoms got worse & worse to where I became nearly psychotic every month & my spouse & I spent a week getting over the trauma. So that's 2 hell weeks per month.

It pains me to say but I was abusive towards my spouse every single time. I had a reason/excuse I guess but I abused him.

Regardless of his love & patience towards me I still had a responsibility to acknowledge the affects of my condition and to get better. My health issues were destroying our marriage & endangering my life.

I guess what I am trying to say is that maybe you need to put aside the PMDD part and be very frank about how the behavior hurts you and is eroding the relationship. It must be discussed after every time it happens IMO. If they aren't compelled to look back after the upheaval & trauma (whatever caused it) and see how it hurts you and your partnership then the problem is bigger than PMDD.

Take care of yourself, friend.
posted by i_mean_come_on_now at 4:13 PM on May 14, 2020 [13 favorites]

Regardless of his love & patience towards me I still had a responsibility to acknowledge the effects of my condition and to get better.

This is an absolutely essential point. It's pretty difficult to talk to a person about health concerns that are impacting you generally, especially mental health concerns. However, even if there is a reason that explains it doesn't mean that is not that person's responsibility to acknowledge and work on it (i_mean_come_on_now, I am glad you are doing better that must have been scary). If this is a partner or unavoidable family member, then you can discuss the behavior as a thing that needs addressing. Leave PMDD out of it unless you both come to a place where they're actively asking "What could explain this?" I concur with what everyone else has said regarding this.

Also, you have knowledge that can help here also. If you suspect this is cyclical behavior that is a real problem, you can also adjust somewhat during these times until the two of you can get to a better place, whether this means leaving the house, adjusting expectations or what.

However, unless this is a situation in which children are involved (in which case, I think it's your responsibility to push harder to advocate for them) people need to come to their own decisions about their own health in their own time.However boundary setting by you, as many have outlines above, can be part of a series of steps that might make that happen.
posted by jessamyn at 4:19 PM on May 14, 2020 [2 favorites]

Soooo, I'm a psychiatrist, I have nothing to do with you or anyone in this question or anyone in this thread or anyone anywhere.

Before I continue: do not diagnose her. Don't have your friend diagnose her. We don't diagnose on the internet or over the phone, and sometimes I don't make final diagnosis until I have seen and treated a person for several months and truly understand what is going on. Psychiatric diagnoses have historically been weaponized against women, minorities, and other vulnerable populations. Please don't be part of that problem.

Now for more stuff:

I see and treat PMDD often, and it's very gratifying to treat b/c with the right meds and therapy women often get better, and their life changes enormously for the better. I feel like my response is going to piss off other people who have commented in this thread (some weird anti-psychiatry vibes going on), but PMDD is real and there's a ton of research into it and it's biological underpinnings. (Also, I'm a woman in case that pisses people off less??) As far as I'm concerned, it's a medical illness.

Many of the women I see who present with PMDD-like symptoms aren't aware that it's correlated with their cycles until I bring it up and they track mood with cycle for a few months. Other times, women present because a close family member or partner has told them that their symptoms (intense irritability, mood lability, etc) are affecting the relationship. This is often a wake-up call, as women with PMDD do not WANT to destroy relationships with loved ones over and over (and I have seen relationships end over untreated PMDD). Sometimes that family member or partner mentions to them it seems like it correlates with their cycle (if they are privy to that information). So then the woman comes to me, we talk about symptoms, think about what's going on, and come up with a plan, and monitor and treat over a long period of time. Just like you would with any doctor.

So--I feel like you can just do that? And she can follow up on that information now, later, or never.

If you noticed your partner perhaps had symptoms of a "medical" illness (as though the brain is not medical! but society is still in the dark ages when it comes to psychiatric illness), are you supposed to just keep your mouth shut about the symptoms for fear of offense or perpetuating stigmas? Or would you be like, Hey, I noticed you have this weird rash on your back, maybe you should see your doctor?

As far as I'm concerned, this is like that; I don't have time or patience for people who think otherwise.
posted by namemeansgazelle at 4:25 PM on May 14, 2020 [28 favorites]

I'm self-deprecating (getting better and more rare these days) and I diagnosed myself with PMDD. I was aware of my mood around this time of the month. I was definitely erratic, depressed, unhappy, and unpleasant to be around. My spouse had boundaries and limits and when he spoke up it made me more aware of my behavior.

Don't be afraid to speak up constructively and kindly and matter-of-factly. Depression and irritability will happen but it doesn't mean you should be the target of that irritability.

I wouldn't mention menstruation or PMDD. I would only state how behavior is not appropriate or hurtful. And yes, also give space and ignore when you can.
posted by loveandhappiness at 4:34 PM on May 14, 2020

It's DSM 5, not DSM V. Seems like a small thing, but just really important to emphasize that using this diagnostic tool is not your job. To appropriately diagnose PMDD takes a minimum of two months of daily testing. It's not generally immediately observable to people in a person's environment, and most people who think they have it, don't. It's reasonable to tell someone close to you about behavior they engage in and how it affects you, and even to ask for change. Making psychiatric diagnoses for a loved one -- or soliciting them from uninvolved parties behind that loved one's back -- isn't appropriate, and isn't likely to lead to an accurate diagnosis, either.
posted by shadygrove at 4:51 PM on May 14, 2020 [2 favorites]

I have PMDD and know it has affected relationships in the past, so I sympathize, but I agree with the vast majority of comments here that the important thing is to set boundaries, pronto. It’s not up to you to get this person a diagnosis. The only thing you can control is your actions — and if you are shutting down your emotions to deal with this person, the person who needs your help is you.

The PMDD is beside the point. Even if this person got in tomorrow and asked and received medical assistance, it’s not a solution to the problem you’ve raised. There’s a person in your life whose anger and other intense emotions makes you feel like your life is ruled by them. Unfortunately, it is your responsibility to do the difficult work of setting boundaries. Be a broken record about what you need and the consequences, e.g. “Yelling at me isn’t okay, so I am going to go into the other room/hang up the phone/etc.” You can be supportive of someone who is suffering from a condition that makes emotions VERY intense and hard to deal with but that doesn’t mean it’s your job to diagnose, convince to treat, or resolve for this person.

You can totally bring up your suspicion that it’s PMDD — but PMDD isn’t a valid reason to walk on eggshells around someone. It sounds like you’re to the point of making an ultimatum about this person getting medical treatment or losing you. But treatment won’t completely negate the condition, speaking as someone who feels like their PMDD is well controlled. You’ve gotta set the framework for the respect and healthy way you want to be treated even on that person’s worst days. Doing that may help make it clear how serious the problem is, whether it’s PMDD or something else.

And I don’t say this lightly, but therapy for you and perhaps with this person in the future would probably be really helpful no matter what. I know this is a question written without the ability to add all the context, but from what you’ve written it sounds like your coping skills might not be serving you long term and you deserve support in that. (As a bonus it’s so awesome to have someone to practice boundary setting with in a safe environment.) I hope things improve!
posted by the thorn bushes have roses at 5:37 PM on May 14, 2020 [6 favorites]

I am not a therapist and I am definitely not your therapist. I think you should get a therapist. And now I'm going to tell you how therapy has helped me with hard conversations, and maybe this will motivate you to get therapy. I am not a mental health professional of any kind, and I am not recommending that you try the skill below without speaking to a therapist first. I use it to illustrate how therapy can help structure thoughts before the conversation.

The skills based therapy modality that I use as a patient (for trauma) is Dialectical Behavior Therapy. It is a skills based practice and I recommend it for you to find yourself a therapist. Every human might benefit from at least some of these skills. Many just aren't taught, and lots of people get the opposite message about how to have emotional lives.

There is an entire module on Interpersonal Skills, which is basically, conversations. And most of it is how to have potentially uncomfortable conversations.

You are asking how to request a thing and it is not clear which is your most important goal of these three, DBT suggests ranking each before approaching the conversation.
  • Maintaining the relationship/how the other person will feel about you after the conversation
  • Feeling good about yourself after the conversation
  • Achieving the outcome of your request being satisfied (or successfully denying the other person's request)
Every person will rank those three differently for different situations with different people in different circumstances. If you were going to bring this behavior up with your boss that might be a very different conversation than with a lover or a parent or a sibling.

Every person has their own barriers to successful conversations of this type. Being mindful of those barriers/obstacles can guide you. (History, environment, physical illness, temporary things, permanent things, there's information about this in a DBT context available as well.)

The DEAR MAN skill from DBT is very very helpful when getting something to happen or change is more important than maintaining the relationship. There are some videos and a worksheet online. Mindfulness is a module of DBT that really informs the use of DEAR MAN. Distress Tolerance is another module that really helps practice it easier to do.

The skill does not guarantee that you will get what you are asking for, in full or in part. The other person may simply not be able to provide what you ask for. It is not magic.

And then when you do have a difficult conversation, keep it factual in the first part (D). Do not theorize about why the behaviors happen. Do not make suggestions for how to accomplish the change. Just be very clear that there are behaviors that you want the person to stop or start, and keep it focused on those behaviors not the entire relationship or how other people see their behaviors. In the E section you can talk about how you feel, but be careful not to make disguised "you" statements or black and white assertions ("I feel like you don't care about me" feels like an accusation, or "I feel frustrated that I can't help because you never do what I suggest")
posted by bilabial at 7:52 PM on May 14, 2020 [3 favorites]

I think the diagnosis is a red herring. The real question you have to answer for yourself is

“the extremes have to level out or... I don't even know what”
You have to decide for yourself what you will do if she doesn’t change, or doesn’t change enough, etc. Would you leave, would you stick around and suffer and resent her, really think about how you want your life to look. Because no matter what you say or how you say it, you cannot change anyone’s behavior but your own.
posted by kapers at 10:19 PM on May 14, 2020

I think you're writing this question with a lot of pain and hurt, and I really wonder about some of the way you've phrased things here. Calling your partner or spouse or wife "this person" seems cold and distancing. You've also said this about yourself:
I tend to be a overly non-emotional, sometimes to a fault, individual

I wonder if you are realizing the impact of this distance on your partner? Could that be related to some of the strong emotions you are seeing expressed? I wonder if you are both stuck in a sick system. Does your partner escalate because it's the best way to get your attention? I could be totally off, but it seems like you've spent a lot of time trying to understand why your partner is behaving this way, and then how to solve the problem... but the focus needs to be on the behavior and how it's hurting you and your relationship. It's not your job to figure out the why. Abusive or cruel behavior isn't okay regardless of cause.

I have a dear friend, a man, who is a pretty logical, thoughtful guy. Sometimes his partner, a lovely woman, will experience extraordinarily strong emotions and can't talk about it, in part because he can be pretty unemotional and not understanding. So when she's down, it's even harder because she can't lean on her partner. Then he will start to wonder if she's "broken." But really what's going on is that he doesn't have great relationship skills in some cases, and that's exacerbating the situation.

Anyway, I think the best thing you can do right now is get into therapy yourself and suggest couples counseling for both of you. Good luck.
posted by bluedaisy at 11:09 PM on May 14, 2020 [7 favorites]

it's kind of wild how you haven't mentioned or described a single specific thing she does or says during these times. if you can't explain to us what happens that bothers you under the veil of anonymity, how exactly are you going to put it to her, when you talk to her? do you expect her to go buy a copy of the DSM to figure out what her objectionable behavior is, or will you just tell her in plain english what it is she does that you can't stand?

Current coping mechanisms are limited to me swallowing all emotions,

without any details, one might guess that this is what she herself does for three out of every four weeks. perhaps this is a clue as to why it is so bad, when whatever the badness is breaks out.

even when met with what I call very confusing/conflicting behavior, and giving space for the person to, at best, suffer alone or, at worst, slowly come down from the place of raging emotions (usually anger or insecurity to the tenth power).

leaving someone alone who's blatantly PMSing is a nice thing to do if it's regular and predictable. usually the sufferers appreciate being left alone at such times. Is this period of heightened emotion lasting for more than a day or two such that it's impossible or impractical to keep on letting her be? or does avoidance not work, does she come after you? again, details are necessary. if not for us, for her.

You say you are swallowing all emotion as a coping mechanism. I guess maybe it feels that way from your perspective. denial of all emotion is a pretty classic coping mechanism for all sorts of problems, but you should know that there are waves and waves of emotion coming off of this post. I believe you that she's got hormonally induced mood swings, though whether she wants to medically adjust them or not is impossible to say from here. I also think you are focusing on her emotions to distract attention from your own, and that is a bigger problem (for you) than any PMDD she does or doesn't have.
posted by queenofbithynia at 2:45 AM on May 15, 2020 [3 favorites]

I assume you are referring to an intimate partner since you are aware of her menstrual cycle. I disagree with the "do not dare mention it could be co-related with her cycle" advice above. This is valuable information that could help her.

I, a human female with a menstrual cycle (AND someone who's been on the receiving end of PMDD abuse by loved ones), am here to say that menstrual cycles are not something so sacred that you or any other person has to suffer from its devastating affects WHILE pretending it doesn't exist. It exists. It can seriously affect people's mental health. You can't work on a problem if you refuse to acknowledge it exists.

It's unfair to expect loved ones to walk on eggshells and sacrifice their own mental health to appease the beast that is (possibly) related to menstrual cycles.
posted by Neekee at 7:05 AM on May 15, 2020 [3 favorites]

receptivity to discussion of periods is an interesting question. some people really aren't receptive to hearing, let's say:

Honey, every month you get so miserable and even if it's natural and normal by some definition, it seems like you're suffering so much and maybe you don't need to. You probably think I don't care about this because I withdraw and pretend not to have any emotions whenever you're upset, but actually I care a great deal and that's why I do it. If you get extra angry because you can't seem to express your cyclical distress in any way that that gets any sympathy from me, you're not imagining things; that really is happening, and that's why.

but other people just aren't receptive to criticism and assumptions and are actually quite receptive to compassion. Does she deserve compassion? sure depends on what you both do, specifically, but I already went though all that.

Among the details you don't mention are whether she's on hormonal birth control, or whether she has been in the past and found it intolerable. the relevance of this cannot be overstated.
posted by queenofbithynia at 10:19 AM on May 15, 2020

you *definitely* should not say “our mutual friend thinks you have X.”

besides, without knowing them, we already know that this statement isn't true. A mutual friend wouldn't say that to one half of a couple-friendship unless they were willing it to say it to the other friend, to her face, in private and with sensitivity, not as part of an intervention ambush. because they care about her independently, not because her partner came and asked them to. Someone willing to speculate behind her back with her spouse about her menstrual cycles is not her friend, even if they were once. they're this anonymous poster's friend.

and if this woman is abusive, that's just as it should be. if she's abusive, sides should be taken. but the mutual friend angle is still clearly not true and is a sketchy way to tell it.
posted by queenofbithynia at 10:52 AM on May 15, 2020

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