Earlier this week I reported from the Women’s Health Forum, held on Monday for the sixth year running. The hardest part about attending the event was deciding which among all the interesting talks to attend.
Among the many sessions, the two that most piqued my interest focused on women's mental health. Katherine (Ellie) Williams, MD, spoke about mood disorders related to the menstrual cycle, and Laraine Zappert, PhD, discussed the psychological impact of sexual assault. Both are from the school's Department of Psychiatry and Behavioral Sciences.
Williams' talk began with a cartoon of a dishwasher bursting with dishes, clothes, a phone, a vacuum - above a caption quip about PMS. The out-of-control energy of the sketch conveys the affective thundercloud often associated with women and their "hormones." Williams identified three periods when this thundercloud may be an actual mood disorder, as opposed to "normal" fluctuations: pre-menstrual, perinatal, and perimenopausal.
Technically speaking, "PMS" is about physical symptoms and is fairly common, whereas pre-menstrual dysphoric disorders (PMDDs) is all about mood and affects less than 5 percent of women. The disruption happens in the luteal phase of a woman's cycle, usually the two weeks after ovulation - this is a big chunk of time we're talking about, nearly 50 percent! Treatments for disorders in all periods include exercise, acupuncture, and diet supplements, and pharmaceuticals like certain birth control pills and antidepressants (which interestingly work differently for women with PMDD than for people in general - when taken only during that luteal phase, they have fast onset time and cause no withdrawal symptoms).
Researchers are learning more about how to predict and prevent cycle-related mood disorders, and increasingly it is clear that life context plays a major role. Stressful life events, interpersonal conflicts, marital tension, and previous mental-health instabilities (from being a perfectionist to having suffered childhood abuse or major depressive breakdowns) are the primary risk factors. This knowledge means clinical practitioners have to think much more broadly about how to help women, particularly in terms of prevention, Williams said.
Zappert was a passionate speaker on the topic of sexual assault, which takes place across the entire spectrum of women's lives. She paid particular attention to college campuses, which have recently come to light as problem spots. Most sexual violence is committed by someone the victim knows, which is what makes it so psychologically damaging: The victim's sense of safety and trust is seriously undermined. It is also the only crime were victims are blamed, and the shame and guilt can be devastating. This leads to high levels of under-reporting, which stands in the way of getting help and treatment (not to mention persecuting rapists). The closer the relationship between offender and victim, the greater the likelihood authorities will not be told.
A disproportionate share of sexual violence happens to women, with an acute risk between the ages of 12 and 18, the time when one's adult sense of self is formed. Additionally, Zappert notes that there is a "strong dose relationship" between early adverse experiences, health risk factors, and serious adult illnesses. For example, the stress of coping with trauma in youth can lead to smoking or overeating, which can in turn lead to cardiovascular disease and diabetes. Complications in pregnancy occur at higher rates among those with a history of abuse. It is crucial that we recognize etiology of illness, said Zappert, and think about where preventative action must really take place.
"Yes means yes" campaigns at campuses across the U.S. are shedding light on sexual assault and the need for real consent (an affirmative verbal agreement about what is going to happen). Rape is the most common violent crime on campuses, and college women are more at risk for sexual assault than women the same age who are not in college. Zappert discussed "rape culture" and the normalization of gender-based abuse, and drinking culture (alcohol is by far the major drug associated with sexual assault), but emphasized that these are contexts, not causes. The only thing that causes rape are rapists.
Previously: Exploring links between domestic violence, depression and reproductive health, "2020 Mom Project" promotes awareness of perinatal mood disorders, When hormonal issues interfere with mental health, Some good, some bad in the state of women's health and Why are women more likely to need mental health help?
Photo by James Jordan