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Evaluation

Category: Women's Health

Symposium 6 - Considering the Role of the Menstrual Cycle in Time-Varying Psychological Processes and Symptoms: Applications for Research and Clinical Practice

Friday, November 17, 2023
8:30 AM – 10:00 AM PST
Location: Tahuya (508), Level 5
CE: 1.5

Keywords: Women's Health, Suicide, DBT (Dialectical Behavior Therapy)
Level of Familiarity: All
Recommended Readings: Owens, S. A., & Eisenlohr-Moul, T. (2018). Suicide risk and the menstrual cycle: a review of candidate RDoC mechanisms. Current psychiatry reports, 20(11), 106.,   Nolan, L. N., & Hughes, L. (2022). Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies. Archives of women's mental health , 25(5), 831–852. https://doi.org/10.1007/s00737-022-01246-4,   Schiller, C. E., Johnson, S. L., Abate, A. C., Schmidt, P. J., & Rubinow, D. R. (2016). Reproductive steroid regulation of mood and behavior. Comprehensive Physiology, 6(3), 1135.,   Epperson, C. N., Steiner, M., Hartlage, S. A., Eriksson, E., Schmidt, P. J., Jones, I., & Yonkers, K. A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465-475.,  

People assigned female at birth (AFAB) demonstrate elevated risk for affective disorders, with twice the risk of depression (Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993) and three times the risk of suicide attempt (Kessler et al., 1999). Ovarian hormone fluctuations likely play a role in these sex differences (e.g., Owens & Eisenlohr-Moul, 2018). A significant minority of menstruating individuals demonstrate neurobiological sensitivity to normal hormone changes that occur across the monthly reproductive cycle, which results in perimenstrual changes in depression, anhedonia, worthlessness/guilt, irritability and anger, anxiety, and rejection sensitivity (Hartlage et al., 2004; Pearlstein et al., 2005; Epperson et al., 2012; Eisenlohr-Moul et al., 2018). Despite growing evidence of the menstrual cycle’s salience in psychopathology, scientists and clinicians generally fail to consider the menstrual cycle when studying within-person changes in basic processes and symptoms, and when designing treatments and delivering interventions. As a result, existing clinical interventions are likely limited by their failure to address a potentially critical source of symptom variability. This symposium aims to advance clinical researchers’ and practitioners’ understanding of menstrual cycle effects, while relying on gold-standard assessments of cycle phases (i.e., menses onset counting and urine luteinizing hormone testing).

 

First, Dr. Elizabeth Mulligan will present an investigation of normative cyclical changes in EEG markers associated with positive and negative valence systems (Event-related Potentials; ERPs) among healthy individuals. This work will begin to explain how the menstrual cycle impacts variability in basic neurobiological systems that underly psychopathology, thus deepening the field’s understanding of mechanisms of change in psychiatric symptoms among AFAB individuals.

 

Two studies will be presented examining the role of the menstrual cycle in suicidal thoughts and behaviors. Hafsah Tauseef, a clinical doctoral student, will present data investigating the unique association of suicide attempt history with premenstrual mood changes, over and above associations with depression and suicidal ideation. Dr. Jaclyn Ross will present work that 1) examines menstrual cycle effects on variability in suicidality and established symptom correlates and 2) tests how daily fluctuations in symptoms mediate the menstrual cycle-suicidality relationship.

 

Dr. Jessica Peters will present work investigating the role of the menstrual cycle in symptom lability among individuals with Borderline Personality Disorder. Dr. Peters will also discuss the implications of these findings for effectively delivering evidence-based assessment and interventions (i.e., Dialectical Behavior Therapy).

 

Finally, Dr. Michelle Martel, an expert on menstrual cycle effects on variability in psychiatric symptoms, particularly externalizing disorders, will discuss the findings presented in the context of research on the menstrual cycle more broadly and as it relates to clinical practice with individuals with difficulties with affective disorders and suicide/self-harming behavior.

Learning Objectives:

At the end of the session, the learner will be able to:
  • Present data demonstrating effects of the menstrual cycle on basic neurobiological processes and psychiatric symptoms.
  • Discuss hormone sensitivity as a transdiagnostic risk factor for psychopathology and suicidality.
  • Discuss premenstrual exacerbation of emotional, interpersonal, and behavioral symptoms as a within-person predictor of imminent suicide risk.
  • Describe methods for enhancing assessment and case conceptualization in clinical practice by accounting for the role of the menstrual cycle.
  • Describe methods for clinicians to integrate knowledge of the menstrual cycle into evidence-based DBT practice.