The role of emotion dysregulation and rumination in predicting premenstrual symptom severity in premenstrual disorders and elevated anxiety or depression

Abstract

Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS) are prevalent and cause significant distress, yet their psychological mechanisms remain poorly understood. Previous research has linked emotion dysregulation with premenstrual symptoms, but it has often relied on retrospective self-reports, which are prone to bias, and rarely compared PMDD with the milder PMS. Additionally, past studies have not differentiated the heightened emotion dysregulation seen in PMDD from that typically observed in other affective conditions. To address these gaps, we examined the association between emotion dysregulation and premenstrual symptoms in a sample of menstruating individuals meeting criteria for provisional PMDD (N = 39), PMS (N = 160), elevated depression or anxiety (DEPANX; N = 88), and controls (N = 172). All participants completed questionnaires on premenstrual symptom severity and trait global emotion dysregulation, rumination, reappraisal, and suppression. A subset of participants completed a sad mood induction task (PMDD/PMS combined: N = 104; DEPANX: N = 54; Control: N = 161) and reported in vivo use of emotion regulation strategies. Compared to controls, all groups reported greater in vivo and trait rumination, higher trait emotion dysregulation, and lower trait reappraisal. The PMDD group endorsed greater rumination and emotion dysregulation than both the PMS and DEPANX groups. Greater trait emotion dysregulation and rumination predicted higher premenstrual symptom severity across groups. Rumination was the strongest predictor of premenstrual symptom severity between groups, compared to other emotion dysregulation measures. These findings raise the possibility that emotion dysregulation, particularly rumination, plays a role in the aetiology and/or maintenance of impairing premenstrual symptoms, although longitudinal research is needed to further explore these relationships.