Understanding premenstrual dysphoric disorder from a psychosomatic and a sensory perspective.

Aim: This mini-review aims to develop a multidimensional framework for Premenstrual Dysphoric Disorder (PMDD) that integrates the role of traumatic experiences, interoceptive awareness, and sensory processing sensitivity (SPS) in symptom development and maintenance.

Background: PMDD is a complex disorder traditionally viewed through hormonal and mood-based lenses, but research shows that many women with PMDD experience significant emotional and physical symptoms that remain unexplained by these factors alone. Early-life trauma and interpersonal trauma may sensitize neural circuits, exacerbating symptom expression during hormonally sensitive periods.

Method: A narrative synthesis of existing literature was conducted, focusing on the impact of trauma (particularly early-life and interpersonal trauma) on the hypothalamic-pituitary-adrenal (HPA) axis, sensory processing, and interoceptive awareness. The neurobiological interplay between these factors and hormonal fluctuations was examined.

Results: Trauma-related dysregulation of neural circuits-including the amygdala, insula, and prefrontal cortex-heightens vulnerability to premenstrual distress by disrupting sensory and emotional processing. Heightened sensory processing and altered interoceptive awareness further amplify symptom severity during the luteal phase.

Conclusion: This trauma-informed sensory framework extends current understandings of PMDD beyond hormonal and mood-based models, highlighting the importance of assessing trauma history and sensory reactivity in clinical practice. Incorporating these factors may improve diagnostic accuracy and treatment outcomes.