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Biological Correlates of Abuse in Women with Premenstrual Dysphoric Disorder and Healthy Controls

From the Departments of Psychiatry (S.S.G., J.L., P.A.S., C.A.P., K.C.L.), Cardiology (A.L.H.), and Dentistry (N.L.C.), University of North Carolina at Chapel Hill and Psychiatry (A.S.), Duke University Medical Center, Durham, North Carolina.

Address reprint requests to: Susan S. Girdler, Ph.D., CB #7175, Medical Research Bldg. A, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175. Email: susan_girdler{at}med.unc.edu

OBJECTIVE: To examine the biological correlates associated with histories of sexual or physical abuse in women meeting DSM criteria for premenstrual dysphoric disorder (PMDD) and in healthy, non-PMDD controls.

METHODS: Twenty-eight women with prospectively confirmed PMDD were compared with 28 non-PMDD women for cardiovascular and neuroendocrine measures at rest and in response to mental stressors, and for ß-adrenergic receptor responsivity, during both the follicular and luteal phase of the menstrual cycle. Structured interview was used to assess psychiatric history and prior sexual and physical abuse experiences. All subjects were free of current psychiatric comorbidity and medication use.

RESULTS: More PMDD women had prior sexual and physical abuse experiences than controls (20 vs. 10, respectively). Relative to nonabused PMDD women, PMDD women with prior abuse (sexual or physical) exhibited significantly lower resting norepinephrine (NE) levels and significantly greater ß1- and ß2-adrenoceptor responsivity and greater luteal phase NE reactivity to mental stress. For non-PMDD control women, abuse was associated with blunted cortisol, cardiac output, and heart rate reactivity to mental stress relative to nonabused controls.

CONCLUSIONS: The results of this initial study suggest that a history of prior abuse is associated with alterations in physiological reactivity to subsequent mental stress in women, but that the biological correlates of abuse may be different for PMDD vs. non-PMDD women.

Key Words: premenstrual dysphoric disorder, • abuse, • stress, • norepinephrine, • cortisol.

Abbreviations: BMI = body mass index;; CO = cardiac output;; DBP = diastolic blood pressure;; HPA = hypothalamic-pituitary-adrenal;; HR = heart rate;; MAP = mean arterial pressure;; PMDD = premenstrual dysphoric disorder;; SCID = structured clinical interview;; SBP = systolic blood pressure;; SV = stroke volume;; TPR = total peripheral resistance.

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