2026 ECNP Congress

PS02-2070

Psychiatric correlates of prospectively confirmed premenstrual dysphoric disorder in individuals assigned female at birth with early-life trauma

Deniz Bengi — K. Dikaios, L.F. Ramos-Lima, B.N. Frey · McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton- Ontario, Canada

2026 ECNP Congress

Early-life trauma (ELT) is a well-established risk factor for affective and trauma-related disorders [1]. Emerging evidence suggests that ELT may also contribute to hormone-related mood vulnerability, yet the underlying mechanisms remain poorly understood. Some individuals assigned female at birth (AFAB) in the reproductive and perimenopausal phases show heightened sensitivity to physiological hormonal fluctuations, which can contribute to premenstrual dysphoric disorder (PMDD) or perimenopausal mood disturbances. Moreover, a recent systematic review and meta-analysis found consistently high comorbidity rates between PMDD/premenstrual syndrome (PMS) and mood disorders, reaching almost 50% across different sampling strategies [2]. Despite growing evidence linking ELT, affective disorders, and hormonal sensitivity, the relationships among them remain underexplored. This preliminary analysis explores the relationship between prospectively confirmed PMDD and a range of affective and trauma-related disorders in AFAB individuals with ELT.

The Effects of Early-life trauma on Complex Post-traumatic stress disorder and Hormonal Sensitivity (ECHOS) study enrols pre- and peri-menopausal individuals aged 16 and older with a history of childhood trauma. Such experiences may include emotional, physical, or sexual abuse, or emotional or physical neglect. Psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-5 (SCID-5) and the International Trauma Questionnaire (ITQ). Trauma history and emotion regulation were measured using the Childhood Trauma Questionnaire (CTQ), the Life Events Checklist for DSM-5 (LEC-5), and the Difficulties in Emotion Regulation Scale (DERS). Premenstrual symptoms were assessed through prospective daily tracking using the McMaster Premenstrual and Mood Symptoms Scale (MAC-PMSS), a DSM-5-based measure for prospective monitoring of premenstrual symptoms [3]. Eligible menstrual cycles required at least 7 consecutive days of symptom tracking before and after menstrual bleeding, consistent with DSM-5-TR criteria requiring prospective confirmation across two menstrual cycles. Firth’s penalised logistic regression examined associations between confirmed PMDD and psychiatric diagnoses, including mood, anxiety, and trauma-related disorders.

Of 51 participants enrolled (42 premenopausal, 9 perimenopausal), 16 had two or more evaluable cycles. Among this subsample, 5 met DSM-5-TR criteria for confirmed PMDD. Agoraphobia was significantly associated with confirmed PMDD (OR=32.20, 95% CI: 2.17–4918.67, p=0.009, likelihood ratio test). Bipolar disorder (BD) was also significantly associated with confirmed PMDD (OR=16.43, 95% CI: 1.02–2493.21, p=0.048, likelihood ratio test). No significant associations were found for major depressive disorder, persistent depressive disorder, post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), generalised anxiety disorder (GAD), or any of the other anxiety disorders measured within SCID-5 module F.

These preliminary findings suggest that agoraphobia and BD may be associated with prospectively confirmed PMDD in trauma-exposed AFAB individuals. These associations align with emerging evidence linking ELT, affective disorders, and heightened risk of premenstrual disorders [2,4]. The small sample size and wide confidence intervals warrant cautious interpretation, and replication with larger samples is needed. As the ECHOS study progresses, biological markers — including allopregnanolone, C-reactive protein (CRP), and stress-related gene expression — will be incorporated to clarify the mechanisms underlying these associations and support the development of targeted interventions tailored to this population.

References

  1. Tonon, A.C., Ramos-Lima, L.F., Kuhathasan, N., Frey, B.N., 2024. Early life trauma, emotion dysregulation and hormonal sensitivity across female reproductive life events. Curr. Psychiatry Rep. 26 (10), 530–542.
  2. Bengi, D., Strawbridge, R., Drorian, M., Juruena, M.F., Young, A., Frey, B.N., Yalin, N., 2025. A systematic review and meta-analysis on the comorbidity of premenstrual dysphoric disorder or premenstrual syndrome with mood disorders: prevalence, clinical and neurobiological correlates. Br. J. Psychiatry, 1–14.
  3. Frey, B.N., Allega, O.R., Eltayebani, M., Syan, S.K., Mendes-Ribeiro, J., Minuzzi, L., 2022. A DSM-5-based tool to monitor concurrent mood and premenstrual symptoms: the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS). BMC Women’s Health 22, 96.
  4. Standeven, L.R., Bajaj, M., McEvoy, K., et al., 2024. The link between childhood traumatic events and the continuum of premenstrual disorders. Front. Psychiatry 15, 1443352.