Symptoms of premenstrual dysphoric disorder and cycle phase are associated with enhanced facial emotion detection: An online cross-sectional study
Abstract
Background: Premenstrual dysphoric disorder is a depressive disorder affecting 5%–8% of people with menstrual
cycles. Despite evidence that facial emotion detection is altered in depressive disorders, with enhanced detection of
negative emotions (negativity bias), minimal research exists on premenstrual dysphoric disorder.
Objectives: The goal of this study was to investigate the effect of premenstrual dysphoric disorder symptoms and the
premenstrual phase on accuracy and intensity at detection of facial emotions.
Design: Cross-sectional quasi-experimental design.
Method: The Facial Emotion Detection Task was administered to 72 individuals assigned female at birth with no
premenstrual dysphoric disorder (n=30), and provisional PMDD (n=42), based on a retrospective Diagnostic and
Statistical Manual of Mental Disorders—Fifth Edition-based measure of premenstrual dysphoric disorder. Facial emotion
detection was examined both irrespective of menstrual cycle phase, and as a function of premenstrual phase (yes, no).
The task used neutral-to-emotional facial expression morphs (15 images/morph). Participants indicated the emotion
detected for each image within the progressive intensity morph. For all six basic emotions (sad, angry, fearful, happy,
disgust, and surprise), two scores were calculated: accuracy of responses and the intensity within the morph at which
the correct emotion was first detected (image number).
Results: Individuals reporting moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and
earlier detection of disgust, regardless of cycle phase. In addition, those with provisional premenstrual dysphoric disorder
detected sad emotions earlier. A premenstrual dysphoric disorder group×cycle phase interaction also emerged:
individuals reporting premenstrual dysphoric disorder symptoms were more accurate at detecting facial emotions during
the premenstrual phase compared to the rest of the cycle, with a large effect size for sad emotions.
Conclusion: The findings suggest enhanced facial emotion processing in individuals reporting symptoms of premenstrual
dysphoric disorder, particularly for sadness and disgust. However, replication is required with larger samples and
prospective designs. This premenstrual dysphoric disorder premenstrual emotion detection advantage suggests an
adaptive cognitive mechanism in premenstrual syndrome/premenstrual dysphoric disorder, and challenges stigma
surrounding premenstrual experiences.