What counts as a premenstrual symptom? Patient and expert health professional perspectives on PMS (Premenstrual Syndrome)

什么算作经前症状？

• 批准号: 1916672
• 金额: --
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-1916672
• 关键词: What; counts; premenstrual; symptom; Patient

PMS (Premenstrual Syndrome) diagnostic guidelines prioritise psychological symptoms, but the clinical reason for doing so remains unclear. Studies show that they are not necessarily the most commonly experienced, nor uniquely determining, nor most disruptive of the (100+) known premenstrual symptoms. Does such medical knowledge/ practice simply reflect and perpetuate the myth of the irrational female?The main aim of this research is to explore how and why certain premenstrual symptoms achieve relative prominence over others, by examining 'expert' clinical constructions of PMS, alongside the experiences and perspectives of 'PMS sufferers'. It builds on the work of Prof. Jane M Ussher, in particular, whose research examines the gendered factors underlying the psychological symptoms of PMS, and identity in relation to the reproductive body.Just as Ussher went on to develop an effective gender-centred psychological treatment for PMS, it is hoped that this research will also directly contribute to the integration of research and clinical practice. Especially in relation to the diagnosis and treatment of PMS, and associated female-prevalent conditions, such as; anxiety, asthma, chronic fatigue syndrome, depression, IBS (Irritable Bowel Syndrome), and migraine.This study will address the following interrelated themes and questions:- Premenstrual symptoms and identity. How do patients/clinicians (experience), explain, and categorise premenstrual changes/symptoms? How do patients associate PMS with their identity (or not), particularly in relation to gender, health, competence, rationality, and (reproductive) anatomy? In general terms, how do clinicians describe patients with PMS?- Contested and stigmatised 'illnesses'. How do patients/clinicians compare PMS to other illnesses e.g. menstrual migraine, or Chronic Fatigue Syndrome? How do patients/clinicians account for the selective criteria used to diagnose PMS? How do patients/clinicians understand, or reveal, that PMS is a stigmatised or contested illness? - Social influences in the construction of medical knowledge and practice. How do medical texts, training resources, and diagnostic/treatment guidelines define premenstrual symptoms, across a range of geographical and historical contexts? How does the gender, medical specialism, or age of a clinician affect the criteria used to diagnose PMS?There is an inherent contradiction in arguments made about PMS: There is compelling evidence that positions it as a socially constructed 'illness' that serves to undermine the rational and political status of all 'women', but when some women (or transgender men) really do experience cyclical premenstrual symptoms, their experiences can in turn be undermined through medical/societal disbelief in their 'biological' validity (Martin, 1980). By seeking to explore 'what counts' as a premenstrual symptom, and by asking this question of both expert medical professionals and 'PMS sufferers', this study hopes to examine this tension around what differentiates a menstrual cycle-related change from a symptom of ill health. As far as I am aware, this will be the first PMS study to include the perspectives of medical professionals, and to explicitly ask expert and lay participants to define, and explain, diagnostic criteria (from their personal perspective, rather than as defined elsewhere).Feminist theorists have already shown how supposedly 'objective' scientific knowledge in this area can actually be highly subjective, and influenced by societal beliefs about gender roles. Likewise, this research project hopes to determine if the current clinical focus on the psychological elements of PMS is based on the lived experience of premenstrual symptoms, or simply reflects and perpetuates a societal myth - the 'naturally' irrational (or hysterical) female.

PMS（经前综合征）诊断指南优先考虑心理症状，但这样做的临床原因尚不清楚。研究表明，它们不一定是最常见的，也不是唯一决定性的，也不是最具破坏性的（100+）已知经前症状。这样的医学知识/实践是否只是反映和延续了非理性女性的神话？本研究的主要目的是探讨如何以及为什么某些经前症状实现相对突出的人，通过检查“专家”的临床结构的经前综合征，以及“经前综合征患者”的经验和观点。它建立在Jane M Ussher教授的工作基础上，特别是，她的研究探讨了PMS心理症状的性别因素，以及与生殖身体的关系。正如Ussher继续开发有效的以性别为中心的PMS心理治疗一样，希望这项研究也将直接有助于研究和临床实践的整合。特别是在诊断和治疗经前综合征，以及相关的女性普遍存在的条件，如;焦虑，哮喘，慢性疲劳综合征，抑郁症，IBS（肠易激综合征），偏头痛。本研究将解决以下相互关联的主题和问题：-经前症状和身份。患者/临床医生如何（经历）、解释和分类经前变化/症状？患者如何将经前综合征与他们的身份（或不）联系起来，特别是与性别、健康、能力、理性和（生殖）解剖学有关的身份？一般来说，临床医生如何描述PMS患者？被争议和污名化的“疾病”。患者/临床医生如何将经前综合征与其他疾病进行比较，例如月经性偏头痛或慢性疲劳综合征？患者/临床医生如何解释用于诊断PMS的选择性标准？患者/临床医生如何理解或揭示经前综合症是一种耻辱或有争议的疾病？- 医学知识与实践建构中的社会影响。医学文本、培训资源和诊断/治疗指南如何在一系列地理和历史背景下定义经前症状？临床医生的性别、医学专长或年龄如何影响经前综合征的诊断标准？关于经前综合症的争论有一个内在的矛盾：有令人信服的证据表明，它是一种社会建构的“疾病”，有助于破坏所有“妇女”的理性和政治地位，但当一些妇女（或跨性别男性）确实经历过周期性经前症状，他们的经历反过来又会因为医学/社会对他们的“生物学”有效性的怀疑而被破坏（Martin，1980）。通过寻求探索“什么是”经前症状，并通过向专业医疗人员和“经前综合症患者”提出这个问题，这项研究希望研究这种紧张关系，即月经周期相关变化与健康状况不佳的症状之间的区别。据我所知，这将是第一个PMS研究，包括医疗专业人士的观点，并明确要求专家和外行参与者定义，并解释，诊断标准（从他们个人的角度，而不是其他地方定义的）。女权主义理论家已经表明，在这一领域所谓的“客观”科学知识实际上是高度主观的，受社会性别观念的影响。同样，这个研究项目希望确定目前对经前综合症心理因素的临床关注是基于经前症状的生活经验，还是仅仅反映和延续了一个社会神话-“自然”非理性（或歇斯底里）女性。