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

经前综合征(PMS)诊断指南优先考虑心理症状，但临床原因尚不清楚。研究表明，在(100+)已知的经前症状中，它们不一定是最常见的，也不是唯一确定的，也不是最具破坏性的。这样的医学知识/实践仅仅是反映并延续了非理性女性的神话吗？这项研究的主要目的是通过研究经前综合症的“专家”临床结构，以及“经前综合症患者”的经历和观点，来探索某些经前症状如何以及为什么会相对突出。它建立在简·M·乌舍教授的工作基础上，他的研究考察了导致经前综合症心理症状的性别因素，以及与生殖身体有关的身份认同。正如乌舍继续开发出有效的以性别为中心的经前综合症心理治疗方法一样，希望这项研究也将直接有助于研究和临床实践的整合。尤其是关于经前综合症的诊断和治疗，以及相关的女性流行疾病，如焦虑、哮喘、慢性疲劳综合征、抑郁症、IBS(肠易激综合征)和偏头痛。这项研究将解决以下相关的主题和问题：-经前症状和身份。患者/临床医生如何(体验)、解释和分类经前变化/症状？患者如何将经前综合症与他们的身份(或不)联系起来，特别是与性别、健康、能力、合理性和(生殖)解剖学有关？总而言之，临床医生如何描述经前综合症患者？--有争议的、被污名化的“疾病”。患者/临床医生如何将经前综合症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经前综合症的选择性标准？患者/临床医生如何理解或揭示经前综合症是一种耻辱的或有争议的疾病？--在医学知识和实践建设中的社会影响。医学文献、培训资源和诊断/治疗指南如何定义一系列地理和历史背景下的经前症状？临床医生的性别、医学专业或年龄如何影响用于诊断经前综合症的标准？关于经前综合症的争论存在内在的矛盾：有令人信服的证据表明，经前综合症是一种社会构建的‘疾病’，服务于破坏所有‘女性’的理性和政治地位，但当一些女性(或变性人男性)真的经历周期性的经前症状时，她们的经历反过来可能会因为医学/社会对其‘生物学’有效性的不信任而受到破坏(Martin，1980)。这项研究试图探索什么才是经前症状，并向专业医学专家和经前综合症患者提出这个问题，希望通过研究与月经周期相关的变化与健康不良症状的区别，来检验这种紧张关系。据我所知，这将是第一次将医学专业人士的观点纳入经前综合症研究，并明确要求专家和非专业参与者定义和解释诊断标准(从他们个人的角度，而不是其他地方定义的标准)。女权主义理论家已经表明，这一领域所谓的“客观”科学知识实际上可以是高度主观的，并受到关于性别角色的社会信仰的影响。同样，这项研究项目希望确定，目前临床上对经前综合症心理因素的关注是基于经前症状的生活经验，还是仅仅反映并延续了一个社会神话--“天生的”不理性(或歇斯底里)的女性。

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.