Premenstrual dysphoric disorder PMDD is a health difficulty that is so similar to premenstrual syndrome PMS but is more serious(1). PMDD causes severe irritability, depression, or anxiety in the week or two days before menstruation. Symptoms normally go away two to three days after menstruation starts(2). PMDD affects up to 8% of women of childbearing age(3). Many women with PMDD may also have anxiety or depression, in this way, lasting irritability or anger that may affect other people, feelings of sadness or despair, or even thoughts of suicide, feelings of tension or anxiety, panic attacks, mood swings or crying often, lack of interest in daily activities and relationships, trouble thinking or focusing, tiredness or low energy, food cravings or binge eating, trouble sleeping, feeling out of control, physical symptoms such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain are some of prevalent symptoms suffer women with PMDD(4). Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role, a brain chemical called serotonin may also play a role in PMDD(5).
Previous studies showed that biological, psychological, and social-cultural factors cause PMDD(4). These factors include educational and marital status, genetic predisposition, age, pain during menses, amount of menstrual bleeding, history of physical and psychiatric illness, treatment seeking behavior, history of traumatic event, sleeping hour, physical exercise, and maternal history of PMDD(6). PMDD has been associated with suicide and accident rate, major depressive disorder, high job absenteeism, poor quality of life, and poor family and coworkers relationship(5). One of the most effective factors can predict intensity of symptoms of PMDD is flexibility in thought changing and selecting different attitudes toward objects(7). it has been shown that psychological maturity, coping styles and self-perception can significantly affect incidence and intensity of PMDD symptoms(1).
Researches have demonstrated that pain is most common complaint among menstruating women; it has some different difficulties for them(8). For instance, generally, PMDD increases perceived pain among women; it dramatically augments the risk of pain medication abuse(3). In this way, it has been reported that psychological distress is another most important symptom women suffer from before and during menstruation(1). After the complaints about pain, psychological distress is the most common symptom that makes women consult with a mental health practitioner(2). It has been observed that pain intensity can be affected by psychosocial variables such as pain catastrophizing, beliefs on pain, coping skills, perceived social support, and learning about pain from important others(5).
Women with PMDD have decreased emotional adjusting more in the premenstrual phase than controls had done (3, 8).among these women, emotional adjusting is negatively associated with depression, anxiety, and stress(5). The premenstrual estrogen negatively correlated with anxiety and stress in women with PMDD(1). So do, there is significant association between PMDD experience and academic performance, moreover, the length of menses significantly associated with academic performance(2).
Several etiological causes have been introduced to explain the disorders, which in turn have led to different treatment methods to control the clinical symptoms(9). hypnosis treatment can attenuate the stress caused by the syndrome and remove the environmental background of the disorder to a large extent(10). hypnosis is a condition that results from attention, acceptance, and concentration, in which there must be degrees of three facets of the same time: decomposition or abstraction, absorption, inclusiveness(11).hypnotherapy is based on the assumption that most psychological disturbances are a negative form of self-hypnosis, so that negative thoughts are accepted critically and even without informed knowledge(12). hypnotherapy involves several basic methods including relaxation, guided imagery, cognitive reconstruction, gradual desensitization, and the training of hypnosis skills(13).With regard to suggested theories on formation of PMDD, it looks to be effective to use hypnotherapy to interevent effective psychological factors of PMDD(9).
In this investigation we aimed to analyze effectiveness of hypnotherapy on pain intensity and psychological distress with regard to applicability of suggestions focused on cognitive flexibility and ego strength.