This mini-review aims to develop a multidimensional framework for Premenstrual Dysphoric Disorder (PMDD) that integrates the role of traumatic experiences, interoceptive awareness, and sensory processing sensitivity (SPS) in symptom development and maintenance. PMDD is a complex disorder traditionally viewed through hormonal and mood-based lenses, but research shows that many women with PMDD experience significant emotional and physical symptoms that remain unexplained by these factors alone. Early-life trauma and interpersonal trauma may sensitize neural circuits, exacerbating symptom expression during hormonally sensitive periods. A narrative synthesis of existing literature was conducted, focusing on the impact of trauma (particularly early-life and interpersonal trauma) on the hypothalamic-pituitary-adrenal (HPA) axis, sensory processing, and interoceptive awareness. The neurobiological interplay between these factors and hormonal fluctuations was examined. Trauma-related dysregulation of neural circuits-including the amygdala, insula, and prefrontal cortex-heightens vulnerability to premenstrual distress by disrupting sensory and emotional processing. Heightened sensory processing and altered interoceptive awareness further amplify symptom severity during the luteal phase. This trauma-informed sensory framework extends current understandings of PMDD beyond hormonal and mood-based models, highlighting the importance of assessing trauma history and sensory reactivity in clinical practice. Incorporating these factors may improve diagnostic accuracy and treatment outcomes.
Arora et al. (Mon,) studied this question.