Disguised-Could PMDD Be The Hidden Link To Autism In Females? Part 1

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Disclaimer: I am not a medical professional, the information provided in the following post are my opinions based on medical research articles. They are not meant for diagnosis. It is indented to open up a dialogue about PMDD and Autism and how they affect Female Health


Quick story, A few month backs I was with my niece, Gabby, talking to her about how my family always confuses her with me.  Usually, when they go to call for her or speak about her, they always say my name. The same thing happens with my nephew Nicolas when my sister talks about him or calls him she will say my name.
I said to my niece, “I think they do that because in some way they see me in both of you, and that’s why they call out my name.” Later that night, I decided to write in my bathroom Mirror, Wilmari(me)=Nicholas? For some reason, that conversation stayed in the back of my mind for a while, and I kept contemplating it and turning it over in my head. 
 Then I ended up here…

Could it Be?

So where is here? Well, I ended up with a theory. But how did I make that leap from writing Wilmari=Nicholas to a theory? Stick with me, and I’ll tell you, but first, the theory…

It is my opinion and speculation that a percentage of women with PMDD are more than likely cases of undiagnosed Autism Spectrum. It is also very possible that PMDD is presentation and characteristic(symptom) of Autism Spectrum in females.

Many factors played into my theory since they are rather lengthy; this will be a three post series. So make sure you are subscribed to my list to stay up to date.

Now get ready because I am about to plead my case and it may get a little ugly, I’ll try to pretty it up, but I promise it will be worth it, so, STICK WITH ME!

PMDD & Autism

To better understand where I am going with this, we first must medically define PMDD and Autism. Also please note that when I say female, I am speaking of AFAB (Assigned Females at Birth).

What is Premenstrual Dysphoric Disorder (PMDD)?

It is described as, a cyclical syndrome characterized by debilitating affective, behavioral, and physical symptoms that occur during the late-luteal (7-14 day before your period arrives), it is resolved by menstruation (in some case unless you have PME) and it affects 1-in-20 women.

What is Autism Spectrum?

There are so many definitions, but for the sake of this post, I will give you the short one. According to Hamilton et al., (2011) article, Autism is distinguished by difficulties with social interaction and situations, communication, and repetitive behaviors and/or rituals.

I caution, there is a saying that states, “If you met one person with Autism, you’ve met one person with autism.” -Dr. Stephen Shore Meaning, no one individual has the same characteristic of Autism; the variation is endless.

Something I also find to be right about females suffering from PMDD, no one Female presents the same symptoms.

The Symptomatology Coincidence

In an article on females on the Spectrum versus Females with Learning Disabilities and the menstrual cycle, the authors reported the following symptoms, which showed a particularly marked increase in prevalence in the autistic group were:

affective lability;anger or irritability; clumsiness; anxiety or tension; depressed mood; impairment of work performance, social activities, or relationships; social withdrawal, isolation and decreased interest in usual activities; decreased concentration; temper tantrums; physical aggression; self harm; stereotypies or repetitive movements; destructive behavior; hypersomnia; insomnia; a change in appetite or a specific food caving; and headaches. (Obaydi & Puri, 2008)

Because PMDD symptoms like Autism symptoms vary from female to female no matter their Neuro condition, I can’t solely base it on the symptomology. Plus it is not necessarily the similarities of the symptoms, though they should not be overlooked, but the widespread presence of PMDD in females on the Autism Spectrum is one of many observations that leads me to my theory.

The finding of the study revealed that 92% of the females on the Autism spectrum satisfied the criteria in the DSM-IV for PMDD diagnosis. Compared to only 11% of females with learning disabilities that were also participants (Obaydi & Puri, 2008.) That is no small number, to be clear that it is more than half of the females. Despite the fact the sample size was small, it is my opinion that it is still significant enough to argue that PMDD could be a symptom of Autism in females.

In another study done by Burk et al., (2010) on teen girls with Down Syndrom(ds), Autism, and Cerebral Palsy(cp). Here they noted that the girls with autism mostly presented with cyclical mood disturbance versus the girls with down syndrome and cerebral palsy. As compared to the girls with DS and CP girls with Autism were more likely to present with “mood and behavior abnormalities” before and during their periods (menstruation.)

Furthermore, In a survey done on females on the Autism Spectrum and Neurotypical Females, they reported that females on the Autism Spectrum would experience menstruation as a “particularly difficult and distressing” event. With Autistic participants citing “symptoms worsen dramatically,” “life much more difficult to manage during periods” and ” it can affect your moods” Steward et al., (2018.) A signal of them possibly experiencing PMDD. Though this was a survey which involves self-reporting, it is still compelling enough to question if PMDD is a symptom of Autism Spectrum in females.

Am I Crazy Or What

But there is also another trend that piqued my interest and contributed to my theory. In both PMDD and Autism, there is a prevalence of women initially being misdiagnosed with a mood disorder or personality disorder.

Now let me explain How I believe this misdiagnosis phenomenon presents in women with PMDD that may actually be undiagnosed Autism Spectrum in females


From a young age, undiagnosed females on the Autism Spectrum develop what medical professionals call “camouflage or masking” by copying peers’ behaviors and characters from books or movies. As they grow and attempt to conform to social expectations, they establish a filing cabinet like system, in their brain, keeping notes of what social behavior are acceptable and which are not. They do this because females on the Autism Spectrum can be sensitive to social expectations, so they “mirror” to hide the traits that make them different, in an attempt to “fit in” and act socially acceptable(Duvekot et al., 2017.)

By the time these females are adults, they continue to “camouflage and mask” their Autism symptoms. Using their tool to navigate social, work, and relationship environments. Tweaking their “camouflage or mask” according to the mental notes they’ve accumulated over time. As they continue to do this unconscious social interaction ritual, it intensifies and requires more and more energy to maintain. Impart due to the demands of the Neurotypical world and its expectation of Females. This unconscious ritual then becomes too much, and the females develop social avoidance, depression, anxiety, social anxiety, fatigue, and loss of identity.

When the females with Undiagnosed Autism reach the two weeks before their menses, the side effects of “camouflaging” become completely unbearable. Moreover, since both PMDD and Autism symptoms tended to increase in intensity with age, it all starts to get out of control. As time passes and demands continue to grow, it becomes too difficult for the females to maintain this unconscious ritual. So after trying their best to cope for a few months or years, they falsely start to assume they are going crazy.

At which point, the females finally decide to get help. But, that’s when all the misdiagnosis and comorbid diagnosis are assigned to the women till they finally conclude its PMDD or some form of mood disorder, and never once consider Autism.

You are Not Crazy

Here is the thing, once they start to treat their PMDD, some of the females still feel as if something is not right. As if they feel different, and that their lives are out of control barely keeping it together. They go from medical professional to medical professional looking for relief, to only find that nothing is working. They increasingly get worse and sometimes feel as if the PMDD is taking over their lives.

But what they do not know is that PMDD may not be their issue, but a symptom of something bigger. Something that actually can change the way they see themselves and how they are coping. A woman that struggles with PMDD or some form a Psychological Disorder or has previously been misdiagnosed may, in fact, be on the Autism Spectrum. In a review done by Meng-Chuan & Baron-Cohen, (2015) on identifying adults with Autism Spectrum, they wrote the following:

In delineating differential diagnoses, real comorbidities, and overlapping behavior with other psychiatric diagnoses, particular attention should be paid to anxiety, depression, obsessive-compulsive disorder, psychosis, personality disorders, neurodevelopmental disorders. Possible misdiagnosis, especially in women. (Meng-Chuan & Baron-Cohen, 2015)

Let’s address the Elephant in the room right away.

Can PMDD be widespread in females on the Autism Spectrum and other Neurological conditions? Yes

Could it be that it can exist in both females with Autism and Neurotypical women? Yes

Could PMDD, co-exist with other Psychological Disorder? Yes

Could Autism, PMDD, and other Psychological Disorders co-exist? Yes

Since many of the diagnostic criteria are based on the male research on Autism Spectrum, and males are 4 times more likely to be diagnosed than females, could it not be possible that the missing gap is a percentage of Females with PMDD? That PMDD may be a symptom of Autism Spectrum that would obviously NOT be present in males.

My theory is not that PMDD is exclusive to females on the Autism Spectrum, but that many females with PMDD may actually be cases of undiagnosed Autism. Thus, I believe that the intense PMDD some females experience is a result of no longer being able to suppress the characteristics of Autism and they may represent the gap between male and female diagnosis. Additionally, PMDD maybe one of the many symptoms missing from the diagnosis criteria for Autism Spectrum in females.

Back To Wilmari=Nicholas

In the last three months, my PMDD seemed to become a nightmare once again! I knew something was not right, at this point in my PMDD journey, I have learned a lot about my self and my body. Making it easy for me to recognize what is normal for me and what is not. That’s when I thought that maybe PMDD was not my condition, but a symptom of something bigger.

That’s when I saw the Wilmari=Nicholas written on my bathroom mirror, and a light bulb went off!

You see my nephew has been diagnosed with Autism for a few years now, and over the years, I have made mental notes in my filing cabinet of behaviors that resemble my own. I vividly remember one day asking my sister if she thought I may be on the spectrum, but she just remarked: “I’ve thought about it!”

So right there in my bathroom, looking at my own writing, I finally got my answer. The answer to why my sister calls my nephew by my name. Because I am a Neurodivergent woman.

Knowing this about myself has freed me a weight was lifted off my shoulders. It was not that I was depressed or a bad mom. No, it was that I had a different perspective on life. I was living in a world that was not created for me. That I was indeed a fraud “camouflaging and masking”  and suppressing my Neurodiverse brain.

The Story Isn’t Over

That is why I am so passionate about my theory on the connection between PMDD and Autism. Because I believe there are a lot of females with PMDD suffering every day, wondering why they don’t fit in. Females that wonder why being a parent, partner, employee, daughter, friend, and human in this world is so hard for them and not others. I believe these females may actually start to really cope with their PMDD in a positive way. When they realize that they are just Neurodivergent and living in a Neurotypical world. 

I want to free them from hell; they are going through every day in their minds. Because they are worth it, and I know first hand how beautiful, and worthy they really are.

Like I mentioned this post is a three-part series. In my next post, I will talk about the NeuroBiological evidence that I found in my research to support my theory. You are not going to want to miss it, I mean what is better than physical evidence… Right!

Here is the next post: Disguised – The NeuroPsychology Between PMDD and Autism-Part 2

Make sure you subscribe to my blog, so you don’t miss it Part 3.

Finally, let me know what you think, I do you agree or disagree with my theory and research? You can even chat with me now, just click here.


Bargiela, S., Steward, R., & Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders46(10), 3281-3294. doi:10.1007/s10803-016-2872-8
Burke, L. M., Kalpakjian, C. Z., Smith, Y. R., & Quint, E. H. (2010). Gynecologic Issues of Adolescents with Down Syndrome, Autism, and Cerebral Palsy. Journal of Pediatric and Adolescent Gynecology23(1), 11-15. doi:10.1016/j.jpag.2009.04.005
Duvekot, J., Van der Ende, J., Verhulst, F. C., Slappendel, G., Van Daalen, E., Maras, A., & Greaves-Lord, K. (2016). Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys. Autism21(6), 646-658. doi:10.1177/1362361316672178
Hamilton, A., Marshal, M. P., & Murray, P. J. (2011). Autism Spectrum Disorders and Menstruation. Journal of Adolescent Health49, 443-445. doi:10.1016/j.jadohealth.2011.01.015
Lai, M., & Baron-Cohen, S., (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry2(11), 1013-1027. doi:10.1016/s2215-0366(15)00277-1
Obaydi, H., & Puri, B., (2008). Prevalence of Premenstrual Syndrome in Autism: A Prospective Observer-rated Study. Journal of International Medical Research36(2), 268-272. doi:10.1177/147323000803600208
Steward, R., Crane, L., Mairi Roy, E., Remington, A., & Pellicano, E. (2018). “Life is Much More Difficult to Manage During Periods”: Autistic Experiences of Menstruation. Journal of Autism and Developmental Disorders48(12), 4287-4292. doi:10.1007/s10803-018-3664-0
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8 comments on “Disguised-Could PMDD Be The Hidden Link To Autism In Females? Part 1

  1. I am fascinated with your article. I was recently diagnosis with severe PMDD. I have a daughter with autism and at times, I wonder if I am undiagnosed but on the spectrum. I’ll keep reading your blog. Thank you

    • Hello Mimi,
      Thank you for taking the time to read my post. I to have PMDD and I was diagnosed on the Spectrum in May of this year at 37. The thing I have learned through this journey is o trust your gut. If you suspect, then I would explore that avenue. Getting a diagnosis has made my life so much better and I have never felt happier.

      In addition, it will help you ad your daughter find ways to tackle life in a more productive way. I am available any time to chat or if you have any questions. I do not have all the answers yet but I will do my best to help you.

      I wiah you the best of luck on your journey and I know you will figuer it out. Sending love and Hugs

  2. Fascinating! Glad I found your blog! I was diagnosed with PMDD two years ago, and despite integrative medical treatment, I still feel like I don’t know myself and just lost. My Bachelor’s degree is in Psychology and autism in females always caught my interest, mostly because I related to it. Everyone says my daughter is exactly like I was, and I’m exhausted in parenting her. She’s brilliant, like I was, but behavioral issues and spacing out are constant struggles, as are repetitive behaviors and social struggles…all of which I also had and have. I have been so curious if there was a connection with PMDD and Autism, so you’re definitely not alone in this theory. I don’t have social media, but I do have LinkedIn and you can email me if you want to discuss further. I’m interested in this on a level I can’t explain.

    • Thank you, Megan, I am on Linkedin. After receiving my diagnosis, I also got off social media. I am currently slowly making my way back. I am also fascinated by this, and I have learned even more since I published this post. I am currently working on myself, my life has completely changed, for the better. But, I have a lot of things that I need to work on, the masking I did for the last 37 years is a hard habit to break. I encourage you to look more into a diagnosis. It will help, I feel, with understanding and treating your PMDD.

      Here is my linkedin account link : mssg me so we can connect, I would be happy to answer any questions the best that I can. https://www.linkedin.com/in/wilmarieckerson/

  3. Thank you for this article. I’m going to be seeing an ONGYN for PMDD, before I started to have severe issues with PMDD, I wanted to get tested to see if I am on the spectrum. I also have OCD. I truly believe there is a link somewhere.

    • I am so happy to hear that you have found it useful. I hope you find a medical professional that takes your concerns seriously. When you know what you are working with life gets easier.

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