Self-Compassion for PMDD: Dealing with Guilt and Self-Criticism

What is self-compassion and why is it important for PMDD?

Self-compassion means being kind and understanding toward yourself, especially in difficult moments. It's the opposite of self-criticism - instead of judging yourself for your PMDD symptoms, you recognize that suffering is part of the human experience and that you deserve to be treated with kindness.

Why is self-compassion so challenging with PMDD?

Common patterns with PMDD:

• Guilt about behavior during luteal phase
- "I'm a bad partner/mother/friend" - "I should have controlled myself better" - "It's my fault that I reacted this way"

• Self-criticism about symptoms
- "I'm weak because I can't handle this" - "Other women have this too, why can't I?" - "I should try harder"

• Identity confusion
- "Is this really me, or is it PMDD?" - "Who am I without PMDD?" - "Is this my personality or my condition?"

• Isolation and shame
- "No one understands me" - "I'm a burden to others" - "I don't deserve help"

Consequence: These patterns often intensify PMDD symptoms and make recovery more difficult.

What does science say about self-compassion?

Research by Kristin Neff

Kristin Neff, psychologist at the University of Texas, has conducted extensive research on self-compassion. Her research shows that self-compassion is associated with:

• Less depression and anxiety
• Better emotion regulation
• More resilience in adversity
• Healthier relationships
• Less perfectionism and self-criticism

Self-compassion and chronic conditions

Research on self-compassion in chronic conditions suggests it can help with:

• Acceptance of the condition
• Reduction of guilt
• Better treatment adherence
• Improved quality of life

Important: Specific research on self-compassion in PMDD is limited, but the principles are applicable to PMDD based on research on similar conditions.

The three components of self-compassion

According to Kristin Neff's model, self-compassion consists of three interconnected components:

1. Self-Kindness

What it means: Instead of being harsh and critical toward yourself, you are warm and understanding, as you would be toward a good friend.

With PMDD:
• Instead of: "I'm a bad mother because I got angry"
• Try: "It's understandable that I struggled - I had intense PMDD symptoms"

Practical exercise: Imagine a good friend is in your situation. What would you say to them? Write this down and direct these words toward yourself.

2. Common Humanity

What it means: You recognize that suffering, failure, and imperfection are part of the shared human experience - you are not alone.

With PMDD:
• Instead of: "Why is this happening to me?"
• Try: "Many women experience PMDD - I'm not alone in this struggle"

Practical exercise: Remind yourself that:
• 3-8% of women have PMDD
• Your symptoms are not unique or abnormal
• Others understand what you're going through

3. Mindfulness

What it means: You observe your painful thoughts and feelings without suppressing or exaggerating them.

With PMDD:
• Instead of: "This is terrible and it will never get better"
• Try: "I feel bad now, and that's difficult. This is a PMDD symptom, not my entire identity"

Practical exercise: When you criticize yourself, pause and observe:
• "I notice I'm criticizing myself"
• "I feel guilty"
• "This is a thought, not a fact"

Practical exercises for self-compassion with PMDD

Exercise 1: Self-Compassion Break

When to use: During intense PMDD symptoms or after a difficult moment.

Steps:

• Acknowledge the suffering:
"This is a moment of suffering" "This is difficult" "I feel pain"

• Common humanity:
"Suffering is part of life" "Other women with PMDD experience this too" "I'm not alone"

• Self-kindness:
"May I be kind to myself" "May I give myself the compassion I need" "May I carry this moment with gentleness"

Tip: Repeat these three phrases aloud or in your head during difficult moments.

Exercise 2: Self-Compassion Letter

Goal: Processing guilt about PMDD behavior.

Steps:

• Write a letter to yourself from the perspective of a kind, understanding friend
• Acknowledge what happened without judgment
• Explain why your reaction was understandable given PMDD
• Offer kindness and support
• Remind yourself of your value as a person

Example: "Dear [your name],

I see you're feeling guilty about [event]. It's important to remember that you had intense PMDD symptoms at that time. Your reaction wasn't because you're a bad person, but because your body and mind were overwhelmed by hormonal changes.

You're doing your best. PMDD is a real, medical condition - not a character flaw. You deserve understanding and compassion, especially from yourself.

With love, Your kind self"

Exercise 3: PMDD vs Identity Distinction

Goal: Gain clarity about what PMDD is and who you are.

Steps:

• Make two columns: "PMDD symptoms" and "My values/qualities"
• In the first column: write what PMDD causes (anger, anxiety, depression, etc.)
• In the second column: write who you are outside PMDD (kind, creative, loyal, etc.)
• Remind yourself: PMDD symptoms are temporary and cyclical - they are not who you are

Example:

| PMDD symptoms (temporary) | My values/qualities (permanent) | |---------------------------|-------------------------------------| | Intense anger during luteal phase | I am normally patient and understanding | | Depressive feelings | I value joy and connection | | Anxiety and panic | I am normally courageous | | Emotional hypersensitivity | I am empathetic and caring |

Exercise 4: Self-Compassion Mantras

Use these phrases during difficult moments:

• "This is difficult, and that's okay"
• "I'm doing my best with what I have"
• "PMDD symptoms are not my fault"
• "I deserve kindness, even from myself"
• "This is temporary - it will pass"
• "I am more than my PMDD symptoms"

Tip: Choose 2-3 mantras that resonate best with you and repeat them regularly.

Exercise 5: Self-Compassion Meditation

Based on Loving-Kindness meditation:

• Sit or lie comfortably
• Close your eyes and breathe calmly
• Imagine receiving compassion from someone who loves you
• Direct this compassion toward yourself:
- "May I be happy" - "May I be free from suffering" - "May I find peace" - "May I live with ease"
• Repeat for 5-10 minutes

Apps that can help:
• Insight Timer (free self-compassion meditations)
• Headspace (self-compassion course)
• Calm (self-compassion exercises)

Dealing with specific situations

Situation 1: Guilt about PMDD behavior

Scenario: You reacted angrily to your partner/children during the luteal phase.

Self-compassion approach:

• Acknowledge what happened:
"I reacted angrily and that wasn't ideal"

• Acknowledge context:
"I had intense PMDD symptoms at that time - my emotions were overwhelming"

• Common humanity:
"Many women with PMDD have experienced this - I'm not alone"

• Take responsibility (without self-criticism):
"I can apologize and work on better coping strategies"

• Self-kindness:
"I deserve understanding, even from myself. I'm doing my best."

Situation 2: Self-criticism about "weakness"

Scenario: You think: "I'm weak because I can't handle PMDD."

Self-compassion approach:

• Recognize the self-criticism:
"I notice I'm criticizing myself for having PMDD"

• Check the facts:
"PMDD is a medical condition, not a character flaw. It's not something I 'should be able to handle' - it's a condition that needs treatment."

• Reframe:
"Instead of weak, I'm strong because I go through these intense symptoms every month and still keep going."

• Self-kindness:
"I deserve respect for my resilience, not criticism for my condition."

Situation 3: Identity confusion

Scenario: You wonder: "Who am I really? Is this my personality or PMDD?"

Self-compassion approach:

• Accept the complexity:
"It's normal to have this question - PMDD and identity are complex"

• Remind yourself:
"PMDD symptoms are cyclical - they come and go. My values, interests, and qualities are more consistent."

• Focus on patterns:
"When I look at my whole cycle, I see that I am [your qualities] during the follicular phase. PMDD symptoms are temporary."

• Self-kindness:
"I don't have to choose between 'PMDD' or 'me' - I'm a complex person with a medical condition."

Self-compassion in combination with other treatments

With therapy

Self-compassion can be part of:
• CBT (Cognitive Behavioral Therapy): Helps recognize and challenge self-critical thoughts
• DBT (Dialectical Behavior Therapy): Mindfulness components overlap with self-compassion
• ACT (Acceptance and Commitment Therapy): Acceptance and self-compassion are core components

With medication

Self-compassion can help with:
• Acceptance of medication: "It's okay to need help"
• Dealing with side effects: "I deserve treatment, even if it's not perfect"
• Treatment choices: "My choices are valid, regardless of what others think"

With lifestyle

Self-compassion supports:
• Setting boundaries: "It's okay to say no"
• Taking rest: "I deserve rest, especially during the luteal phase"
• Asking for help: "Asking for help is a strength, not a weakness"

Common pitfalls

Pitfall 1: Confusing self-compassion with self-pity

Self-pity: "Why is this happening to me? It's so unfair!" (isolating, passive)

Self-compassion: "This is difficult, and I deserve support. What can I do to help myself?" (connecting, active)

Solution: Focus on common humanity and action, not isolation.

Pitfall 2: Using self-compassion to avoid responsibility

Not: "It's okay that I got angry - it's PMDD" (no responsibility)

Yes: "I had intense PMDD symptoms, and I can apologize and work on better strategies" (responsibility + compassion)

Solution: Self-compassion means understanding, not excuse for harmful behavior.

Pitfall 3: Perfectionism in self-compassion

Not: "I must be perfect at self-compassion!"

Yes: "Sometimes I forget self-compassion - that's okay. I can try again."

Solution: Self-compassion is a practice, not perfection.

When to seek professional help?

Consider therapy if:
• Self-criticism is constant and overwhelming
• Guilt interferes with your daily functioning
• You have difficulty distinguishing between PMDD and identity
• Self-compassion exercises feel impossible or triggering
• You have thoughts of self-harm or suicide

Therapy can help with:
• CBT for self-critical thoughts
• DBT for emotion regulation and mindfulness
• ACT for acceptance and values
• Trauma therapy if there is underlying trauma

Practical tips for daily use

1. Self-Compassion Check-in

Daily (e.g., evening):
• "How was I toward myself today?"
• "Did I need self-compassion but got self-criticism?"
• "What can I do differently tomorrow?"

2. Self-Compassion Reminders

• Sticky notes with mantras on mirror
• Phone alarm with self-compassion reminder
• Calendar reminder during luteal phase

3. Self-Compassion Journal

Write daily:
• A moment when you needed self-compassion
• How you reacted (self-criticism or self-compassion)
• What you could do differently

4. Self-Compassion in Relationships

Communicate with others:
• "I need self-compassion right now"
• "Can you help me remember that PMDD symptoms aren't my fault?"
• "I feel guilty - can you help me put this in perspective?"

Scientific sources

This information is based on:
• Neff, K. (2003). "Self-compassion: An alternative conceptualization of a healthy attitude toward oneself"
• Neff, K. & Germer, C. (2013). "A pilot study and randomized controlled trial of the mindful self-compassion program"
• Sirois, F. M. et al. (2015). "Self-compassion, stress, and coping in the context of chronic illness"
• Research on self-compassion in chronic conditions and emotion regulation

Please note: This article describes evidence-based psychological techniques based on scientific research. This is what women report about self-compassion exercises, but individual experiences may vary. Self-compassion techniques are complementary to professional treatment.

---

*This article is intended for educational purposes and does not replace medical or psychological advice. Self-compassion techniques are complementary to professional treatment. If you struggle with self-criticism, guilt, or identity questions, consider seeking professional help from a psychologist or therapist. We advise against self-medication: always discuss this with your healthcare provider.*

Last updated: December 2024 Reading time: 12 minutes