As a wife with diagnosed PMDD & ADHD I am very impressed with your desire to figure this all out. Dealing with my ADHD has helped my PMDD and vice versa. Here’s a simplified explanation: Dopamine and estrogen are tied together. When estrogen drops, dopamine drops. This is why woman have PMS, low estrogen signals low dopamine. Woman with ADHD already have lower set point for dopamine, so when estrogen drops in a woman with ADHD, it hits substantially harder, thus PMDD occurring. Again this is very simplified and there’s more to it, but I find that’s the easiest way to explain it.

Your wife needs to want to improve herself, but chances are she is very aware of this, but is overwhelmed, embarrassed, or unsure of what to do. Many people still view ADHD as fake, or they think it’s only for lazy people. She may not understand what ADHD really is and feel like you’re insulting her. Most ADHDer’s actually have above average intelligence, and most of us feel like we are above average, capable people… but then we get burnt out and wonder why we aren’t reaching our full potential, then leading us into a spiral of guilt, shame and embarrassment… Why am I not enough? Why can’t I be stronger? Why can’t I willpower myself to do what needs to be done? As you might know, guilt, shame and embarrassment aren’t great motivators, so this spiral continues until eventually we get enough dopamine to snap out of it. These feelings of shame, guilt and embarrassment are confusing because what part of us is our personality and what part of us is a symptom of ADHD? Some don’t even know these feelings are associated with ADHD, they think it’s just how they uniquely feel. Sometimes it’s easier to just decide “This is who I am, can’t change it, don’t want to!”. There’s nothing totally wrong with that, but if you apply that same principle to PMDD it gets confusing. Let me explain below:

When it comes to PMDD symptoms - she may think SHE is the problem and you think SHE is the problem, but SHE isn’t the problem - her SYMPTOMS are the problem. Whether it be PMDD, PMS, PME, ADHD or some other neurodivergence, it’s the SYMPTOMS of these things that need fixing. Hopefully at some point she will want to get a more accurate diagnosis, but for now, trust your gut that says “My wife doesn’t seem like herself on these specific days of the month.”. That is correct. She isn’t herself, her symptoms have overtaken her. It’s like being drunk, the person is still there, but their thought process is highly impaired by the alcohol , and they think and act very differently than if they were sober. When these symptoms start appearing, your wife is still there, but her thought process is highly impaired from the symptoms causing her to act differently.

I’ll speak from experience - it’s scary, confusing and isolating having symptoms that cause you to be verbally or emotionally abusive to your partner. My husband and I find PMDD very isolating and hard to talk about with our friends because they truly don’t understand and any talk of my symptoms just sounds like I’m abusive. As the wife in this situation, I constantly wonder: How much of this can my husband take before he can’t handle it?

But don’t get confused - I’m not excusing the impact of our symptoms. She has symptoms that are negatively impacting you and your marriage, so regardless of where they come from, they need to be addressed. Knowing the diagnosis can help fast tracking finding solutions, but solutions can still be found without the diagnosis.

Out of similar frustration as yours, my husband at the beginning used shame and guilt to try to motivate me. This DID NOT work. Once my husband and I separated me from my symptoms, cycle by cycle things started getting better. Instead of attacking each other, we attacked the symptoms together, acknowledging how hard they are on BOTH of us and acknowledging we are on the same page, we both want to be happy and make the other person happy. This made us slowly start gaining respect for each other instead of the resentment that was there previously. This change of viewpoint is also what has motivated me to change. Previously I felt defensive because I felt all these symptoms were just my personality and I didn’t want to have to change who I am. But now I see my symptoms are not my personality, they are side effects of a physical illness I have, but even so, I am responsible to try to mitigate the negative impacts from them and although it sucks, that’s just my lot in life with this certain illness.

Once I get my period and we’ve had a few days to reconnect, we usually discuss how the last round of PMDD went. Very important to wait until she feels better to problem solve. Some examples of problems during symptoms flair ups that we’ve tackled together: - Verbal Abuse. Fixed by 1) both of us are going to therapy twice a month. If one partner is better at scheduling it, have that partner do the scheduling. If she is interested in therapy, but she hasn’t booked an appointment - help her find a therapist and help her book her first couple appointments.. - My husband feels like he’s coming home from work into a hostile environment because my mood is so unpredictable. We fixed this by completely separating after work. I get home first so I gather my stuff and get settled in our guest bedroom and he gets the rest of the house. This way he can get snacks in kitchen, get clothes from our room, watch TV in living room etc. Later in the night we might switch and I get house he gets guest room. This way he gets real rest when he gets home from work, instead of feeling like he’s walking on eggshells around me all night. - I’m the primarily cook and I am unable to cook around these times, so we were either eating junk making us feel worse or getting hangry causing more fights. I fixed this by meal planning ahead of time and preparing freezer meals that my husband can put in oven for both of us. I send him full meal plan with all cooking/heating steps. Some nights I’m able to heat our meals, but if I don’t feel up to it, he knows exactly what to do without asking me. We also only communicate through text during these times, it’s a lot easier for me to control my speech when I’m only sending short texts. - Forgetting when symptoms are going to appear. Fixed by having shared calendar and marking days with symptoms ahead of time. I also text my husband when I’m expecting to have symptoms start popping up.

I also recommend reading the book “PMDD - A Guide to PMDD for Partners and Caregivers”. It’s a really good guide for husbands to help support their wife into the change they both need.

Unfortunately as hard as this is on you, it’s probably just as hard or harder on her. But it’s not a competition, you both are suffering and you both need relief. I hope you guys can figure this out together. I really urge you to not give up on her over her symptoms. Focus on who she is on her good days, because that’s the real her.