Can Premenstrual Syndrome Actually Trigger Insanity?

Rajasthan HC acquits woman accused of murder citing insanity triggered by PMS. Can PMS lead women to commit crime?

Rajasthan High Court has acquitted a woman charged with murdering a child on the ground that at the time of committing the crime, she was suffering from insanity triggered by premenstrual stress syndrome or PMS. The court relied on the testimony of three doctors who agreed that the woman suffered from severe PMS, with one doctor saying her symptoms were so severe she needed to be tranquillised.

The judges also relied on books and research papers on the subject. In their judgement they wrote:

Although the law has not much developed in India as to the Premenstrual Stress Syndrome being set up as the defense of insanity, yet the accused has a right to plead and probabilize such defence to show that she was suffering from ‘premenstrual stress syndrome.’

Too caught up to read? Listen to the story here:

But Can PMS Cause Such Severe Symptoms?

The problem is that PMS is not a clearly defined syndrome. Researchers have identified as many as 150 symptoms that fall in this category.

A 2011 study in the Journal of Women’s Health stated that 20 percent of menstruating women have PMS that affects their life enough for them to seek help for it.

The problem is that we lack data in India. We, as doctors, are also not trained to deal with PMS as a serious condition that requires attention. Are we referring these cases to psychiatrists? Is there enough follow up?

Dr Nikita Sopti, Gyneacologist, Max Hospital, Gurugram

So how do you diagnose PMS?

• If symptoms like depression, insomnia, and extreme fatigue are recurring (for at least two menstrual cycles).
• If the onset of symptoms is around ovulation and they significantly disrupt your life.
• If these symptoms disappear within five days after bleeding begins, you may have PMS.

There is a form of PMS that is more serious. Premenstrual Dysphoric Disease or PMDD has been recognised as a mental health disorder by American Psychiatric Association’s Diagnosis and Statistical Manual of Mental Disorders.

According to Mayo Clinic:

The cause of PMDD isn’t clear. Underlying depression and anxiety are common in both PMS and PMDD, so it’s possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders. Treatment of PMDD is directed at preventing or minimising symptoms and may include antidepressants.

But can someone with PMDD commit the ultimate act of violence that is murder?

If it’s left undiagnosed and untreated for long, if the feel good hormone is not being secreted in the brain and cycle after cycle a person goes through this, can someone take an extreme step? It’s quite possible.

Dr Nikita Sopti

Speaking with FIT, Delhi based psychologist Dr Aruna Broota says she has seen cases of PMS where women display symptoms like anxiety, hysterical behaviour like crying, screaming, throwing things, or even beating their children.

However those personalities that have borderline agitation depression or display borderline mania, their symptoms can perhaps worsen during PMS. Killing itself is psychotic behaviour.

Dr Aruna Broota

PMS Triggered Insanity as Defence

PMS, or more correctly PMDD, as criminal defence is rare in India. But insanity triggered by PMS is reportedly recognised in France, and there have been cases, some very high profile ones, where women have pleaded diminished responsibility or mitigating circumstances due to PMS in the UK . Australian criminologist Dr Patricia Easteal, in her paper PMS in the Courtroom, has collated different instances where severe PMS was used as defence, and Rajasthan HC has referred to her work in their judgement.

An attempt in the US to apply this defence was met by resistance, mainly by feminist organisations that feared it would perpetuate the image of a woman as a slave of her hormones.

It’s a real fear, but so is the medical condition that leads to severe PMS. In her paper, Dr Easteal talks about the burden of proof and how it must meet the most rigid requirements in these cases.