The welfare system is failing people with Premenstrual Dysphoric Disorder (PMDD), according to a new interim report from researchers at the University of the West of Scotland.

Funded by the Royal Society of Edinburgh, the study reveals significant shortcomings in how fluctuating conditions like PMDD, a debilitating hormone-based mood disorder, are assessed and calls for urgent reform to ensure equitable access to benefits. 

The report, titled Premenstrual Dysphoric Disorder. The Welfare State: Recommendations for Reform, highlights the trauma-inducing nature of the application process, the lack of recognition for PMDD’s unique challenges, and systemic inconsistencies in benefit assessment outcomes for individuals applying for Adult Disability Payment (ADP) in Scotland or Personal Independence Payment (PIP) in other parts of the UK. 

Mhairi Campbell, who is a lecturer on the Bachelor of Arts Law programme at UWS and is one of the report’s lead authors, said: “Our findings show a stark need for reform to ensure people with PMDD are not retraumatised during the welfare application process.

“Participants described harrowing experiences, including being asked inappropriate and deeply upsetting questions about their mental health history. One participant was even asked why they had not acted on suicidal thoughts—a question that not only displays a lack of empathy but also demonstrates the systemic failure to apply trauma-informed practices.” 

PMDD, which affects 1 in 20 women and people who menstruate, can result in severe physical, emotional, and cognitive symptoms. Despite its recognised diagnostic criteria and treatment guidelines, the condition is often overlooked in welfare assessments. 

“Participants spoke about the overwhelming psychological toll of the process,” added Ms Campbell. “They described feeling disbelieved and judged, with decisions often based on arbitrary observations rather than medical evidence.

“For instance, one individual was told that their ability to scroll on Facebook disqualified them from receiving support, while another was denied benefits because they ‘laughed’ during their assessment.” 

The report also found that a one-size-fits-all application process poses severe challenges for those with fluctuating conditions. Applicants often struggled to convey the severity of their symptoms, which are not constant but remain life-altering. 

Co-author and lecturer in Public Health at UWS, Dr Lynsay Matthews said: “The nature of the benefits system means people with PMDD are forced to fit their experiences into narrow boxes that don’t reflect the realities of their condition.

“We heard accounts of individuals being denied benefits even when they had medical diagnoses and supporting letters. In many cases, the system focuses on physical impairments, leaving those with mental health symptoms at a distinct disadvantage.” 

The lack of awareness about available support services compounds these challenges. Many participants were unaware of the help that was available to them, while others reported being deterred by poor experiences with overstretched and underfunded services. 

The report’s authors are urging policymakers to take immediate action to reform the welfare system, with recommendations including: 

  • Embedding trauma-informed practices across the benefits process. 
  • Refining eligibility criteria to better assess mental health symptoms. 
  • Enhancing training for case managers on fluctuating conditions. 
  • Improving promotion of and access to support services. 
The current system is essentially unfair. We need a compassionate, trauma-informed approach that acknowledges the unique challenges of living with conditions like PMDD. People deserve a system that works with them—not against them—during their most vulnerable moments. 

Dr Lynsay Matthews, UWS

The final report will include expanded recommendations and will be shared with policymakers, advocacy groups, and welfare practitioners later this year.   

This research aligns with several United Nations Sustainable Development Goals (UNSDGs), including Goal 3: Good Health and Well-Being, by addressing the mental and physical health challenges faced by individuals with PMDD; Goal 5: Gender Equality, by advocating for systemic reforms to tackle gender-specific disparities; and Goal 10: Reduced Inequalities, by calling for fair and transparent access to financial support for those with fluctuating health conditions. By pushing for inclusive, trauma-informed welfare systems, the study also contributes to Goal 16: Peace, Justice, and Strong Institutions.

The report can be accessed here