Diagnosing Womanhood: How Psych Has Misunderstood Women’s Mental Health

Written By Gia Varela

By: Gia Varela

Trigger Warning This post discusses misogyny in psychiatry, emotional invalidation, and women’s mental health struggles, including PMDD. Some content may be distressing for those with lived experiences of medical trauma or dismissal.

Mental health has long been seen as a field of healing, but when we peel back the clinical curtain, what we often find is a deeply gendered, and sometimes misogynistic, history. From the days of “female hysteria” to the modern dismissal of PMDD and other hormone-related disorders, psychiatry hasn’t always been a safe space for women. In fact, it’s often been a place where women’s experiences were misunderstood, minimized, or outright pathologized.

This post is a reflection on how we got here and what it means to reclaim women’s mental health from a system that was never fully built for us.

Hysteria and the Historical Control of Women’s Emotions

The earliest roots of psychiatric care were soaked in patriarchal assumptions. “Hysteria,” one of the first documented mental disorders, was quite literally derived from hystera, the Greek word for uterus. This diagnosis (applied almost exclusively to women) was a catch-all for everything from sexual desire to grief, irritability to fatigue. The implication was clear: women’s mental health struggles weren’t valid; they were symptomatic of their biology, their irrationality, their “femaleness.”

Women who defied social norms or showed strong emotion were institutionalized or drugged, not supported. Normal responses to trauma, oppression, or unmet needs were branded as illness. In some ways, we’ve come a long way since then, but in many ways, the echoes of this era still haunt modern diagnoses.

The DSM and Diagnostic Double Standards

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered the “bible” of mental health. Yet its authorship and evolution have long been shaped by a male-dominated psychiatric establishment.

Take Borderline Personality Disorder (BPD): it’s a diagnosis given predominantly to women (around 75% of cases) often characterized by emotional instability, fear of abandonment, and intense relationships. But critics argue that BPD often pathologizes behaviors that are gendered responses to trauma. The label has historically punished women for emotional intensity, relational needs, and even survival strategies developed in invalidating environments.

Then there’s Histrionic Personality Disorder, which paints individuals as overly dramatic, attention-seeking, and superficial. Sound familiar? It should—it’s the same language often used to invalidate women’s voices in everyday life.

PMDD: A Diagnosis Hidden in the Shadows

Premenstrual Dysphoric Disorder (PMDD) affects roughly 3–8% of menstruating individuals. It’s a severe, sometimes debilitating condition involving mood swings, rage, sadness, fatigue, anxiety, and physical symptoms that cyclically appear in the luteal phase of the menstrual cycle.

Yet for years, PMDD wasn’t considered a “real” diagnosis. It wasn’t until DSM-IV (1994) that it even appeared in the appendix for “further study," and it only became a recognized disorder in DSM-5 in 2013.

What does this mean in practice? It means millions of women went (and still go) undiagnosed or misdiagnosed with depression, bipolar disorder, or generalized anxiety—conditions that don’t fully explain the cyclical nature of their distress. PMDD is just one example in a larger pattern: when women say they’re in pain, they are often not believed.

This isn’t just about the DSM—it’s about a research system that still allocates only a fraction of its funding toward conditions that disproportionately affect women. It’s about medical schools that don’t emphasize hormone education. It’s about doctors who wave away monthly agony as “just PMS.”

The Feminist Therapy Movement: Rewriting the Narrative

There is a growing movement toward feminist-informed therapy, where clinicians actively consider the socio-political systems that shape a client’s mental health, not just symptoms in a vacuum.

Feminist therapists ask:

  • What societal forces are invalidating this person’s experience?

  • How have gender roles or cultural expectations contributed to their distress?

  • In what ways has their pain been dismissed—by loved ones, by healthcare systems, or by the culture at large?

This lens is vital, especially when working with women (and gender-expansive individuals) whose mental health is shaped by hormones, identity, reproductive roles, and a lifetime of being told to “calm down.”

Where Do We Go From Here?

Reclaiming women’s mental health means changing the system and the conversation.

We need more research, more funding, more providers trained in hormone-informed care. We need to normalize conversations about menstruation, menopause, postpartum, and the unique rhythms of the body. There's a strong need for a diagnostic system that sees women as full human beings—not emotional problems to be solved.

Mental health care should be a tool of empowerment, not another arm of systemic control.

Reflection Questions

  • Have you ever had a health concern dismissed by a doctor?

  • Have you or someone you love been misdiagnosed or misunderstood in a mental health context?

  • What role do you think gender has played in how your emotions have been treated—or mistreated?

Resources

If you want to learn more or support change, here are some places to start:

Gia Varela
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