Can difficulty expressing emotions explain why childhood trauma increases PMS symptoms?

Premenstrual syndrome (PMS) is a common and often debilitating condition characterized by emotional, cognitive, and physical symptoms that significantly impact well-being. Research suggests that childhood trauma is associated with heightened PMS symptoms, yet the mechanisms underlying this relationship remain unclear. Alexithymia-a trait marked by difficulties in identifying and expressing emotions-may serve as a key psychological pathway linking childhood trauma to PMS, but this role for alexithymia has not yet been well characterized. Using cross-sectional data from N = 117 women, we assessed childhood trauma exposure (six-item Childhood Trauma Questionnaire), alexithymia (Toronto Alexithymia Scale-20), and premenstrual symptoms (Premenstrual Symptoms Questionnaire). We used mediation analysis to test a proposed causal pathway between childhood trauma, alexithymia, and PMS that can be validated in future studies with longitudinal designs. Childhood trauma predicted higher alexithymia scores (Betas = 0.24, p = 0.009), which in turn predicted increased PMS symptoms (Betas = 0.40, p < 0.001). We further found evidence for a significant indirect effect of childhood trauma on PMS through alexithymia (Betas = 0.10, SE = 0.05, 95% CI [0.003, 0.20]). These findings highlight alexithymia as a critical factor in the link between childhood trauma and PMS, suggesting that difficulties in emotion processing may exacerbate premenstrual symptom severity. Addressing alexithymia in clinical interventions may improve PMS management, particularly in individuals with trauma histories. Future research should further investigate these associations longitudinally and assess targeted interventions for PMS that address alexithymia in individuals with a history of childhood trauma.

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