PCOS and Emotional Dysregulation
Do you have PCOS, and wonder why you might struggle with emotions? Do you often feel irritable, anxious, depressed, angry, sad? Do you feel like your emotions are not information, rather the thing that controls you? Well, you’re not alone. Your PCOS, and issues linked to your PCOS, may be playing on your emotions.
PCOS is associated with epigenetic dysregulation of the hypothalmic-pituitary-ovarian axis, or the connection between the brain and female reproductive organs. Some researchers have hypothesized that psychological stressors, low self-esteem, mood problems, and/or metabolic issues may be responsible for this dysregulation. Additionally, researchers have found that those with insulin resistance and inflammation have greater emotional responses than those without. Let’s dive into a few in more detail…
pcos & Low Self-esteem
PCOS causes a host of issues that can negatively impact our self-esteem. Low self-esteem is thought to arise from repeated feelings of exclusion or negative feedback. From weight issues in a society that prizes thinness at any expense, to overgrowth of hair in unwanted places, to acne, and loss of hair on our heads…we can often feel self conscious about our appearance. To add to this, we can also question our self-worth and place in the world when confronted with sleepless nights and daytime fatigue. We may try to overcompensate, throw ourselves into a perfectionist mindset, and when we experience burnout, we may feel worthless. Sensations of guilt as we try to produce at the level of that of our peers can contribute to low self esteem.
low self-esteem and emotional reactivity
Studies have been conducted to reveal that healthy levels of self esteem help us regulate our emotional reactivity and processing. Those with low self-esteem are more likely to predict rejection, expending more attention to search for cues of potential rejection. Not only are psychological reactions more intense when faced with rejection for those with low self-esteem, but also the body responds in a more aggressive manner. This is likely because of continued perception of rejection, and a desire to be accepted. With PCOS, it is more likely we are more sensitive to issues in relationships, negative social cues, etc. This makes it more likely for us to overreact, and overall experience negative feelings much more intensely than those with higher self-esteem.
Laboratory studies have also revealed that those with low self-esteem also release more stress hormones, namely cortisol, after dealing with failure and/or negative comments. And, it has been found that those with low self-esteem have a lower “set point” for emotions overall. That is, those with higher self-esteem are more likely to experience positive emotions to a fuller extent. And conversely, those with low self-esteem have more visceral reactions to perceived negative emotions in others, making those of us with low self-esteem more emotionally reactive.
pcos, insulin resistance, and the limbic system
Once again, insulin resistance is posing frustrating issues for PCOS warriors. We have insulin receptors in many areas of our body, including the portion of our brain responsible for processing emotions. Insulin has a significant impact on the metabolic health of the brain, and functional insulin sensitivity is crucial for neuropreservation. In particular, high concentrations of insulin receptors are found in the cerebellum, cortex and the hypothalamus. There is some debate over which portions of the brain comprise the limbic system, but for the most part, it is accepted that the hypothalamus and cortex at minimum are part of the limbic system. Often called the “emotional brain”, the limbic system helps us regulate, process and react to emotions.
The hypothalamus links our nervous and endocrine systems, modulating the autonomic nervous system, and the release of stress hormones like cortisol. The cingulate cortex helps with emotional response, empathy, socializing and pain perception. When in a hyper-insulinemic state, our brain function can be altered, disrupting the typical function of emotions, potentially leading to more exaggerated, or even subdued, emotional responses.
pcos, insulin resistance, and neurotransmitters
Insulin can also impact our emotional behavior because of its effect on neurotransmitter balance. Studies have found that abnormal glucose and insulin metabolism are associated with depression, with high blood glucose levels negatively impacting mood, and decreasing the level of positive emotions. Insulin increases the amount of tryptophan, the precursor to serotonin, available in the brain. At the same time, however, insulin inhibits the activity of monoamine oxidase, which degrades serotonin. So, high levels of insulin decrease serotonin, which is one of our “feel-good” neurotransmitters that help with mood regulation. Insulin also influences another key emotion modifier, dopamine, which is known as our pleasure hormone. Effectively when we have insulin resistance with our PCOS, dopamine signaling is disrupted, affecting our motivation and mood, and can even lead to depression or addiction. Other neurotransmitters that insulin resistance may affect and disrupt our emotional processing include Gamma-aminobutyric acid (GABA) and glutamate.
pcos, chronic low-grade inflammation, and emotional dysregulation
It’s widely accepted that PCOS and chronic low-grade inflammation tend to go hand in hand. A 2021 meta-analysis revealed that circulating C-reactive protein is higher in PCOS patients than in controls, independent of obesity, indicating low-grade chronic inflammation. We know many PCOS struggles are exacerbated by inflammation, including insulin resistance, abnormal lipid levels, weight difficulties, menstrual irregularities, and high androgen levels. What is less widely discussed is the effect of inflammation on the brain and on emotions.
A 2019 study to examine the relationship between inflammation and resting-state brain functional connectivity was performed using functional magnetic resonance imaging (fMRI) scans. The study revealed that higher inflammation scores were associated with lower functional connectivity (or strength of brain connection and activity) in the emotion regulation network of the brain. There was also weakened brain connectivity in areas responsible for executive function. So, PCOS is highly associated with elevated inflammation, and inflammation is associated with weakened brain function in areas of the brain that help us regulate emotions and carry out decision-making, disciplinary and organizational behaviors. Thus emotional dysregulation, or trouble managing our emotions, can result.
What’s next?
This is by no means an exhaustive list of why PCOS can influence our emotions, but it helps us with some sort of framework for thinking about what may be causing our emotional dysregulation. Next week, I’ll provide some more information into how learning to manage emotions has looked for me. Until then, try not to blame yourself for emotional reactivity. You are brave to explore and ask questions as to why emotions may be more of a battlefield for you than they are for others. I’m always rooting for you!
Happy Healing!