Dysphoric Milk Ejection Reflex (D-MER): A Novel Neuroendocrine Condition with Psychiatric Manifestations.
Journal
Harvard review of psychiatry
ISSN: 1465-7309
Titre abrégé: Harv Rev Psychiatry
Pays: United States
ID NLM: 9312789
Informations de publication
Date de publication:
01 Jul 2024
01 Jul 2024
Historique:
medline:
11
7
2024
pubmed:
11
7
2024
entrez:
11
7
2024
Statut:
ppublish
Résumé
• Describe how the symptoms of dysphoric milk ejection reflex (D-MER) affect nursing patients.• Discuss how physicians, psychologists, and clinicians can support their patients experiencing D-MER. Dysphoric milk ejection reflex (D-MER) is characterized by a sudden onset of profoundly negative emotions that are temporally linked to milk letdown when breastfeeding or pumping breast milk. These affective experiences have no psychological precipitants and only last for minutes. D-MER is relatively underappreciated in the physician-oriented medical literature, although there are important clinical and public health consequences when a nursing parent experiences unwanted, negative emotions paired with breastfeeding. D-MER can undermine the parent's confidence and may affect bonding with their infant; it may also contribute to weaning earlier than planned. It is especially important for psychiatrists and other health care professionals who may be called upon to evaluate postpartum patients or nursing parents to be knowledgeable about D-MER. This perspective article aims to provide information about D-MER to the psychiatric and broader medical communities, and to underscore the need for additional research on this topic. Drawing on a literature search, the article first traces historical recognition of D-MER as a clinical entity, then summarizes the clinical characteristics of D-MER and recommends an assessment and management approach that emphasizes psychoeducation. The article also discusses factors that have contributed to the underappreciation of this condition, outlines gaps in our understanding, and suggests next steps for epidemiological and clinical research. D-MER is likely a neuroendocrine condition with psychiatric manifestations. Given that it is episodic but with predictable timing, this condition presents a unique opportunity for scientific investigation.
Identifiants
pubmed: 38990901
doi: 10.1097/HRP.0000000000000402
pii: 00023727-202407000-00002
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
133-139Informations de copyright
Copyright © 2024 President and Fellows of Harvard College.
Références
Cooper B. Single spies and battalions: the clinical epidemiology of mental disorders. Psychol Med 1993;23:891–907.
Ureño TL, Buchheit TL, Hopkinson SG, Berry-Cabán CS. Dysphoric milk ejection reflex: a case series. Breastfeed Med 2018;13:85–8.
Ureño TL, Berry-Cabán CS, Adams A, Buchheit TL, Hopkinson SG. Dysphoric milk ejection reflex: a descriptive study. Breastfeed Med 2019;14:666–73.
Heise AM, Wiessinger D. Dysphoric milk ejection reflex: a case report. Int Breastfeed J 2011;6:6.
Skowrońska K, Chmura A, Baciur P, Środoń A. Dysphoric milk ejection reflex as a new diagnostic and therapeutic challenge in lactation care - literature review. Journal of Education, Health and Sport 2022;12:485–3.
Deif R, Burch EM, Azar J, et al. Dysphoric milk ejection reflex: the psychoneurobiology of the breastfeeding experience. Front Glob Womens Health 2021;2:669826.
Frawley T, McGuinness D. Dysphoric milk ejection reflex (D-MER) and its implications for mental health nursing. Int J Ment Health Nurs 2023;32:620–6.
Morns MA, Burns E, McIntyre E, Steel AE. The prevalence of breastfeeding aversion response in Australia: a national cross-sectional survey. Matern Child Nutr 2023;19(4):e13536.
Flower HD. Breastfeeding during pregnancy. moving from fear to instinct. Midwifery Today Int Midwife 2003:30–3.
Watkinson M, Murray C, Simpson J. Maternal experiences of embodied emotional sensations during breast feeding: an interpretative phenomenological analysis. Midwifery 2016;36:53–60.
2022 breastfeeding report card. Washington, DC: Centers for Disease Control and Prevention, April 13, 2023. https://www.cdc.gov/breastfeeding/data/reportcard.htm.
Hauck YL, Fenwick J, Dhaliwal SS, Butt J. A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns. Matern Child Health J 2011;15:260–8.
Beggs B, Koshy L, Neiterman E. Women’s perceptions and experiences of breastfeeding: a scoping review of the literature. BMC Public Health 2021;21:2169.
Kennedy AJ. Breast or bottle — the illusion of choice. N Engl J Med 2023;388:1447–9.
Yate ZM. A qualitative study on negative emotions triggered by breastfeeding; describing the phenomenon of breastfeeding/nursing aversion and agitation in breastfeeding mothers. Iran J Nurs Midwifery Res 2017;22:449–54.
Nilsson IMS, Kronborg H, Rahbek K, Strandberg-Larsen K. The significance of early breastfeeding experiences on breastfeeding self-efficacy one week postpartum. Matern Child Nutr 2020;16:e12986.
McGuire E. Breastfeeding aversion and agitation. Breastfeeding Review 2018;26:37–40.
Morns MA, Steel AE, Burns E, McIntyre E. Women who experience feelings of aversion while breastfeeding: a meta-ethnographic review. Women Birth 2021;34:128–35.
Morns MA, Steel AE, McIntyre E, Burns E. “It makes my skin crawl”: women’s experience of breastfeeding aversion response (BAR). Women Birth 2022;35:582–92.
Morns MA, Steel AE, McIntyre E, Burns E. Breastfeeding aversion response (BAR): a descriptive study. J Midwifery Womens Health 2023;68:430–41.
Cox S. A case of dysphoric milk ejection reflex (D-MER). Breastfeed Rev 2010;18:16–8.
Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical profession. 9th ed. Philadelphia, PA: Elsevier, 2021.
Liu H, Li J, Li X, Lu H. Dysphoric milk ejection reflex: report of two cases and postulated mechanisms and treatment. Breastfeed Med 2023;18:388–94.
Grose J. "These New Breastfeeding Guidelines Ignore the Reality of Many American Moms," The New York Times, 2022. https://www.nytimes.com/2022/07/06/opinion/breastfeeding-guidelines.html?referringSource=articleShare.
Friedlander J. "A New mom, She Expected Breastfeeding to Be a Sweet Experience. Yet Every Time She Nursed, She Was Hit with Sudden Terror or Sadness." The Washington Post, 2021. https://www.washingtonpost.com/health/breastfeeding-intense-sadness/2021/02/19/cc8ffd40-6635-11eb-886d-5264d4ceb46d_story.html.
Uvnas-Moberg K, Kendall-Tackett K. The mystery of D-MER: what can hormonal research tell us about dysphoric milk-ejection reflex? Clinical Lactation 2018;9:23–9.
Grattan DR. 60 years of neuroendocrinology: the hypothalamo-prolactin axis. J Endocrinol 2015;226:T101–22.
Hannan FM, Elajnaf T, Vandenberg LN, Kennedy SH, Thakker RV. Hormonal regulation of mammary gland development and lactation. Nat Rev Endocrinol 2023;19:46–61.
McNeilly AS, Robinson IC, Houston MJ, Howie PW. Release of oxytocin and prolactin in response to suckling. Br Med J (Clin Res Ed) 1983;286:257–9.
Valtcheva S, Issa HA, Bair-Marshall CJ, et al. Neural circuitry for maternal oxytocin release induced by infant cries. Nature 2023;621:788–95.
Groff E, Steger F. The ethics of ancient lactation and the cult of the perfect breastfeeding mother. Healthcare 2023;11:2941.
Global Breastfeeding Collective. Global Breastfeeding Collective. Accessed June 8, 2023. https://www.globalbreastfeedingcollective.org/.
Beery AK, Zucker I. Sex bias in neuroscience and biomedical research. Neurosci Biobehav Rev 2011;35:565–72.
Mirin AA. Gender disparity in the funding of diseases by the U.S. National Institutes of Health. J Womens Health 2021;30:956–63.
Rivera J, O’Brien B, Wamsley M. “Getting out of that siloed mentality early”: interprofessional learning in a longitudinal placement for early medical students. Acad Med. 2020;95:122–8.
Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine. Accessed September 15, 2023. https://www.bfmed.org/.