Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment

Liu, Huan; Li, Jin; Li, Xiaomei; Lu, Huapeng

doi:10.1089/bfm.2022.0206

Cited by 8 publications

(8 citation statements)

References 18 publications

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“…The most common symptoms of D-MER were irritability, anxiety, and sadness. The symptoms were similar to those reported in previous case studies [ 3 , 9 , 10 ]. Although there are individual differences, the occurrence of these symptoms during breastfeeding can lead to increased mental stress.…”

Section: Discussionsupporting

confidence: 89%

“…To minimize research that is invasive to mothers, it is necessary to collect as much information from mothers as possible through questionnaires. Only one research report regarding D-MER was found in the literature for all of Asia, a study conducted in China [ 10 ]. Previous studies in Japan have focused on anxiety and difficulty in breastfeeding; however, there are no research reports of difficulty breastfeeding due to D-MER, nor on the actual state of D-MER and the mother’s perception of it.…”

Section: Introductionmentioning

confidence: 99%

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Dysphoric milk ejection reflex among Japanese mothers: a self-administered survey

Moriyama,

Nakao,

Yamamoto

et al. 2024

Int Breastfeed J

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Background The dysphoric milk ejection reflex (D-MER) is a reflex that causes temporary discomfort during milk ejection. D-MER develops due to the effects of hormones involved in lactation, and it has been reported that it is a physiological symptom different from postpartum depression, but the actual situation is unknown in Japan. Methods This study was conducted using a self-administered, anonymous survey of mothers of children who had undergone health checkups at three years of age at five health centers in Kagoshima city and aimed to clarify the reality and perceptions of mothers regarding D-MER. The survey period was from May to September, 2022. The questionnaires were distributed to 389 mothers, and 216 (55.5% recovery rate) responses were received, of which 202 (valid response rate 93.5%) were included in the analysis. Results Regarding the experience of D-MER, 202 mothers in the study population had given birth to a total of 403 children and experienced D-MER when breastfeeding 62 children (15.4%). Of the 202 mothers included in the analysis, 47 (23.3%) answered that they had experienced D-MER with at least one child while breastfeeding. Sixty-six mothers (32.7%) knew about D-MER. Compared to those who had not experienced D-MER, those who had experienced D-MER had significantly higher scores on the items related to having had trouble breastfeeding (odds ratio (OR]: 3.78; 95% confidence interval (CI]: 1.57, 9.09) and knowing about D-MER (OR 2.41; 95% CI 1.20, 4.84). Regarding symptoms, irritability (n = 24, 51.1%), anxiety (n = 22, 46.8%), and sadness (n = 18, 38.3%) ranked high. Coping strategies included distraction, focusing on the child, and, in some cases, cessation of breastfeeding. Thirty mothers (63.8%) answered that they did not consult anyone, citing reasons such as a belief that no one would be likely to understand their symptoms, and that they could not sufficiently explain their symptoms. Conclusion The low level of awareness of D-MER suggests that it is necessary to inform and educate mothers and the public about the physiological symptoms of D-MER. Moreover, it is necessary to listen to the feelings of mothers with D-MER and support them in coping with their symptoms.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Dysphoric milk ejection reflex among Japanese mothers: a self-administered survey

Moriyama,

Nakao,

Yamamoto

et al. 2024

Int Breastfeed J

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“…The only statistics available estimate the prevalence of D-MER to be 9.1% ( 3 ), being on average in the same range as postpartum depression which has an estimated prevalence of 6.5% to 20% as per the latest update of the National Library of Medicine ( 4 ). This is ironic because, to the best of our knowledge, a total of five cases of D-MER have been published (see 2 , 5 – 7 ). In the absence of published cases involving Arab mothers with D-MER, the primary aim of this case report is to provide a comprehensive psychological understanding of D-MER in a psychosocial context, emphasizing aspects of attachment, the transition into motherhood, and the sociocultural sexualization of the female body.…”

Section: Introductionmentioning

confidence: 99%

“…D-MER is not regarded as a psychological disorder, but rather a physiological one primarily influenced by hormonal factors ( 7 ). To begin with, breastfeeding involves increased production of oxytocin that also affects how quickly cortisol levels drop during breastfeeding.…”

Section: Introductionmentioning

confidence: 99%

“…Another core difference is the nature of the emotions experienced in D-MER there is a feeling of dread, dysphoria, or sadness unlike BAA which is primarily marked by anger and agitation (8). D-MER is not regarded as a psychological disorder, but rather a physiological one primarily influenced by hormonal factors (7). To begin with, breastfeeding involves increased production of oxytocin that also affects how quickly cortisol levels drop during breastfeeding.…”

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confidence: 99%

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Case report: Psychotherapy for enhancing psychological adjustment to dysphoric milk ejection reflex

Deif

2024

Front. Psychiatry

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Given its endless benefits, breastfeeding is widely acknowledged as the optimal choice for both maternal and infant health. Nevertheless, breastfeeding mothers often encounter various challenges that may hinder their ability to fully embrace this experience. This report delves into a compelling case of Dysphoric Milk Ejection Reflex (D-MER), a largely underexamined mental health issue among lactating mothers. D-MER is characterized by intense aversion right before milk let down, which can significantly impede a mother’s willingness to breastfeed. The primary aim of this case report is to provide a comprehensive psychological understanding of D-MER, emphasizing aspects of attachment, the transition into motherhood, and the sociocultural sexualization of the female body. We also offer an overview of the psychotherapeutic journey, highlighting key insights and progress achieved over a span of six months. Therapy adopted an integrative approach combining narrative techniques and skills training such as mindfulness to facilitate a comprehensive therapeutic experience. This case underscores the psychological dimensions of the breastfeeding experience, complementing the well-established biochemical and physiological aspects of D-MER. It also emphasizes the need for further research into the psychological facets of both successful and less successful breastfeeding experiences.

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Re: “Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment” by Liu et al.

Macrina Heise,

Wiessinger

2023

Breastfeeding Medicine

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Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment

Cited by 8 publications

References 18 publications

Dysphoric milk ejection reflex among Japanese mothers: a self-administered survey

Dysphoric milk ejection reflex among Japanese mothers: a self-administered survey

Case report: Psychotherapy for enhancing psychological adjustment to dysphoric milk ejection reflex

Re: “Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment” by Liu et al.

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