Menstrual pain in adolescents linked to psychological distress, but cognitive disengagement syndrome adds little

Menstrual pain in adolescent girls appears to travel alongside small elevations in psychological distress and attention-related symptoms, but a much-discussed attention profile known as cognitive disengagement syndrome adds no explanatory power once distress is taken into account, according to a cross-sectional study published in BMC Women’s Health.

The study included 205 girls aged 12 to 17 years who were recruited from a child and adolescent psychiatry clinic. Menstrual pain intensity was measured with a 0–10 visual analogue scale. Adolescents and their parents completed questionnaires covering cognitive disengagement syndrome, which is characterised by daydreaming and mental fogginess, as well as attention-deficit and hyperactivity/impulsivity symptoms and executive functioning. The adolescents themselves also completed the Brief Symptom Inventory, a measure of psychological distress.

On average, higher reported pain intensity showed small positive correlations with adolescent-reported cognitive disengagement syndrome (a rank correlation of 0.21), attention-deficit symptoms (0.17), hyperactivity/impulsivity symptoms (0.18) and all five subscales of the Brief Symptom Inventory (0.16 to 0.26), with all of these associations remaining statistically significant after adjustment for the false discovery rate. Notably, pain intensity was not correlated with executive functioning, and none of the parent-reported measures showed a significant association with menstrual pain.

The researchers then used hierarchical linear regression to test whether cognitive disengagement syndrome was related to pain intensity beyond demographic factors and distress. After adjustment for age and body mass index, cognitive disengagement syndrome was associated with pain intensity, with a small regression coefficient of 0.022 (95% confidence interval 0.005 to 0.039). However, once psychological distress was added to the model, that association disappeared, with the coefficient falling to −0.004 (95% confidence interval −0.030 to 0.023).

Psychological distress itself remained associated with higher pain intensity in that model, with a coefficient of 0.014 per unit (95% confidence interval 0.003 to 0.025), and the full model explained 8.9% of the variance in pain intensity. In other words, the shared variance between cognitive disengagement syndrome and distress appears to account for the apparent link between the syndrome and menstrual pain, leaving distress as the more robust statistical companion of pain severity in this sample.

The study also examined whether menstrual pain affected daily life. A total of 112 adolescents, or 54.6% of the sample, reported an appreciable adverse impact on everyday life. In a fully adjusted complete-case logistic regression model with 196 participants and 106 such events, greater pain intensity was associated with this outcome, with an odds ratio of 1.82 per visual analogue scale point (95% confidence interval 1.51 to 2.25). Lower body mass index was also associated with the outcome, with an odds ratio of 0.83 per kg/m² increase (95% confidence interval 0.75 to 0.91), meaning that girls with lower body mass index had higher odds of reporting an appreciable adverse impact.

By contrast, cognitive disengagement syndrome, psychological distress and sleep problems were not statistically significant predictors of everyday-life impact in that fully adjusted model. This pattern suggests that the sheer intensity of the pain, rather than the accompanying psychological or cognitive profile, was the dominant factor in whether adolescents reported that menstrual pain disrupted their daily activities.

The authors conclude that, in this psychiatric outpatient sample, menstrual pain co-occurred with small elevations in adolescent-reported cognitive disengagement syndrome, attention-related symptoms and psychological distress, while no parent-reported associations were found. They emphasise that cognitive disengagement syndrome showed no additional association with pain after adjustment for psychological distress.

Several limitations deserve emphasis. The study is cross-sectional, so it cannot establish causality or the temporal direction of any relationship; it is not possible to say whether distress amplifies the experience of menstrual pain, whether severe pain contributes to distress, or whether both reflect other factors. The sample consisted of girls attending a child and adolescent psychiatry clinic, which may limit how far the findings generalise to adolescents in the general population. The correlations reported were small, and the pain model explained less than a tenth of the variance in pain intensity.

Despite these caveats, the authors suggest that the findings support asking adolescents directly about menstrual pain in clinical settings. Given that more than half of the participants reported an appreciable adverse impact on everyday life, and that pain intensity was the strongest statistical predictor of that impact, the study underscores that menstrual pain is a common and consequential complaint in this age group, one that clinicians may wish to raise with adolescent patients and their families rather than relying on parent reports alone.

Subject of Research: Cross-sectional associations between dysmenorrhoea severity and psychological and cognitive symptoms in adolescent girls

Article Title: Psychological and cognitive symptom correlates of dysmenorrhoea severity in adolescents: a cross-sectional study of cognitive disengagement syndrome

Article References: Kabukçu, C., Başay, Ö., Kabukçu Başay, B., & Ormancı, Z. I. (2026). Psychological and cognitive symptom correlates of dysmenorrhoea severity in adolescents: a cross-sectional study of cognitive disengagement syndrome. BMC Women's Health. https://doi.org/10.1186/s12905-026-05034-5

Image Credits: AI Generated

DOI: 10.1186/s12905-026-05034-5

Keywords: dysmenorrhoea, adolescents, menstrual pain, cognitive disengagement syndrome, psychological distress, cross-sectional study, child and adolescent psychiatry, visual analogue scale, body mass index, BMC Women's Health, Psychological, cognitive