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Diagnosing D-MER
Why Diagnosis is Important
Not every breastfeeding mother with a negative feeling when breastfeeding has D-MER and it is usually not a valid reason for weaning

D-MER is not a breastfeeding problem that should give mothers an excuse to give up breastfeeding, or at least give up easily. Mothers who truly do have D-MER can use their new found diagnosis as encouragement so that they can continue breastfeeding. This is why d-mer.org is here and why the battle was fought to make it a recognized condition, so that mothers were empowered, so that they understood what was happening and so that they could go on. Mothers can diagnose themselves, of course, especially if they are not seeking treatment. But it needs to be done thoughtfully and carefully and not used as a reason to not choose breastfeeding. (see weaning below)

Who Suffers from D-MER 
No likely predisposition to D-MER other than a history of D-MER

It is not yet known what causes one mother to have D-MER and not another. At this time is appears to be a breakdown in the way the hormone functions, since once a mother has D-MER, she will have it with any subsequent nurslings. (see "similar experiences" below)

How Do Mothers Get D-MER
Known mechanism but unknown cause

It is known D-MER is dopamine mediated but it is unknown why some mothers have this particular problem and not others. It could be an environmental effect, a nutritional deficiency, a breakdown in normal hormonal activity as she ages. It could be she is more sensitive to a normal drop in dopamine, dopamine receptor mutation,  a predisposition to abnormal dopamine activity or some other unknown cause.

History
A mother's medical or personal history does not dictate D-MER

Mothers do not get D-MER because they were sexually abused or because of a traumatic birthing experience. If a mother feels reminiscent of an earlier time in her life during D-MER it is not indicative of a psychological response to breastfeeding. When a mother experiences D-MER, the emotions she feels may cause her to remember those upsetting times in her life, but the experiences are not triggering the D-MER. The emotions she experiences with D-MER may be reminiscent of how she felt during those times, and therefore make her think back to them because the feeling is similar. This is likely because D-MER by itself  creates this dopamine drop in a mother's body, making her feel this way regardless of her past life experiences. If she happened  to have a life experience in the past that caused the same dopamine drop to occur, then she is likely to have a deja vu feeling with each D-MER as that dopamine drop repeats itself.

The Language She Uses
The way a mother describes her D-MER helps determine the diagnosis of D-MER

Mothers with D-MER often use very similar language and words. Very rarely will be an utterance of "I don't like breastfeeding". In fact many mothers with D-MER like breastfeeding aside from their moments of dysphoria. When a mother begins to open up about the negative feelings she is having at the time of milk release she often uses many of the following words and phrases: hollow, intense, feels like, seconds, stomach, rush, overwhelming, minutes, fade away, feelings, before letdown, lose of appetite, wave, sudden, pit in stomach, negative. 

D-MER with Letdowns
When and how often she experiences D-MER with letdowns helps determine D-MER

A mother with D-MER will experience dysphoria with at least the first milk ejection reflex of a feeding while the baby is at the breast. This is part of the criteria for diagnosis. She may also experience dysphoria with further MERs during the feeding (2-12 during a feeding is possible). Many mothers with D-MER have dysphoria with MER(s) during pumping and with spontaneous milk ejection but these points are not necessary criteria for a diagnosis. There have been a very small sample of mothers that have reported experiencing dysphoira just when they pump and not when they put the baby to the breast, we are still exploring the possibility of this being D-MER, it is not yet known. It is known that exclusive pumpers can have D-MER and many mothers report the dysphoira with pumping and with spontaneous letdowns to be worse than the dysphoira with MER that is felt when the baby is at the breast. It is felt at this time that this is possible because the bonding and oxytocin effect is greater when nursing at the breast than it is with spontaneous letdowns and with pumping. Meaning, higher oxytocin levels may help cancel out some of the dysphoric feelings.

Other Possible Causes
Other things can cause mothers to have an emotional reaction to breastfeeding

D-MER can be misdiagnosed and not every emotional reaction to breastfeeding will be D-MER. If D-MER does not seem to be a good fit it is important to explore some other possibilities. All of these other possibilities are valid reasons for mothers to be uncomfortable breastfeeding and other solutions should be found to help her work through the issues. These other possibilities can include: 
  • Breastfeeding aversion due to nursing an older baby or if she is nursing while pregnant
  • A Physical reactions to letdown such as nausea 
  • Postpartum depression
  • A general dislike of breastfeeding (it takes too long, hurts too much, etc.)
  • A psychological response to breastfeeding (history of sexual abuse as an example) 

Similar Experiences 
Some mothers report having D-MER-type feelings with other medical causes

Though it is not a rule by any means it has been found that a few mothers explain having D-MER type feelings unrelated to lactation in the following situations: restless leg syndrome, premenstrual dysphoric disorder, prior to hot flashes during menopause, emotional reaction to nipple play in sexual situations, a dysphoric feeling in the stomach prior to experiencing a seizure and dysphoria after orgasm. These situation may all be dopamine mediated and it is possible that if a mother has a history of dysphoria in these situations she may be more predisposed to D-MER. 

Weaning
Most mothers with D-MER do not feel the need to wean
In our survey of 100 breastfeeding  mothers with D-MER we saw very few people who found their D-MER to be so intrusive that they decided to wean. Only in the severe cases of D-MER, which are the most uncommon, did we find mother's at risk for weaning. What we did find in our survey was that mother's who nursed in spite of D-MER were often not "main stream" mothers. These D-MER mothers that found our survey were ones who had decided prenatally that breastfeeding was a "do or die" type of choice. Lots of mothers go into the birth "undecided" or "willing to try" and many things can go wrong that make them decide breastfeeding is going to work for them. It is true that D-MER is and will be used as an excuse for weaning. But most often in these cases (with the exception of severe D-MER that does not respond to treatment) the mothers who are weaning would have likely found some other reason to wean anyway.