Response to Helse and Wiessinger re: “Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment”

Dear Editor:

Thank you very much for your letter, and I would also like to thank Alia Heise and Diane Wiessinger for their comment ¹ and attention to our article, ² and express my gratitude and respect for their rigorous attitude toward scientific research. After carefully reading the comment, I notice that there is some disagreement about the use of the term “suicidal tendency” in our article. I would like to address this matter with the following responses.

First, we reported two mothers with Dysphoric milk ejection reflex (D-MER) in our article. D-MER is characterized by abrupt negative emotions that occur just before milk release and last no more than a few minutes. The mother in the first case recalled having suicidal ideation during breastfeeding and also an act of suicidal attempt (or self-harm). She once hit her head with a water glass and said it was a momentary impulse. She recalled that being troubled by chores and having a strained marital relationship during the lactation period, so she was unsure whether her suicidal ideation or self-harm was caused by D-MER or other negative factors. Owing to the unknown reasons of her act, we did not mention about her suicidal attempt (or self-harm) in the article, but we had paid much attention to her D-MER experience.

Second, after reviewing research about D-MER, we learned that severe negative emotions are common among lactating women with D-MER, and when we searched for information on https://d-mer.org, we found the D-MER handouts that described the content that “Some mothers have very mild D-MER.…..there are some mothers who feel extreme emotions resulting in suicidal ideation, thoughts of self-harm or feelings of anger.” But it seems that the handouts can no longer be found and downloaded on the website now (the content is in page 11 of Appendix 2).

After considering the experience of the mother in the above case, we decided to use the term “suicidal tendency” to draw attention to the potential effects of D-MER. In addition, many studies have shown that suicidal ideation is related to suicidal behavior, although suicidal ideation does not necessarily lead to suicidal behavior, “suicidal ideation/thought/attempt” is still a significant predictor of suicidal behavior that should not be neglected.^3–5

In addition, to make our writing more rigorous, we used the word “may” to describe the effects of D-MER in the article: “These emotions (D-MER) may adversely affect …, negatively influence … and even result in self-harm or suicidal tendencies in lactating women.” Since our native language is Chinese, the Chinese words for “suicidal ideation” and “suicidal tendency” are “” and “” (or ), respectively, which are very close in meaning.

Perhaps this is also the reason why some of the grammar or vocabulary may not be as precise in the writing process. Therefore, I completely understand Heise's and Wiessinger's concerns and I would like to once again express my gratitude and respect for their comments, as well as their rigorous attitude toward scientific research, which reminds me to be more rigorous and careful in my future scientific writing.

Lastly, our purpose in researching D-MER is the same as Heise's. It is to raise awareness of the physical and psychological health concerns of lactating women and to promote better understanding of D-MER.

We thank the staff of editorial office of Breastfeeding Medicine for their hard work and warm help earnestly. Have a nice day!