Women who suffer from severe dysphoric premenstrual complaints can now be accurately diagnosed. A diagnosis of premenstrual dysphoric disorder is best made by ruling out other psychiatric and general medical conditions and by collecting daily ratings of symptom expression across the menstrual cycle. Recent treatment findings support the use of (1) antidepressants that block the serotonin transporter, and (2) the benzodiazepine anxiolytic alprazolam. Medication administered only during the luteal phase of the cycle will result in substantial relief for patients suffering from severe premenstrual dysphoric disorder.