Criteria for premenstrual dysphoric disorder: secondary analyses of relevant data sets

Arch Gen Psychiatry. 2012 Mar;69(3):300-5. doi: 10.1001/archgenpsychiatry.2011.1368.


Context: There is substantial information that premenstrual dysphoric disorder (PMDD) is a clinically significant disorder with biological underpinnings that differ from other psychiatric disorders. However, data regarding the symptoms noted in DSM-IV and timing of their expression in the menstrual cycle have had little empirical support.

Objective: To provide evidence informing the definitional criteria for PMDD.

Design: Prospective surveys.

Setting: General community and clinical settings.

Participants: Two cohorts that included a representative sample and a self-identified treatment-seeking cohort. Main Outcome Measure Daily ratings of perimenstrual symptoms and functioning.

Results: Mood and physical symptoms were most severe and were accompanied by impairment in the 4 days before through the first 2 days of menses for the self-identified group and in the 3 days before through the first 3 days of menses in the community sample. The most problematic symptoms endorsed were those listed in DSM-IV, but depressed mood was less frequent than other affective symptoms. In the combined sample, 4 or more symptoms was the optimal cutoff point for maximizing both sensitivity and specificity when predicting impairment.

Conclusions: This is informative for DSM-5 in that the most symptomatic period typically includes the few days before through the first 3 days of menses rather than only the premenstrual phase. Further, we validated the salience of PMDD symptoms included in DSM-IV. Although the number of symptoms most associated with distress and impairment differed between the 2 cohorts, results from the combined cohort suggest that 4 symptoms are linked with impairment from PMDD symptoms.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect
  • Female
  • Humans
  • Premenstrual Syndrome / diagnosis
  • Premenstrual Syndrome / physiopathology
  • Premenstrual Syndrome / psychology*
  • Prospective Studies
  • Severity of Illness Index