Premenstrual Dysphoric Disorder

Excerpt

Premenstrual symptoms include a constellation of mood, behavioral, and physical indications that occur in a cyclic pattern prior to menstruation and then wane off after the menstrual period in women of reproductive age. Most females have only mild discomfort, and symptoms do not interfere with their personal, social, or professional lives; however, 5% to 8% of women have moderate-to-severe symptoms that can cause significant distress and functional impairment.

Although premenstrual symptoms have been recognized for a long time, the diagnostic criteria have been specified only recently. The nomenclature for premenstrual disorders has changed significantly over the years, evolving from "menses moodiness" in the 18th century to "premenstrual tension" in the early part of the 19th century to finally, "premenstrual syndrome" in the 1950s. While some discomfort prior to menses is quite common, premenstrual syndrome (PMS) includes the subset of women who experience symptoms that are severe enough to impact daily activities and functioning. Late luteal dysphoric disorder (LLDD), now known as premenstrual dysphoric disorder (PMDD), accounts for the most severe form of PMS with the greatest impairment of women’s functioning and perceived quality of life, often prompting them to seek treatment. Anyone who has ovaries can have PMDD, including transgender individuals.

Currently, PMDD is listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a separate entity under Depressive disorders, with the criteria for diagnosis as follows:

Criterion A - At least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) should be present:

1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

2. Marked anxiety, tension, feelings of being “keyed up” or “on edge”

3. Marked affective lability

4. Persistent and marked anger or irritability or increased interpersonal conflicts

5. Decreased interest in usual activities (eg, work, school, friends, and hobbies)

6. Subjective sense of difficulty in concentrating

7. Lethargy, easy fatigability, or marked lack of energy

8. Marked change in appetite, overeating, or specific food cravings

9. Hypersomnia or insomnia

10. A subjective sense of being overwhelmed or out of control

11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.

Criterion B - symptoms severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning.

Criterion C - symptoms discretely related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although the symptoms may be superimposed on those of these disorders).

Criterion D - criteria A, B, and C are confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.

Women with moderate-to-severe PMS or PMDD experience more quality-of-life detriments and work-productivity losses and incur greater healthcare costs than women with no or only mild symptoms.