diagnosis of premenstrual dysphoric disorder

Last edited 09/2018

• premenstrual dysphoric disorder (PMDD) is a relatively new term, with more specific and stringent diagnostic criteria
  • the diagnostic criteria emphasise the severity and associated major disruption to life and relationships caused by the disorder
  • PMDD is believed to affect around 3-8% of women of reproductive age
  • to fulfil the diagnosis of PMDD, a woman should have had at least five of the following, present to a marked degree, in the week before menstruation for most months of the previous year:
    • depressed mood
    • emotional lability
    • irritability and anger
    • poor concentration
    • tension and anxiety
    • loss of interest in usual activities
    • altered eating habits or food cravings
    • disturbed sleep patterns;
    • lethargy and fatigue
    • feeling overwhelmed or out of control
    • physical symptoms such as headache, breast tenderness, weight gain and feeling bloated
    • the features must include at least one mood or anxiety symptom and should severely interfere with social and occupational functioning
      
      
  • diagnosis of PMDD must be confirmed prospectively by means of daily diary ratings of symptoms - this is undertaken over at least two consecutive cycles
    • the diary should show reveal evidence of worsening during the 14 days preceding onset of menses (i.e. in the luteal phase) with at least 1 week free from symptoms in the follicular phase
    • note that retrospectively recalled symptoms are unreliable and should not be used to make the diagnosis
    • it is important to exclude premenstrual exacerbations of other disorders such as major depression or anxiety disorders, which commonly co-exist with PMDD
      • prospective diary records will usually distinguish PMDD from major depression, since only in PMDD do the symptoms remit completely during the follicular phase of the cycle
        
        

    diagnostic criteria for premenstrual dysphoric disorder

    DSM-V diagnostic criteria for premenstrual dysphoric disorder include;

  A) five (or more) of the following symptoms occurred during the week before menses and remitted a few days after the onset of menses

  • At least one of the symptoms being either 1, 2, 3 or 4:

    • marked lability (e.g., mood swings, suddenly feeling sad or tearful, or increased sensitivity to rejection)
    • marked irritability or anger
    • markedly depressed mood
    • marked anxiety and tension
    • decreased interest in usual activities
    • difficulty in concentration
    • lethargy and marked lack of energy
    • marked change in appetite (e.g., overeating or specific food cravings)
    • hypersomnia or insomnia
    • feeling overwhelmed or out of control
    • physical symptoms (e.g., breast tenderness or swelling, joint or muscle pain, a sensation of 'bloating' and weight gain)
      
      

    B) the symptoms interfere with work, school, usual social activities or relationships with others
    
    C) the symptoms are not an exacerbation of the symptoms of another disorder (e.g., major depressive disorder, panic disorder, dysthymic disorder or a personality disorder)
    
    D) criteria A, B and C should be confirmed by prospective daily ratings during at least two consecutive cycles
    
    E) the symptoms are not due to the direct physiologic effects of drugs of abuse, medications or an underlying medical disorder

Reference:

1. Drug and Therapeutics Bulletin (2002); 40(9):70-2.
2. Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Women's Health. 2013;9(6): 537-556