PMDD (premenstrual dysphoric disorder)

Last edited 09/2018

Premenstrual dysphoric disorder (PMDD)

PMDD is considered to be a severe form of premenstrual syndrome (1).

Premenstrual dysphoric disorder (PMDD) is term adopted by the American Psychiatric Association (APA) to describe a severe, debilitating form of premenstrual disorder (1).

• introduced in the American Psychiatric Association in Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, PMDD was described in the appendix since additional research was needed to confirm the distinctiveness of the diagnosis from other disorders. However in DSM-V, PMDD has been moved to the full diagnostic category (1)

It is believed to affect around 3-8% of women of reproductive age (1,2)

• one study has reported that up to 18% of women lacked only one of the requisite symptoms for a PMDD classification, indicating that many women are "near threshold" for the diagnosis (2)

Women with PMDD have a 50-78% lifetime incidence of other psychiatric disorders (1).

A substantial impairment of productivity in the workplace and a higher rate of absenteeism have been documented in women with PMDD.

• in addition, adverse effects of the condition were found to be greater than chronic back pain, and comparable to debilitating conditions, such as osteoarthritis and rheumatoid arthritis.
• women suffering from PMDD were significantly more likely to report suicidal ideation when compare to women without PMS (1)

Note that bth premenstrual syndrome (PMS) and PMDD fall under the umbrella of "core PMD" (1).

Notes (2,3):

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 o for diagnosis of PMDD, above three criteria 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

Reference:

• Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Women's Health. 2013;9(6): 537-556
• Grady-Weliky TA. Clinical practice. Premenstrual dysphoric disorder. N Engl J Med. 2003;348(5):433-8
• Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. Am Fam Physician. 2002;66(7):1239-48