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Diagnosis of premenstrual dysphoric disorder

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  • Premenstrual dysphoric disorder (PMDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as occurring when a woman suffers from at least five distinct psychological premenstrual symptoms. Severe PMS is referred to as premenstrual dysphoric disorder (PMDD).
    • 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

    • A diagnosis of PMDD must be confirmed prospectively by means of daily diary ratings of symptoms - this is undertaken over at least two consecutive cycles diagnostic criteria for premenstrual dysphoric disorder DSM-V diagnostic criteria for premenstrual dysphoric disorder include;
      • 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

    • At least one of the symptoms; (3)
    • interferes with work, school, usual social activities or relationships with others
    • is not an exacerbation of the symptoms of another disorder (e.g., major depressive disorder, panic disorder, dysthymic disorder or a personality disorder)
    • is confirmed by prospective daily ratings during at least two consecutive cycles
    • is not due to the direct physiologic effects of drugs of abuse, medications or an underlying medical disorder
      • 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)

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
  3. Premenstrual syndrome | Health topics A to Z | CKS | NICE (https://cks.nice.org.uk/topics/premenstrual-syndrome/)

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