Diagnosis of premenstrual dysphoric disorder

• 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/)