Medical Health Encyclopedia

Premenstrual dysphoric disorder (PMDD), also called late-luteal dysphoric disorder, is a condition marked by severe depression, irritability, and tension before menstruation. Studies in Europe and the US estimate that PMDD affects between 3 - 8% of women in their reproductive years. PMDD has features of both anxiety and depression disorders, although increasingly experts believe it is a distinct disorder with specific biochemical actions.

Diagnostic Criteria. Symptoms must occur during the last week of the premenstrual (luteal) phase in most menstrual cycles. They should resolve within a few days after the period starts.

Five or more of the following symptoms must be present:

• Feeling of sadness or hopelessness, possible suicidal thoughts.
• Feelings of tension or anxiety. (Panic attacks, in fact, may be much more common in patients with PMDD than in the general population.)
• Mood swings marked by periods of teariness.
• Persistent irritability or anger that affects other people.
• Disinterest in daily activities and relationships.
• Trouble concentrating.
• Fatigue or low energy.
• Food cravings or bingeing.
• Sleep disturbances.
• Feeling out of control.
• Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain.

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Some experts are concerned that the inclusion of premenstrual dysphoric disorder (PMDD) in the psychiatric diagnostic literature may misrepresent the physical nature of the problem. They warn that such categorization may restrict research on PMS only to psychiatric areas. Furthermore, both women with PMDD and their doctors may view their PMS only as a psychiatric disorder and not as a condition that may have physiologic causes unrelated to classic depression.

From The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, DC, ©American Psychiatric Association 1994.