Symptoms of Premenstrual Dysphoric Disorder

05 September, 2020
It's estimated that 3-5% of women experience premenstrual symptoms that prevent them from leading a normal life. In this article, we'll talk about this problem in more detail.
 

Premenstrual dysphoric disorder (PMDD) is a serious, and sometimes disabling, form of PMS. Silvia Gaviria provides us with one of the aptest definitions of premenstrual dysphoric disorder. She describes it as a set of emotional, behavioral, and somatic symptoms that appear at the end of the luteal phase, disappearing again two to three days after menstruation begins.

Both PMS and PMDD can cause physical and emotional symptoms. However, in the case of PMDD, the person may experience extreme mood swings that disrupt their work and damage their relationships.

In both PMS and PMDD, symptoms generally begin seven to ten days before menstruation begins, and continue throughout the first few days of menstruation. In terms of physical symptoms, the person may experience breast swelling and tenderness, fatigue, and changes in sleeping and eating habits.

Depression and mood disorders.

Epidemiology

Premenstrual dysphoria is a severe form of premenstrual syndrome that affects approximately 5% of women of childbearing age. Many patients report experiencing symptoms of PMDD from as early as their first menstrual period. It tends to become more common as women reach their thirties and forties, and usually continues until menopause. In a small number of cases, symptoms can also spontaneously disappear.

 

Symptoms often appear or worsen after childbirth, with age, after starting or stopping oral contraceptives, and after undergoing tubal ligation.

Among the many clinical variables associated with premenstrual dysphoric disorder are a history of major depressive disorder and postpartum depression, both of which also tend to occur more frequently in those who’ve been diagnosed with PMDD.

Causes

Premenstrual dysphoric disorder is caused by a number of closely related genetic, neurobiological, and endocrine factors. Most researchers believe that it may be an abnormal reaction to hormonal changes linked to the menstrual cycle.

Studies have shown a connection between premenstrual dysphoric disorder and low serotonin levels. Hormonal changes can cause a decrease in serotonin production, leading to symptoms of premenstrual dysphoric disorder.

Symptoms of premenstrual dysphoric disorder, according to the DSM and ICD

After the publication of the DSM-IIIR, this disorder began to receive more attention in the world of psychiatry, under the name of Late Luteal Phase Dysphoric Disorder. It wasn’t until later, with the publication of the DSM-IV, that it became known as premenstrual dysphoric disorder.

In manuals such as the ICD-10, PMDD isn’t considered a disorder at all, differing in both its interpretation and definition of the condition. However, in the new DSM-5, premenstrual dysphoric disorder is classified as a type of depressive disorder.

 

To ensure an accurate diagnosis, the doctor must take a medical history and carry out a physical examination. The patient should keep a calendar or diary of their symptoms to help their doctor diagnose PMDD.

You must have five or more symptoms of PMDD, including one mood-related symptom, in order to be diagnosed.

Diagnostic criteria of premenstrual dysphoric disorder (PMDD) according to the DSM-5

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

B. One (or more) of the following symptoms must be present:

  1. Marked affective lability.
  2. Marked irritability or anger or increased interpersonal conflicts.
  3. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.

C. One (or more) of the following symptoms must be present to reach a total of five symptoms when combined with symptoms from Criterion B above.

  1. Decreased interest in usual activities.
  2. Subjective difficulty in concentration.
  3. Lethargy, easy fatigability, or marked lack of energy.
  4. Marked change in appetite; overeating or specific food cravings.
  5. Hypersomnia or insomnia.
  6. A sense of being overwhelmed or out of control.
  7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or weight gain.
 

Note: the symptoms listed in Criteria A-C must have been met in the majority of menstrual cycles that occurred in the preceding year.

D.  The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (note: The diagnosis may be made provisionally before this confirmation.)

G. The symptoms are not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).

A woman sitting in bed.

Diagnosing premenstrual dysphoric disorder: criticisms and controversy

The DSM-5 diagnostic criteria have sparked great criticism, due to concerns of over-pathologization. Premenstrual dysphoric disorder is at the center of this debate. The DSM-5 classifies PMDD and the symptoms experienced in the days before menstruation as a depressive disorder.

 

However, many experts have questioned whether it’s appropriate to label half the population with a mental disorder once a month. This is the question at the heart of the debate. Is it really possible to pathologize a natural process based on the symptoms it causes in a small proportion of women for a few days each month?