Premenstrual Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of mood disorder that occurs in the second half (luteal phase) of the menstrual cycle. The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that happens with each menstrual cycle. The hormone changes may cause a serotonin deficiency.

Any woman can develop PMDD; women with a personal or family history of depression, postpartum depression or other mood disorders are at increased risk. 

PMDD is defined in the Diagnostic and Statistical Manual for DSM-5 by:

• In the majority of menstrual cycles, at least five symptoms listed below 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 after the menstrual flow begins.
• One or more of the following symptoms must be present:
  • Marked mood lability or increased sensitivity to rejection
  • Marked irritability or anger or increased interpersonal conflicts
  • Depressed mood, feelings of hopelessness or self-deprecating thoughts
  • Anxiety, tension and/or feelings of being keyed up or on edge
• One (or more) of the following symptoms must also be present to reach a total of five symptoms when combined with symptoms from above:
  • Decreased interest in usual activities
  • Difficulty in concentration
  • Lethargy, easy fatigability or marked lack of energy
  • Marked change in appetite; overeating or specific food cravings
  • Sleeping too much or too little
  • Feeling overwhelmed or out of control
  • Symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain
• In terms of the severity of symptoms, the symptoms are associated with clinically significant distress or interference with work, school, usual social activities or relationships with others
• Consider other psychiatric disorders: 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)

Confirmation of the disorder — the recurring pattern of symptoms described in the first bullet above — is confirmed by prospective daily ratings during at least two symptomatic cycles. If you believe you may have PMDD, chart your symptoms course on a calendar.