The defining characteristics of premenstrual dysphoric disorder (PMDD) is the expression of mood lability, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the premenstrual phase of the cycle and remit around the onset of menses or shortly thereafter.
The prevalence of premenstrual dysphoric disorder is between 2 and 6 percent.
Specific Symptoms of Premenstrual Dysphoric Disorder
1. In the majority of menstrual cycles, at least 5 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 after menses.
2. One or more of the following symptoms must be present:
- Marked affective lability (e.g., mood swings, e.g., feeling suddenly sad or tearful, or increased sensitivity to rejection).
- Marked irritability or anger, or increased interpersonal conflicts.
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
3. One or more of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with the symptoms from #2 above:
- Decreased interest in usual activities (e.g., work, school, friends, hobbies).
- Subjective difficulty in concentration.
- Lethargy, easily fatigued, or marked lack of energy.
- Marked change in appetite, e.g., overeating or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being overwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or weight gain.
The above symptoms must have been met for most menstrual cycles that occurred in the preceding year.
4. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
5. 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).
6. The first criteria (#1) should be confirmed by prospective daily ratings during at least two symptomatic cycles.
7. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
This diagnosis is new to the DSM-5. Code: 625.4 (N94.3)