What You Need to Know About Premenstrual Dysphoric Disorder
Most women would say they have PMS. Inevitably, once a month you get cranky, weep at funny movies, have mood swings, get cramps or feel bloated. In fact, about 85 percent of women experience one or two premenstrual symptoms.
But this isn’t PMS, also known as premenstrual syndrome. According to Andrea Rapkin, M.D., a professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, there’s confusion over the true definition of premenstrual syndrome – and it seems to get applied to everyone who has a period.
In actuality, only about 8 to 18 percent of women struggle with PMS, she said. The American Congress of Obstetricians and Gynecologists (ACOG) defines PMS as severe enough to significantly disrupt a woman’s day-to-day life.
About 5 to 10 percent of women struggle with an even more debilitating form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD), which impairs social and occupational functioning, according to Samantha Meltzer-Brody, MD, MPH, director of the Perinatal Psychiatry Program at the UNC Center for Women’s Mood Disorders. PMDD begins one to two weeks before menstruation and stops within four days after the onset of menstruation (called the luteal phase).
Women struggle with a variety of symptoms, such as irritability, anxiety, anger, sadness or loss of interest. Some may be argumentative, lash out at loved ones (and feel guilty afterward) and even feel paranoid.
According to the DSM-IV, in order to be diagnosed with PMDD, a woman must have five of the following symptoms for at least a year (* with at least one of these symptoms).
- Mood swings*
- Loss of interest in activities
- Difficulty concentrating
- Lack of energy
- Depressed mood or hopelessness*
- Tension or anxiety*
- Sleep changes
- Appetite changes
- Feeling out of control or overwhelmed
- Physical symptoms, such as bloating
PMDD often gets confused with major depression (MDD) because of their similar symptoms. “At least 50 percent of women who self refer for PMDD actually have MDD,” according to Dr. Meltzer-Brody. For this reason, a diagnosis is only made after a woman keeps daily ratings of her symptoms for at least two months, she said. Retroactive recall, she said, is not accurate.
But it can still get tricky, because women with major depression may notice that their mood sinks even more during the luteal phase, Meltzer-Brody said. “However, women with MDD will not return to normal mood in the follicular phase [the first half of the menstrual cycle] – they will continue to exhibit mood symptoms all month to some degree,” she said.