Premenstrual Dysphoric Disorder (PMDD)

The premenstrual dysphoric disorder (English  premenstrual dysphoric disorder ,  PMDD ) is a severe disorder, sometimes disabling. The most appropriate definition was given by Silvia Gaviria, a scholar who presents this disorder as a set of emotional, behavioral and somatic symptoms that appear at the end of the luteal phase and end with menstruation.

Both PMS and PMD are characterized by physical and emotional symptoms. In the second, however, extreme mood swings occur that can even interrupt work and damage relationships.

In both cases, symptoms appear seven to ten days before the period begins and continue during the first days of menstruation. Nipple swelling and pain, fatigue, sleep and eating disorders may occur. In the following lines, however, we focus on the symptoms of premenstrual dysphoric disorder.

Epidemiology

Premenstrual dysphoric disorder is a severe variant of PMS that affects approximately 5% of women of childbearing age. This disease already occurs with menarche in many women. The likelihood of suffering from it increases between the ages of thirty and forty, remaining until menopause. In some cases it stops manifesting spontaneously.

Symptoms usually begin or worsen after childbirth, with age, with taking or stopping oral contraceptives, or after having tubal closure surgery.

Clinical variables associated with PMD include major depressive disorder and postpartum depression, which in turn occur more frequently after a diagnosis of PMDD.

Causes of premenstrual dysphoric disorder

It is caused by closely related genetic, neurobiological and endocrine factors. The scientific community believes that it may be an abnormal reaction to hormonal changes related to the menstrual cycle.

Field studies have shown a connection between premenstrual dysphoric disorder and low serotonin levels. Hormonal fluctuations can cause decreased serotonin secretion, which leads to symptoms of premenstrual dysphoric disorder.

Symptoms table for premenstrual dysphoric disorder

Since the edition of the DSM III-R this disorder has been included and studied in psychiatry under the name of premenstrual dysphoric disorder (PMDD). later, in the DSM-IV, it was included under the nomenclature of dysphoric disorder of the luteal phase.

In the ICD-10 classification it is not considered a disorder, and significant differences have been highlighted both in the literature and in its interpretation and definition. However, premenstrual dysphoric disorder is included among the depressive disorders in the new DSM-5.

In order to make an accurate diagnosis, the doctor must know the patient’s medical history and proceed with a physical examination. It is recommended that you keep a calendar or symptom diary to aid in diagnosis. Specifically, you must have five or more symptoms, including a mood-related symptom.

Diagnostic criteria of premenstrual dysphoric disorder in DSM-5

A. In most menstrual cycles, at least five symptoms must occur in the week preceding the onset of menstruation; these begin to improve a few days after the start of menstruation and become minimal or disappear in the following week.

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

1. Intense emotional lability.
2. Strong temper or anger or increased interpersonal conflict.
3. Very depressed mood, feelings of hopelessness or self-denial.
4. Anxiety, tension and / or feeling extremely excited or nervous.

C. One (or more) of the following symptoms must also be present, for a total of five symptoms when combined with the symptoms in Criterion B.

1. Decreased interest in habitual activities (work, school, social life, hobbies).
2. Difficulty concentrating.
3. Lethargy, fatigue or severe lack of energy.
4. Changes in appetite: a tendency to overeat or a desire to eat specific foods.
5. Hypersomnia or insomnia.
6. Feeling overwhelmed or out of control.
7. Physical symptoms such as breast pain or swelling, joint or muscle pain, a feeling of ‘bloating’ or weight gain.

Note: Symptoms in the AC criteria must have been met for most of the previous year’s menstrual cycles.

D. Symptoms are associated with clinically significant distress.

E. The disorder is not simply an exacerbation of another’s symptoms, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia) or personality disorder. However, it can coexist with one of them.

F. Criterion A must be confirmed by prospective daily assessments for at least two symptomatic cycles. (Note: the diagnosis can be made provisionally before this confirmation).

G. Symptoms cannot be attributed to the physiological effects of a substance or to another medical condition (for example, hyperthyroidism).

The debate

The diagnostic categories of the DSM-5 have raised numerous controversies in terms of excessive pathologization; premenstrual dysphoric disorder is at the center of this controversy. This pathology appears in the DSM-5 within depressive disorders and mainly refers to the mood of the woman in the days before menstruation.

The question is, can we define half of the population as mentally ill once a month? Can a natural physiological process become a real pathology due to the reactions that affect some women during menstruation? The debate remains open.