Premenstrual Dysphoric Disorder (PMDD)

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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When should I call a doctor about PMDD?

It is appropriate to seek medical care for troubling physical or emotional symptoms related to the menstrual cycle.

It is important to note that the depressive symptoms of PMDD may be associated with thoughts of suicide and suicidal behavior. This is a medical emergency for which medical attention should be accessed immediately.

How is PMDD diagnosed?

PMDD must be distinguished from other physical and psychological conditions that can produce the same symptoms. The differential diagnosis (list of conditions that may produce the same symptoms) includes both mood and anxiety disorders as well as medical conditions such as thyroid disease. In addition to a thorough medical history and physical examination, blood tests may be performed to rule out whether medical conditions may be present that may account for the PMDD symptoms.

If PMDD is a concern, it is recommended that women complete a symptom chart or calendar prospectively (meaning that they record their symptoms each day for a given period) to establish the diagnosis. The symptom chart can be compared with the menstrual calendar to illustrate the relationship of symptoms to the menstrual cycle.

The American Psychiatric Association has established formal guidelines for the diagnosis of PMDD in their Diagnostic and Statistical Manual (DSM-IV). The DSM-IV diagnostic criteria for the diagnosis of PMDD require prospective documentation of symptoms being present for at least two consecutive menstrual cycles.

Five or more of the following symptoms must have been present during the week prior to the menstrual period and resolve within a few days of the start of the woman's period. The symptoms must interfere with the activities of a woman's daily living and not be a result of another condition or illness. At least one of the symptoms must be one of the first four on the list:

  • feeling sad, hopeless, or self-deprecating;
  • feeling tense, anxious, or "on edge;"
  • marked changes in mood, becoming sad or tearful;
  • persistent irritability, anger, and increased interpersonal conflicts;
  • decreased interest in usual activities, which may be associated with withdrawal from social relationships;
  • difficulty concentrating;
  • feeling fatigued, lethargic, or lacking in energy;
  • marked changes in appetite, which may be associated with binge eating or craving certain foods;
  • hypersomnia (excessive sleeping) or insomnia;
  • a subjective feeling of being overwhelmed or out of control; and
  • other physical symptoms, such as breast tenderness or swelling, headaches,joint or muscle pain, a sensation of bloating, weight gain.
Medically Reviewed by a Doctor on 2/6/2015
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