PMS vs. PMDD - Whats' the Difference?

Medical Author: Carolyn Janet Crandall, M.D., FACP
Medical Editors: Melissa Conrad Stöppler, MD and William C. Shiel Jr., MD, FACP, FACR

Ms. B.T. is 38 years old. Her co-workers always seem to know when she has her period. During this time, she becomes extremely irritable. She feels guilty because she gets very angry at her children for no logical reason or for apparently trivial reasons. In fact, one of her coworkers, with whom she is quite friendly, suggested she come in before her supervisor noticed problems on the job. She heard that there is a severe version of PMS that requires special treatment. Ms. B.T. wants to know if this is her problem.

Premenstrual syndrome (PMS) has been the term used for mood, and sometimes physical, symptoms that occur cyclically (predictably in relation to menses) in the second half of the menstrual cycle and interfere with a woman's quality of life. Some women experience even more severe symptoms. These women may have a conditions known as premenstrual dysphoric disorder (PMDD).

In order to determine what condition is affecting Ms. B.T., the doctor first requests that she keep a symptom diary, which is required for the diagnosis of PMDD. In the diary, she records in detail her mood and physical symptoms, and eating and sleeping patterns over two menstrual cycles.

Ms. B.T. returns to the doctor with her diary. The doctor is interested in the10 symptoms listed below, regarding her premenstrual symptoms. For the diagnosis of PMDD, she must have at least five symptoms on the list (including at least one of the first four) cyclically in the time prior to her menstrual period.

  1. markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts (thoughts of being "harsh" on herself, feeling like she is worthless);

  2. significant anxiety or tension;

  3. marked swings in emotions (for example, becoming tearful easily and frequently);

  4. persistent and pronounced anger or irritability, or increased conflicts with other people;

  5. decreased interest in usual activity;

  6. difficulty concentrating;

  7. sluggishness, easy fatigue, lack of energy;

  8. substantial change in appetite, food cravings, overeating;

  9. excessive sleeping or insomnia; and

  10. physical symptoms such as breast pain, bloating, or headaches.