What are the diagnostic criteria for Premenstrual Dysphoric Disorder (PMDD) in a 15-year-old female?

Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD) in a 15-Year-Old Female

According to the ICD-11 criteria, PMDD is characterized by a pattern of mood symptoms (e.g., depressed mood), somatic symptoms (e.g., overeating), or cognitive symptoms (e.g., forgetfulness) that begin several days before the onset of menses, start to improve within a few days after the onset of menses, and then become minimal or absent within 1 week following the onset of menses. 1

Core Diagnostic Features

Timing Pattern

• Symptoms must occur during the luteal phase of the menstrual cycle (approximately 1 week before onset of menstrual bleeding)
• Symptoms must improve after onset of menses
• Symptoms must be minimal or absent in the week after menstruation 1, 2

Symptom Requirements

• Symptoms must be documented prospectively for at least two consecutive menstrual cycles using daily symptom logs 3
• Symptoms must cause significant functional impairment 2
• Symptoms must be severe enough to cause marked distress 4

Specific Symptoms

At least five of the following symptoms must be present:

1. Mood symptoms:

   • Marked affective lability (mood swings)
   • Marked irritability or anger
   • Marked depressed mood or feelings of hopelessness
   • Marked anxiety or tension

2. Behavioral and cognitive symptoms:

   • Decreased interest in usual activities
   • Difficulty concentrating
   • Lethargy or fatigue
   • Marked change in appetite (overeating or food cravings)
   • Sleep disturbances (insomnia or hypersomnia)
   • Feeling overwhelmed or out of control
   • Physical symptoms such as breast tenderness, bloating, weight gain, or joint/muscle pain 2, 4

Differential Diagnosis

PMDD must be distinguished from:

• Regular premenstrual syndrome (PMS) - which is less severe and doesn't require five symptoms
• Other psychiatric disorders (depression, anxiety disorders) - PMDD symptoms are cyclical and tied to menstrual cycle 5
• Medical conditions that may worsen premenstrually

Important Considerations for Adolescents

• In adolescents, menstrual cycles may range between 21-45 days (compared to 21-35 days in adults) 1
• Symptoms may present differently in adolescents, with irritability and mood lability often being more prominent than depressed mood 2
• The diagnosis requires careful documentation as irregular cycles are common in early adolescence
• Symptoms must be distinguished from normal developmental mood fluctuations

Diagnostic Process

1. Prospective daily symptom tracking:

   • Have the adolescent keep a daily symptom diary for at least two consecutive menstrual cycles
   • Document the severity of symptoms on a scale (0-3 or similar)
   • Note the exact days of menstrual bleeding

2. Confirm cyclical pattern:

   • Verify that symptoms appear in luteal phase
   • Confirm symptoms improve with onset of menses
   • Ensure symptom-free period in follicular phase

3. Assess functional impairment:

   • Evaluate impact on school performance
   • Assess effects on social relationships
   • Determine impact on daily activities and quality of life

Clinical Pearls

• PMDD is distinct from regular PMS by its severity and significant functional impairment
• No laboratory or hormone test can diagnose PMDD - diagnosis is clinical and based on symptom patterns
• Adolescents may not recognize the cyclical nature of their symptoms without prospective tracking
• The prevalence of PMDD is approximately 5% of menstruating females, with an additional 20% experiencing clinically significant premenstrual symptoms 6
• Early identification and treatment can significantly improve quality of life and prevent academic/social difficulties

Remember that while PMDD shares some features with depression and anxiety disorders, it is a distinct diagnostic entity with its own characteristic symptom pattern tied specifically to the menstrual cycle 5.