What are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria for Premenstrual Dysphoric Disorder (PMDD)?

DSM-5 Criteria for Premenstrual Dysphoric Disorder (PMDD)

According to the DSM-5, Premenstrual Dysphoric Disorder (PMDD) is characterized by a pattern of mood symptoms, somatic symptoms, or cognitive symptoms that begin several days before menses, improve within a few days after onset of menses, and become minimal or absent within one week following the onset of menses.

Core Diagnostic Criteria

A. Timing Pattern

• Symptoms must occur in the majority of menstrual cycles
• Symptoms begin in the week before menses, start to improve within a few days after onset of menses, and become minimal or absent in the week following menses 1

B. Symptom Requirements

• At least 5 of the following symptoms must be present:
  1. Marked affective lability (mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection)
  2. Marked irritability or anger or increased interpersonal conflicts
  3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
  4. Marked anxiety, tension, feelings of being "keyed up" or "on edge"
  5. Decreased interest in usual activities
  6. Difficulty in concentration
  7. Lethargy, easy fatigability, or marked lack of energy
  8. Marked change in appetite, overeating, or specific food cravings
  9. Hypersomnia or insomnia
  10. A sense of being overwhelmed or out of control
  11. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating, or weight gain

C. Severity and Impairment

• At least one of the symptoms must be from the first four listed (affective symptoms)
• Symptoms must be associated with clinically significant distress or interference with work, school, usual social activities, or relationships 2
• Symptoms must cause functional impairment in social, academic, or occupational domains

D. Exclusion Criteria

• Symptoms are not merely an exacerbation of another disorder
• Symptoms are not attributable to the physiological effects of a substance or another medical condition
• The disturbance is not better explained by another mental disorder

Clinical Assessment Requirements

Prospective Daily Ratings

• Diagnosis requires prospective daily symptom ratings for at least two symptomatic cycles 3, 4
• Retrospective reports alone are insufficient for diagnosis

Most Symptomatic Period

• Research indicates the most symptomatic period typically includes the few days before through the first 3 days of menses 2
• This is important to note when tracking symptoms for diagnosis

Epidemiology and Clinical Significance

• PMDD affects approximately 2-5% of premenopausal women 5
• The disorder is chronic and can significantly impact quality of life
• PMDD was moved from DSM-IV Appendix B ("Criterion Sets and Axes Provided for Further Study") to a full diagnostic category in DSM-5 5

Differential Diagnosis

• Must be distinguished from:
  • Premenstrual syndrome (PMS), which is less severe and requires only one distressing symptom 4
  • Exacerbation of another mental disorder
  • Other medical conditions that may worsen premenstrually

Common Pitfalls in Diagnosis

• Relying solely on retrospective symptom reporting
• Failing to document symptoms prospectively for at least two cycles
• Not distinguishing between normal menstrual changes and clinically significant PMDD
• Missing comorbid conditions that may complicate the clinical picture
• Confusing PMS (milder) with PMDD (more severe, with specific affective symptoms)

PMDD represents a distinct clinical entity with specific diagnostic criteria that must be carefully applied to ensure accurate diagnosis and appropriate treatment planning.