What are the diagnosis criteria for Premenstrual Dysphoric Disorder (PMDD)?

Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD)

PMDD is diagnosed based on specific symptom criteria occurring during the luteal phase of the menstrual cycle, substantially interfering with daily activities, and resolving during menstruation or shortly after. 1

Core Diagnostic Requirements

• PMDD is officially recognized as a distinct diagnostic entity in both the DSM-5 and ICD-11 1
• Diagnosis requires prospective symptom charting over at least 2 menstrual cycles to confirm symptom timing and rule out other diagnoses 2
• Symptoms must occur during the luteal phase (week before menstruation) and resolve shortly after menstruation begins 3
• Symptoms must cause significant functional impairment in personal, social, family, or professional life 4

Specific Symptom Criteria (DSM-5)

The following symptoms must be present:

• Required timing pattern: Symptoms must occur during the luteal phase of most menstrual cycles, improve within a few days after onset of menstruation, and become minimal or absent in the week after menses 3

• Symptom severity requirement: At least 5 of the following symptoms must be present, with at least one being from the first four listed 3, 2:

1. Core emotional/behavioral symptoms (at least one required):

   • Marked affective lability (mood swings, feeling suddenly sad or tearful) 4
   • Marked irritability or anger 4
   • Marked depressed mood, feelings of hopelessness 4
   • Marked anxiety or tension 4

2. Additional symptoms (to reach total of five):

   • Decreased interest in usual activities 5
   • Difficulty concentrating 5
   • Lethargy or fatigue 5
   • Change in appetite, food cravings 5
   • Sleep disturbances (insomnia or hypersomnia) 4
   • Feeling overwhelmed or out of control 5
   • Physical symptoms such as breast tenderness, joint/muscle pain, bloating, weight gain 5

Diagnostic Differentiation

• Symptoms must be distinguished from those of other conditions:

  • Major depressive disorder
  • Generalized anxiety disorder
  • Premenstrual exacerbation of another disorder 3

• Premenstrual syndrome (PMS) is a less severe form of premenstrual symptoms that doesn't meet the full criteria for PMDD 5, 3

• PMDD affects approximately 3-8% of menstruating women, while clinically significant PMS affects at least an additional 20% 6, 2

Diagnostic Assessment Methods

• Daily symptom charting: The current diagnostic standard requires prospective daily symptom diaries for at least two consecutive menstrual cycles 3, 2

• No laboratory tests: No hormone or laboratory test can confirm a PMDD diagnosis 3

• Differential diagnosis: Must rule out other medical and psychiatric conditions that could cause similar symptoms 3

• Severity assessment: Must determine that symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships 4, 2

Clinical Implications

• PMDD diagnosis should only be made by qualified healthcare providers 5

• The burden of illness includes disruption of parenting and partner relationships, decreased work productivity, and increased healthcare utilization 2

• Treatment should be initiated only after proper diagnosis through prospective symptom charting 2

• First-line treatments include selective serotonin reuptake inhibitors (SSRIs) and oral contraceptives containing drospirenone 4

Remember that accurate diagnosis through prospective symptom tracking is essential before initiating treatment for PMDD, as symptoms can overlap with other psychiatric and medical conditions 3, 2.