What are the changes in the diagnosis of premenstrual dysphoric disorder (PMDD) across Diagnostic and Statistical Manual of Mental Disorders (DSM) versions 3, 3-TR (Text Revision), 4, 5, and 5-TR (Text Revision), and International Classification of Diseases (ICD) versions 10 and 11?

Evolution of Premenstrual Dysphoric Disorder Diagnosis Across DSM and ICD Versions

Premenstrual dysphoric disorder (PMDD) achieved full diagnostic recognition as a distinct psychiatric entity in DSM-5 (2013) and ICD-11 (2019), after decades of evolving from a research concept to a formally recognized depressive disorder. 1, 2

DSM Evolution

DSM-III (1980) and DSM-III-R (1987)

• PMDD did not exist as a formal diagnosis in DSM-III. 3
• In DSM-III-R (1987), the condition was first introduced as "Late Luteal Phase Dysphoric Disorder (LLPDD)" and placed in Appendix A (criteria sets provided for further study), indicating it was not yet accepted as an official diagnosis. 3
• Prior to these editions, only the broader term "premenstrual syndrome (PMS)" was used clinically, primarily by gynecologists rather than psychiatrists. 3

DSM-IV (1994)

• The terminology changed from "Late Luteal Phase Dysphoric Disorder" to "Premenstrual Dysphoric Disorder (PMDD)" in 1994. 1, 4
• PMDD was listed in the "Mood Disorder Not Otherwise Specified" section, meaning it remained under consideration but was not yet a standalone diagnostic category. 1
• Rigorous and specific diagnostic criteria were established for the first time, requiring prospective daily symptom charting to confirm the luteal phase timing of symptoms. 4
• This edition marked the beginning of well-designed, placebo-controlled treatment studies due to the operationalized criteria. 4, 3

DSM-5 (2013)

• PMDD achieved full diagnostic legitimacy and was moved to the "Depressive Disorders" chapter, no longer relegated to appendices or "not otherwise specified" categories. 1, 4
• This reclassification in July 2013 represented formal recognition that PMDD is a distinct psychiatric disorder affecting 3-8% of menstruating women, far more severe than PMS (which affects 20-40%). 1, 5
• The diagnostic criteria were reaffirmed and solidified, opening possibilities for clinical, pathophysiological, and therapeutic research development. 1, 4

DSM-5-TR (2022)

• The provided evidence does not document specific changes to PMDD criteria between DSM-5 and DSM-5-TR, suggesting the diagnostic framework remained stable.

ICD Evolution

ICD-10 (1992-2019)

• PMDD was not recognized as a distinct diagnostic entity in ICD-10. 2
• Women with severe premenstrual symptoms would have been classified under broader categories without specific recognition of the disorder's unique characteristics. 2

ICD-11 (2019-2022)

• ICD-11 introduced PMDD as a new diagnostic category in 2019, solidifying international recognition of the disorder. 1, 2
• 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." 2
• This addition was part of a broader expansion that added 12 new diagnostic categories to the Mental, Behavioural or Neurodevelopmental Disorders chapter. 2
• The ICD-11 implementation by WHO member states began January 1,2022. 2

Clinical Implications of Diagnostic Evolution

The 26-year journey from research concept (1987) to full diagnostic recognition (2013) has fundamentally changed clinical management:

• Before DSM-5 (2013): Women with PMDD were often misdiagnosed or their symptoms dismissed, as the condition lacked formal psychiatric recognition. 1
• After DSM-5 and ICD-11: Clear diagnostic criteria enable proper identification, differentiation from PMS (milder symptoms) and premenstrual magnification of other psychiatric disorders, and access to evidence-based treatments. 6, 5
• The recognition that PMDD affects personal, social, family, and professional life has legitimized the need for psychiatric intervention rather than dismissing symptoms as normal premenstrual changes. 1

Key Diagnostic Distinctions Established

PMDD must be differentiated from:

• PMS: Milder physical symptoms, headache, and minor mood changes affecting 20-40% of women versus PMDD's severe affective symptoms in 3-8%. 6, 5
• Premenstrual magnification: Worsening of underlying psychiatric or medical conditions during the luteal phase, rather than symptoms that are minimal or absent in the follicular phase. 6