Premenstrual Dysphoric Disorder Is Real — Let’s Talk About It

Symptoms, diagnosis, and how it’s different from PMS

Photo of author by Anthony Nielsen

What is PMDD and what causes it?

Premenstrual dysphoric disorder is a severe mood disorder during the luteal phase that mostly or completely resolves during the follicular phase (read the Phases of the Menstrual Cycle here) and is related to reproductive hormones (1) — but not in the way that you might think. In fact, hormone levels in people with PMDD are similar to those without it (2). Rather than the hormones themselves causing the issue, an increased sensitivity to those hormones seems to be the culprit: This sensitivity alters the brain chemistry and neurological pathways that control your mood and sense of well-being (3).

Why haven’t I heard of PMDD before? Is it rare?

PMDD was only recently recognized as a diagnosable disorder and added to the diagnostic manual by the American Psychological Association (APA) in 2013 (10) and was added to the World Health Organization’s International Classification of Diseases in June 2019 (11, 12).

What is the difference between PMDD and PMS?

The physical symptoms of PMDD are similar to PMS, but PMDD also has severe emotional symptoms, including depression and such feelings of hopelessness (13) that 15% of patients with PMDD attempt suicide (8). Symptoms of PMDD are so extreme that they impact relationships, day-to-day function, and quality of life (14).

What are the symptoms of PMDD and how is it diagnosed?

PMDD has a broad spectrum of symptoms, and no single test can definitively determine whether or not you have it (3). Diagnostics are limited, and symptoms not only vary among individuals, but they also overlap with other disorders and illnesses; therefore, seeking professional help is critical to rule out other potential causes of your symptoms (8).

Symptoms

Your symptoms must include at least one related to mood, such as mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection, marked irritability or anger, increased interpersonal conflicts, depressed mood, feelings of hopelessness, self-deprecating thoughts, noticeable anxiety, tension, and/or feelings of being keyed up or on edge (10).

Diagnosis

According to the official diagnostic guidelines from the APA (10), to be diagnosed with PMDD, your symptoms must meet all of the following criteria:

  1. Be present in the week before your period begins, also known as the luteal phase, for at least 2 cycles.
  2. Improve after your period starts, and either completely resolve or be minimal in the week after your period.
  3. Cause significant distress or interference with work, school, usual social activities, or relationships.
  4. Not be attributed to anything else, such as a medical condition, another psychiatric or personality disorder, or medication.

What should I do if I think I have PMDD?

PMDD should not be confused with PMS (16) and is a serious, chronic condition that requires treatment. If you think you have PMDD, talk to your doctor about your symptoms right away (17). As mentioned above, your healthcare provider may perform an exam, blood tests, or other diagnostics to rule out certain conditions and may ask you to track your symptoms for at least 2 months (18).

More Resources

International Association for Premenstrual Disorders

References

  1. Hantsoo, L., & Epperson, C. N. (2015). Premenstrual dysphoric disorder: epidemiology and treatment. Current psychiatry reports, 17(11), 87.
  2. Snyder, P., Crowley, W., Moynihan, L., Martin, K. (2009). Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). RBS Medical, Women’s Health.
  3. Chisholm, A. (2017). Premenstrual dysphoria disorder: It’s biology, not a behavior choice. Harvard Health Publishing, Harvard Health Blog.
  4. Bhatia, S. C., & Bhatia, S. K. (2002). Diagnosis and treatment of premenstrual dysphoric disorder. American family physician, 66(7), 1239.
  5. MGH Center for Women’s Mental Health. (n.d.). PMDD/PMD: When PMS symptoms interfere with functioning & quality of life.
  6. Asher, J. (2017). Sex hormone-sensitive gene complex linked to premenstrual mood disorder. National Institute of Mental Health.
  7. Rubinow, D. (2007). Spotlight on PMDD: Hereditary Link to PMDD Identified: An Expert Interview With David R. Rubinow, MD. Medscape.
  8. Harvard Mental Health Letter. (2019). Treating premenstrual dysphoric disorder. Harvard Health Publishing.
  9. Khajehei, M., Behroozpour, E., Hajizadeh, N. (2010). Premenstrual syndrome and premenstrual dysphoric disorder. International Conference on Cognitive, Psychological and Behavioural Sciences., At Paris, France.
  10. Reid RL. Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) [Updated 2017 Jan 23]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 1, Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD).
  11. International Association for Premenstrual Disorders. (2019, June). World Health Organization Adds Premenstrual Dysphoric Disorder (PMDD) Into The ICD-11.
  12. Reed, G. M., First, M. B., Kogan, C. S., Hyman, S. E., Gureje, O., Gaebel, W., … & Claudino, A. (2019). Innovations and changes in the ICD‐11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry, 18(1), 3–19.
  13. Ricciotti, H. (2015). Premenstrual dysphoric disorder: When it’s more than just PMS. Harvard Health Publishing, Harvard Health Blog.
  14. Berga, S., Spencer, J., Dominguez, C. (2020, April). PMDD Spotlight: Diagnosis and Treatment. Medscape Ob/Gyn.
  15. Mayo Clinic. (2020). Premenstrual syndrome (PMS).
  16. Welch, S. (2015, April). The Efficacy of Traditional Chinese Medicine on Reducing Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Capstone project for Doctor of Acupuncture and Oriental Medicine Degree at Yo San University.
  17. John Hopkins Medicine. (n.d.). Premenstrual Dysphoric Disorder (PMDD).
  18. Planned Parenthood. (n.d.). What is premenstrual dysphoric disorder (PMDD)?

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