Premenstrual dysphoric disorder

Essential (Required) Features:

• During a majority of menstrual cycles within the past year, a pattern of mood, somatic, or cognitive symptoms is present that begins several days before the onset of menses, starts to improve within a few days after the onset of menses, and then becomes minimal or absent within approximately 1 week following the onset of menses. The temporal relationship of the symptoms and luteal and menstrual phases of the cycle should ideally be confirmed by a prospective symptom diary over at least two symptomatic menstrual cycles.
• The symptoms include:
• At least one affective symptom such as mood lability, irritability, depressed mood, or anxiety, and
• Additional somatic or cognitive symptom(s) such as lethargy, joint pain, overeating, hypersomnia, breast tenderness, swelling of extremities, concentration difficulties, or forgetfulness.
• The symptoms are not better accounted for by another mental disorder (e.g., a Mood Disorder, an Anxiety or Fear-Related Disorder).
• The symptoms are not a manifestation of another medical condition (e.g., endometriosis, polycystic ovary disease, adrenal system disorders and hyperprolactinemia) and are not due to the effects of a substance or medication on the central nervous system (e.g., hormone treatment, alcohol), including withdrawal effects (e.g., from stimulants).
• The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Boundary with Normality (Threshold):

• Mild mood changes (e.g., increased emotional lability, irritability, subjective tension) that occur during late luteal or menstrual phase of the cycle for many women should not be labelled as Premenstrual Dysphoric Disorder. In contrast to Premenstrual Dysphoric Disorder, these symptoms are less intense and do not typically result in significant distress or impairment.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Premenstrual Tension Syndrome: Many women may experience cyclic emotional, physical, or behavioural symptoms that interfere with their lifestyles during the luteal phase of the menstrual cycle that are appropriately diagnosed and treated as Premenstrual Tension Syndrome. This is in contrast to Premenstrual Dysphoric Disorder, in which the symptoms are considerably more severe and cause significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
• Boundary with other Mental, Behavioural or Neurodevelopmental Disorders including Mood Disorders that are exacerbated premenstrually: Mood symptoms characteristic of Premenstrual Dysphoric Disorder including depressed mood, irritability, and anxiety can be present in other Mental, Behavioural or Neurodevelopmental Disorders (e.g., Depressive Disorders, Bipolar Disorders, Generalized Anxiety Disorder). Although symptoms of these disorders may be exacerbated during the late luteal and menstrual phases, Premenstrual Dysphoric Disorder is differentiated by the absence of symptoms 1 week post-menses. Because of the difficulty in accurate recall of the relationship between menstrual cycle and the course of symptoms, prospective mood ratings for two consecutive cycles should be considered.
• Boundary with Dysmenorrhea: Dysmenorrhea is characterized by cyclic pelvic pain or lower, umbilical, or suprapubic abdominal pain preceding or accompanying menstruation that interferes with daily activities. Unlike Premenstrual Dysphoric Disorder, the onset of Dysmenorrhea is coincident with the start of rather than prior to menses. Furthermore, mood symptoms are not typically associated with this condition.
• Boundary with the effects of hormones and their synthetic substitutes and antagonists: Use of hormone treatments, including for contraceptive purposes, may result in unwanted side effects that include mood, somatic, and cognitive symptoms. If symptoms do not persist after cessation of these medications beyond the period when their physiological effects should have subsided a diagnosis of Premenstrual Dysphoric Disorder should not be assigned.