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DeFining Premenstrual Syndrome
21 •
physicians.) Another five to six percent are affected so much by their
PMS symptoms that their daily lives are severely disrupted during
this time. These women suffer from premenstrual dysphoric dis-
order (PMDD), a less prevalent but more distressful form of PMS
recognized by the American Psychiatric Association (APA) as a “de-
pressive disorder.” Although PMDD shares the same symptoms as
PMS, it differs in the severity of the symptoms and the necessity of
specific treatment to control them.
Premenstrual Dysphoric Disorder
According to the fourth edition of the American Psychiatric Associa-
tion’s
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision
(DSM-IV-TR), a diagnosis of PMDD can be
made when five or more of the following symptoms are consistently
present during the first week of the luteal phase, with at least one
symptom being among the first four listings:
1. feeling sad, hopeless, or down on yourself
2. feeling tense, anxious or “on edge”
3. marked instability of mood interspersed with frequent tear-
fulness
4. persistent irritability, anger, and increased interpersonal con-
flicts
5. decreased interest in usual activities, which may be associ-
ated with withdrawal from social relationships
6. difficulty concentrating
7. feeling fatigued, lethargic, or lacking in energy
8. marked changes in appetite, including binge eating or food
cravings
9. hypersomnia (excessive sleeping) or insomnia (lack of sleep)
10. feeling overwhelmed or out of control
11. physical symptoms such as breast tenderness, headaches,
bloating, weight gain, or muscle or joint pain