8. Premenstrual Syndrome Flashcards
What is Premenstrual Dysphoric Disorder (PMDD)?
PMDD is a severe mood disorder affecting 3-8% of women, characterized by significant distress and impairment in social or occupational functioning. Unlike Premenstrual Syndrome (PMS), which causes mild mood changes, PMDD involves more intense mood disturbances and occurs in the second half of the menstrual cycle, resolving with the onset of menstruation.
How does PMDD differ from Premenstrual Syndrome (PMS)?
PMDD is more severe than PMS. While PMS is marked by mild symptoms like mood changes, breast tenderness, and food cravings, PMDD involves severe mood disturbances with significant distress and functional impairment, especially in social or work life.
When do symptoms of PMDD occur?
Symptoms of PMDD typically occur in the second half of the menstrual cycle and resolve with the onset of the menstrual period.
What are the common symptoms of PMDD?
Common symptoms include:
- Depressed mood
- Anxiety and panic attacks
- Marked irritability
- Feelings of being overwhelmed
- Difficulty concentrating
- Fatigue
- Suicidal thoughts
How is Premenstrual Dysphoric Disorder (PMDD) diagnosed?
The diagnosis of PMDD is based on the criteria set by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which includes four main criteria (A through D).
What is Criterion A for diagnosing PMDD?
Criterion A requires that, in most menstrual cycles over the past year, at least 5 of the following 11 symptoms are present (with at least one of the first four listed):
- Markedly depressed mood, hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, or feeling “on edge”
- Affective lability (eg, sudden sadness or tearfulness, increased sensitivity to rejection)
- Persistent anger or irritability or increased interpersonal conflicts
- Decreased interest in usual activities (eg, work, school, social life)
- Difficulty concentrating
- Lethargy or fatigue, marked lack of energy
- Marked change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia
- A sense of being overwhelmed or out of control
- Other physical symptoms (eg, breast tenderness, headaches, bloating, or weight gain)
When must the symptoms occur for a diagnosis of PMDD to be made?
The symptoms must be present for most of the time during the last week of the luteal phase (before menstruation), must remit within a few days of the onset of menstrual flow, and must be absent in the week after menstruation.
What is Criterion B for diagnosing PMDD?
Criterion B states that the symptoms must be severe enough to significantly interfere with social, occupational, sexual, or scholastic functioning.
What is Criterion C for diagnosing PMDD?
Criterion C requires that the symptoms be directly related to the menstrual cycle and not represent an exacerbation of another disorder, such as major depressive disorder, panic disorder, or a personality disorder (though they may overlap with these conditions).
What is Criterion D for diagnosing PMDD?
Criterion D requires confirmation of criteria A, B, and C through prospective daily ratings during at least two consecutive symptomatic menstrual cycles. However, a provisional diagnosis may be made before this confirmation.
How does PMDD impact daily life?
PMDD can significantly affect daily life due to its intermittent nature. Because symptoms resolve with menstruation, both the individual and those around them may wonder if it’s “all in the mind.” The intense mood swings, irritability, and emotional distress can be difficult for partners and family to cope with, and women with PMDD may feel helpless or guilty. This can lead to relationship issues and problems at work.
Is PMDD caused by altered hormone levels?
No, PMDD is not caused by abnormal hormone levels. Women with PMDD have hormone levels that are within the normal range, and there is no difference in estrogen or progesterone levels between women with and without PMDD.
What is believed to cause PMDD if not altered hormone levels?
It is thought that women with PMDD may have altered sensitivity to normal levels of progesterone or that their bodies break down progesterone in ways that lead to increased anxiety and low mood. Normally, progesterone is broken down into compounds that promote calmness and better sleep, but in women with PMDD, it may be broken down into compounds that cause anxiety, irritability, and depression.
Is there a genetic basis for PMDD?
Yes, there is a genetic component to PMDD. Women with PMDD are 56% more likely to have family members who also have the condition. Additionally, dysregulation has been found in gene complexes that control responses to estrogen and progesterone in women with PMDD.
How is PMDD treated?
PMDD is best treated through a combination of approaches, including medication, psychotherapy, and lifestyle changes.
