Premenstrual Dysphoric Disorder is a mood disorder in women that begins in the week prior to the onset of menstruation and subsides within the first few days of menstruation. Women experience mood swings, including markedly depressed mood, anxiety, feelings of helplessness, and decreased interest in activities. In contrast to premenstrual syndrome, the symptoms must be severe enough to impair functioning in social activities, work, and relationships. Only a small percentage of women with premenstrual syndrome meet criteria for this disorder. Also called late luteal phase dysphoric disorder.
According to statistics, approximately around 70-90% of the women in the US in their reproductive age group face some premenstrual discomfort. One third of the women face discomfort like feeling bothersome enough to have a diagnosis of PMS (Pre Menstrual Syndrome). Severe symptoms of PMDD are reported in 3-8% of the PMS cases. Individuals with PMDD on an average experience 6.4 days of severe pain per cycle. This can certainly lead to distress and concerns in daily functioning during pain.
Research suggests that the pathophysiology of PMDD stems from certain reproductive hormones, which release in a normal pattern in women with PMS and PMDD, but they have a heightened sensitivity to cyclical variations in reproductive hormone levels which in turn affects their mood, behaviour, and somatic symptoms.
Symptoms of PMDD
According to the Diagnostic and Statistical Manual, the symptoms of PMDD are as follows:
Criterion A
At least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) should be present:
- Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, feelings of being “keyed up” or “on edge”
- Marked affective lability
- Persistent and marked anger or irritability or increased interpersonal conflicts
- Decreased interest in usual activities (eg, work, school, friends, and hobbies)
- Subjective sense of difficulty in concentrating
- Lethargy, easy fatigability, or marked lack of energy
- Marked change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia
- A subjective sense of being overwhelmed or out of control
- Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.
Criterion B
Symptoms severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning.
Criterion C
Symptoms discretely related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder.
Criterion D
Criteria A, B, and C are confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.
Risk Factors and Evaluation
The cause of PMDD is not exactly yet known, but the risk factors that can lead to PMDD have been researched. Some proven risk factors include past traumatic events, obesity, smoking, or any other substance.
Evaluation of PMDD has now become easier with various assessments that can be taken, such as:
- Premenstrual Symptom Screening Tool
- Calendar of Premenstrual Experiences
- Visual Analogue Scale
- Daily Record of Severity Problem
These tools can help women identify and assess their symptoms and their severity.
Treatment Approaches
Treatment approaches to PMDD can be a combination of both or either medication along with non-pharmacological treatment, or either of the two, depending upon the client’s symptoms.
Pharmacological Treatment
Pharmacological treatment includes medication like Serotonin Reuptake Inhibitors (SRIs), which helps women with their severe mood swings and somatic symptoms. Benzodiazepine can also be effective in women with only severe anxiety and premenstrual insomnia. Hormonal therapies can also be given to women with severe symptoms for relief.
Non-Pharmacological Treatment
Non-Pharmacological treatment includes psychotherapy or counselling sessions, which help clients deal with their concerns in a much healthier way. Counselling helps them manage their stress, any past traumatic events or psychosomatic symptoms, and helps function better in all settings. Other non-pharmacological treatments include exercise and dietary improvement, which help improve the symptoms through elevation of the required hormones. For example, exercise helps elevate endorphin levels, and eating complex carbohydrates or proteins helps increase tryptophan availability, leading to increased serotonin levels which help improve mood.
Conclusion
In conclusion, Premenstrual Dysphoric Disorder (PMDD) is a serious and often debilitating condition that extends far beyond the typical discomfort associated with premenstrual syndrome. Although its exact cause remains unclear, research highlights the crucial role of hormonal sensitivity and psychosocial factors in its development. With accurate diagnosis—supported by structured assessments—and a comprehensive treatment approach combining pharmacological and non-pharmacological strategies, women with PMDD can experience significant relief and improvement in their quality of life. Increasing awareness, early detection, and holistic management are essential to empower women to navigate PMDD with greater resilience, ensuring better functioning across all areas of their lives.