Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD)a is identified by a variety of physical and emotional symptoms that occur during the last week of the luteal phase of the menstrual cycle and that remit within a few days after the onset of the follicular phase. In most women, these symptoms occur in the week before, and remit within a few days after, the onset of menses. The disorder has also been reported in nonmenstruating women who have had a hysterectomy but who retain ovarian function. The diagnosis is given only when the symptoms are sufficiently severe to cause marked impairment in social or occupational functioning and have occurred during a majority of menstrual cycles in the past year (APA, 2000).

What is premenstrual dysphoric disorder (PMDD)?

PMDD is a severe form of a common problem called premenstrual syndrome, or PMS. About 75 percent of women of childbearing age have some PMS problems. About 2 to 10 percent of women in this age group have PMDD.

Predisposing Factors

1. Physiological

a. Biochemical. An imbalance of the hormones estrogen and progesterone has been implicated in the predisposition to PMDD. It is postulated that excess estrogen or a high estrogen-to-progesterone ratio during the luteal phase causes water retention and that this hormonal imbalance has other effects as well, resulting in the symptoms associated with premenstrual syndrome (Kaplan & Sadock, 1998).

b. Nutritional. A number of nutritional alterations have been implicated in the cause of PMDD. They include deficiencies in the B vitamins, calcium, magnesium, manganese, vitamin E, and linolenic acid (Frackiewicz & Shiovitz, 2001). Glucose tolerance fluctuations, abnormal fatty acid metabolism, and sensitivity to caffeine and alcohol may also play a role in bringing about the symptoms associated with this disorder.

Symptomatology (Subjective and Objective Data)

The American Psychiatric Association (2000) has identified the following symptoms as diagnostic for PMDD:

1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

2. Marked anxiety, tension, feelings of being "keyed up" or "on edge"

3. Marked affective lability (e.g., feeling suddenly sad or tearful or increased sensitivity to rejection)

4. Persistent and marked anger or irritability or increased interpersonal conflicts

5. Decreased interest in usual activities (e.g., work, school, friends, hobbies)

6. Subjective sense of difficulty in concentrating

7. Lethargy, easy fatigability, or marked lack of energy