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A.
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 the luteal and menstrual phases of the cycle should ideally be confirmed by a prospective symptom diary over at least two symptomatic menstrual cycles.
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B.
The symptoms include:
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•
At least one affective symptom such as mood lability, irritability, depressed mood, or anxiety
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•
Additional somatic or cognitive symptom(s) such as lethargy, joint pain, overeating, hypersomnia, breast tenderness, swelling of extremities, concentration difficulties, or forgetfulness.
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C.
The symptoms are not better accounted for another mental disorder (e.g., a mood disorder, an anxiety, or a fear-related disorder).
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D.
The symptoms are not a manifestation of another medical condition (e.g., endometriosis, polycystic ovary disease, adrenal system disorders, and hyperprolactinaemia) 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).
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E.
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 the late luteal or menstrual phase of the cycle for many women should not be labelled as PMDD. In contrast to PMDD, these symptoms are less intense and do not typically result in significant distress or impairment. |
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A.
In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.
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B.
One (or more) of the following symptoms must be present:
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1.
Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
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2.
Marked irritability or anger or increased interpersonal conflicts.
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3.
Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
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4.
Marked anxiety, tension, and/or feelings of being keyed up or on edge.
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C.
One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
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1.
Decreased interest in usual activities (e.g., work, school, friends, hobbies).
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2.
Subjective difficulty in concentration.
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3.
Lethargy, easy fatigability, or marked lack of energy.
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4.
Marked change in appetite; overeating; or specific food cravings.
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5.
Hypersomnia or insomnia.
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6.
A sense of being overwhelmed or out of control.
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7.
Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
Note: The symptoms in Criteria A–C must have been met for most menstrual cycles that occurred in the preceding year.
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D.
The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
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E.
The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder (although it may co-occur with any of these disorders).
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F.
Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)
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G.
The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
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