TABLE 3.

Criteria for diagnosis of premenstrual dysphoric disorder (DSM-IV)

Criteria
A. In most menstrual cycles during the past year, 5 (or more) of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week postmenses, with at least 1 of the symptoms being either (1), (2), (3), or (4).
Cardinal symptoms
1. Markedly depressed mood, feeling of hopelessness, or self-deprecating thoughts.
2. Marked tension, feelings of being “keyed up” or “on edge.”
3. Marked affective lability (eg, feeling suddenly sad or tearful or increased sensitivity to rejection).
4. Persistent and marked anger or irritability or increased interpersonal conflicts.
Other associated symptoms
5. Decreased interest in usual activities (eg, work, school, friends, hobbies).
6. Subjective sense of difficulty in concentrating.
7. Lethargy, easy fatigability, or marked lack of energy.
8. Marked change in appetite, overeating, or specific food cravings.
9. Hypersomnia or insomnia.
10. A subjective sense of being overwhelmed or out of control.
11. Other physical symptoms, such as breast tenderness or swelling headaches, joint or muscle pain, a sensation of bloating or weight gain.
B. The disturbance markedly interferes with work or school or with usual social activities and relationships with others (eg, avoidance of social activities, decreased productivity and efficiency at work or school).
C. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although it may be superimposed on any of these disorders).
D. Criteria A, B, and C must be confirmed by prospective ratings during at least 2 consecutive symptomatic cycles. (The diagnosis may be made provisionally before this confirmation.)

Reproduced, with permission, from the American Psychiatric Association.³⁶