Table 1.

DSM-5 diagnostic criteria for PMDD

Timing of symptoms

A) In the majority of menstrual cycles, at least 5 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

Symptoms

B) One or more of the following symptoms must be present:

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

2) Marked irritability or anger or increased interpersonal conflicts

3) Markedly depressed mood, feelings of hopelessness or self-deprecating thoughts

4) Marked anxiety, tension and/or feelings of being keyed up or on edge

C) One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from criterion B above:

1) Decreased interest in usual activities

2).Subjective difficulty in concentration

3) Lethargy, easy fatigability or marked lack of energy

4) Marked change in appetite; overeating or specific food cravings

5) Hypersomnia or insomnia

6) A sense of being overwhelmed or out of control

7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain

Severity

A. D) The symptoms are associated with clinically significant distress or interference with work, school, usual social activities or relationships with others

B. E) Consider Other Psychiatric Disorders. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia) or a personality disorder (although it may co-occur with any of these disorders)

Confirmation of the disorder

F) Criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles (although a provisional diagnosis may be made prior to this confirmation). Exclude other Medical Explanations

G) The symptoms are not attributable to the physiological effects of a substance (e.g. drug abuse, medication or other treatment) or another medical condition (e.g. hyperthyroidism)