Overview of PMDD
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that is included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). PMDD affects a large proportion of women and has a significant impact on daily functioning.
In this article, we will take an in-depth look at PMDD and discuss the different aspects of its diagnosis, treatment and management:
Definition of PMDD
Premenstrual Dysmorphic Disorder (PMDD) is a severe and disabling form of premenstrual syndrome, a condition in which symptoms such as mood swings, tension, irritability, depression and anxiety develop in the week or two preceding the onset of menstruation each month. While PMS can present significant discomfort for many women for several weeks every month, PMDD brings about debilitating symptoms that interfere with daily activities and interpersonal relationships.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official guide used by psychologists and psychiatrists to classify mental health conditions includes PMDD as a distinct disorder under its category “Depressive Disorders”. In order to be diagnosed with PMDD according to the DSM-5 criteria, at least five out of nineten symptoms must be experienced during most menstrual cycles over a period of at least one year before diagnosis.
Of these nine symptoms, four must involve mood such as marked irritability or anger; four must involve physical or behavioral issues such as fatigue or decreased libido; and one must involve changes in cognition or behavior like difficulty concentrating. The presence of these symptoms should cause clinically significant distress or impairment in social functioning not seen in other premenstrual disorders including premenstrual syndrome.
Symptoms of PMDD
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, which affects around 3-8% of women in reproductive age. It is listed as a diagnosable condition in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Women with PMDD experience physical and psychological symptoms during 7-10 days of the menstrual cycle, usually prior to menstruation. Common symptoms include:
- Physical Symptoms:
- Abdominal bloating
- Breast tenderness
- Headaches or migraines
- Joint or muscle pain
- Changes in appetite
- Psychological Symptoms:
- Anxiety or tension
- Depressed mood
- Irritability and difficultly controlling anger
- Lack of energy or fatigue
- Difficulty concentrating or thinking clearly
- Problems sleeping or lack of sleep
Other symptoms may also be present, including changes in sex drive, increased crying spells, unusually intense mood swings and being overly self conscious. These can significantly impact everyday life and make it difficult for women to go about their usual activities.
DSM-5 Classification
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the current manual used by mental health professionals to diagnose mental health disorders. DSM-5 classifies and describes a number of different disorders, including premenstrual dysphoric disorder (PMDD). Let’s take a closer look at how PMDD is classified in the DSM-5.
History of PMDD’s DSM Classification
Premenstrual dysphoric disorder (PMDD) is a cyclic syndrome that affects 3-8% of women during premenstrual phase of the menstrual cycle. PMDD was first described and diagnosed in 1931. Changes in the DSM-IV defined PMDD and included eight diagnostic criteria that could be used for diagnosis. In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an authoritative reference for mental health providers, recognized PMDD as its own condition as well as a depressive disorder. This marked an important shift from previous DSM-IV guidelines which classified PMDD under “Premenstrual Syndrome” instead of separate category.
The revised DSM-5 criteria includes 5 specific symptoms related to emotion regulation and behavioral control, which are necessary for diagnosis:
- Irritability or anger
- Depression or hopelessness
- Loss of interest in usual activities
- Trouble concentrating or focusing
- Fatigue or low energy levels
In addition to these five core symptoms, at least one additional symptom must be present such as:
- Sleep disturbances (difficulty sleeping or sleeping too much)
- Appetite changes (increased appetite with bloating or decreased appetite)
- Physical symptoms such as headaches and breast tenderness
These criteria must be met over a period of time throughout three consecutive menstrual cycles in order for a correct diagnosis to be made by healthcare providers.
Current DSM-5 Classification of PMDD
The current DSM-5 classification of Premenstrual Dysphoric Disorder (PMDD) is listed in the same section as “Other Specified Depressive Disorders.” The criteria that must be satisfied for a PMDD diagnosis is defined in this section as having five or more of the following symptoms during the majority of menstrual cycles over a one year period:
- Marked affective lability (i.e., sudden and marked shifts in mood)
- Marked irritability or anger
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, and/or feelings of being overwhelmed
- Uncharacteristic behavior changes such as marked interpersonal conflicts with friends/families or other social withdrawal
- Difficulty concentrating
- Lack of energy
- Change in appetite or sleeping pattern
- Physical symptoms such as bloating, breast tenderness and headache that are not associated with another physical condition
To receive a diagnosis for PMDD, at least one symptom must involve either depressed mood, anxiety or anger and last for most of the week before menses begins until several days after it ends each month with no intervening exacerbation of the symptoms during mid-cycle when ovulation occurs. There is also stipulation that this disturbance negatively influences activities at work/school or are associated with significant stress on social relationships including partner conflict and work productivity declines due to fatigue caused by lack of sleep caused by night awakening due to agitated/distressed states – usually starting 1-2 weeks before onset menses associated with somatic complaints which are relieved shortly after menses starts (lasting up to 1 week).
Treatment Options
Pre-Menstrual Dysphoric Disorder (PMDD) is a disorder that affects many women and girls during their menstrual cycle. While it was not included in the DSM 5, family doctors, OBGYNs, psychiatrists, and other medical professionals can still diagnose and treat PMDD.
In this section, we’ll explore the various treatment options available for PMDD:
Medications
Medications are the most common form of treatment for PMDD and can be used in combination with other therapeutic treatments. As of the DSM-5, there is no official medical diagnosis for PMDD or FDA approved treatments. Nonetheless, many medications have been shown to help manage symptoms and reduce the severity of PMDD.
The following are common types of medications used to treat PMDD:
- Antidepressants: As their name implies, antidepressants primarily regulate levels of serotonin, a neurotransmitter associated with mood regulation. Common types include selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).
- Oral Contraceptives: Birth control pills are commonly used in managing the hormonal fluctuations that typically accompany PMDD. Common types include monophasic contraceptives (same dose each day), triphasic contraceptives (different doses with “pause days” between cycles) and extended cycle pills (longer dosing cycles).
- Hormone Therapy: Progesterone is sometimes used in conjunction with other medications to gauge hormonal fluctuations associated with menopause and menstrual cycles. This type of therapy may also include supplemental progesterone delivery through patches or gel forms.
- Anti-anxiety Medication: Benzodiazepines such as Xanax and Klonopin may be prescribed for short periods if anxiety symptoms become unmanageable during treatment phases.
In addition to standard medical treatments, alternative methods such as dietary changes or lifestyle modifications may also help alleviate symptoms of PMDD. Discuss your options thoroughly with a trained mental health professional before beginning any type of treatment protocol.
Therapy
The primary recommended form of treatment for premenstrual dysphoric disorder (PMDD) is psychotherapy and lifestyle changes. Specifically, cognitive behavioral therapy (CBT) has been found to be the most effective form of treatment for individuals struggling with PMDD. This type of therapy is focused on helping individuals identify and reduce negative thought patterns that distort cognition and strongly influence behavior.
In addition to learning how to manage symptoms through CBT, individuals may also benefit from other forms of therapy such as interpersonal and problem-solving therapies.
In order to help manage the physical symptoms associated with PMDD, it is important to work on improving overall well-being through lifestyle changes such as:
- Regular exercise
- Eating a balanced diet low in processed sugars
- Getting adequate sleep each night
- Limiting caffeine intake
- Practicing relaxation techniques like yoga or meditation
- Avoiding alcohol and/or recreational drugs/nicotine products
- Finding effective stress management strategies that work best for you
- Slowing down your pace at times if feeling overwhelmed or anxious.
Lifestyle Changes
Certain lifestyle modifications have been recommended to help alleviate symptoms of premenstrual dysphoric disorder (PMDD). Regular exercise, healthy diet, and other lifestyle changes can be effective in helping manage PMDD symptoms.
Intermittent fasting as well as a balanced Mediterranean diet are a few of the recommended dietary changes for PMDD sufferers. Intermittent fasting is an 8-hour window when food intake is permitted during the day followed by a 16-hour period where no food is consumed. This cycle can be repeated indefinitely and has been found to help balance hormones and even improve moods, which could ultimately reduce the severity of PMDD symptoms. The Mediterranean diet involves eating mostly plant-based foods such as vegetables, nuts, fruits, legumes, fish and whole grains while limiting red meat and processed foods; this diet emphasizes healthy fats like olives and olive oil, as well as spices like rosemary to round off flavorful dishes.
Exercise is also essential for reducing PMDD symptoms – it facilitates the release of endorphins that improve moods naturally. Regular physical activity likewise has beneficial effects on physical health such as improved blood pressure levels and beneficial weight regulation; although it should be noted that any change in weight could also worsen PMDD signs so maintaining an appropriate exercise regimen is key.
Other lifestyle changes include relaxation techniques such as mindfulness meditation and yoga to help manage stress levels that may worsen PMDD signs or increase depression risks associated with them. Finally, engaging with supportive friends or family members can provide emotional support needed by those with premenstrual dysphoric disorder while avoiding negative behaviors like substance abuse or smoking; these coping tools may provide stability amid difficult periods in life caused by emotional distress due to contractions of signs related to antepartum depression.
Conclusion
After examining the evidence, it’s clear that PMDD is now officially recognized as a mental disorder in the DSM 5. This means it is now accepted as a valid diagnosis and healthcare providers are encouraged to use it when diagnosing and treating their patients. The inclusion of PMDD in the DSM 5 has a number of implications for patients and professionals alike. Let’s examine the implications in more depth:
Summary of PMDD Classification in DSM-5
Premenstrual Dysphoric Disorder (PMDD) is a severe premenstrual syndrome with at least five additional symptoms that occur in the luteal phase of the hormonal cycle. PMDD can affect social, occupational, marital, and academic areas in a woman’s life, as well as her psychological health. In 2013, PMDD was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a distinct disorder under Depressive Disorders.
The DSM-5 criteria for diagnosis of PMDD are based on five core motor and psychological symptom domains:
- Affective and behavioral changes.
- Heightened physical symptoms.
- Interpersonal sensitivity.
- Anxiety/tension.
- Impaired cognitive ability.
A diagnosis is made when at least five or more symptoms are present for most menstrual cycles during the previous year with Psychoeducation and psychotherapy being recommended for treatment interventions.
In conclusion, due to the changes implemented in DSM-5, it is now possible to accurately diagnose PMDD as it is classified as a distinct disorder in this diagnostic manual. It is important to note that although it may appear similar to other mental health conditions such as Major Depressive Disorder (MDD) or Premenstrual Syndrome (PMS), both have completely different diagnostic criteria which can be used to differentiate them from one another.
Overview of Treatment Options
The DSM-5 acknowledges that there is no one-size-fits-all solution for treating PMDD, and outlines a wide range of evidence-based treatment options for individuals experiencing this disorder. These treatments can be broadly divided into psychosocial and pharmacological options, as detailed below.
Psychosocial Treatments
Psychosocial treatments refer to interventions that focus on helping individuals better understand their own psychological functioning. These may include cognitive behavioral therapy (CBT) to teach individuals how to recognize and manage symptoms of PMDD, mindfulness-based therapies to reduce stress, interpersonal psychotherapy to enhance relationships between partners or family members, group therapy for support and encouragement from other women with similar experiences, and lifestyle management skills such as diet and exercise.
Pharmacological Treatments
Pharmacological treatments refer to medications prescribed by a physician that can help mitigate the psychological symptoms associated with PMDD. Generally speaking, these medications are SSRIs (Selective Serotonin Reuptake Inhibitors), which regulate levels of serotonin in the brain—a neurotransmitter believed to be closely related to depression and anxiety. Common SSRIs prescribed for this disorder include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) or escitalopram (Lexapro). Women may also try selective estrogen receptor modulators such as drospirenone/ethinyl estradiol or levonorgestrel/ethinyl estradiol combination pills as hormonal forms of contraception that have been found helpful in managing PMDD symptoms by maintaining consistent hormone levels throughout the menstrual cycle.