PMS vs. PMDD

What Is PMDD?

Premenstrual dysphoric disorder (PMDD) can interfere with a woman’s relationships and her ability to get through the day. It is the severity and consistency of a combination of emotional and physical symptoms that determine whether a woman has PMS or PMDD. With PMDD, the mood swings, irritability, anxiety, tension, hopelessness and sadness can all be extreme and overwhelming. Physically, a woman with PMDD may experience debilitating fatigue, insomnia, listlessness and problems like headache and/or increased sensitivity to pain that don’t respond to ordinary treatment. Symptoms of PMDD generally start 7 to 10 days before menstruation begins and disappear within a few days after the bleeding begins.

The cause of PMDD – like the cause of PMS – is unknown. But most doctors and researchers believe symptoms are brought about by the hormonal ups and downs of the menstrual cycle. Recent medical studies demonstrate a relationship between lower-than-normal levels of the brain chemical serotonin and the onset of PMDD symptoms.

When lifestyle modifications do not help, treatment options for both PMS and PMDD can include oral contraceptives (birth control pills) that suppress ovulation and help even out the menstrual cycle’s hormonal fluctuations. Of course, it’s critical to discuss your treatment options with your healthcare provider, so you can feel better sooner.

Criteria for PMDD

Listed below are the official criteria from the American Phychiatric Association for a diagnosis of PMDD. “Luteal phase” refers to the second half of the menstrual cycle, following release of an egg. “Follicular phase” refers to the first half of the cycle.

1. In most menstrual cycles during the past year, symptoms in B occurred during the last week of the luteal phase and remitted within a few days after onset of the follicular phase. In menstruating females, these phases correspond to the week before, and a few days after, the onset of menses. (In nonmenstruating females who had a hysterectomy, the timing of luteal and follicular phases may require measurement of circulating reproductive hormones.)
2. At least 5 of the following symptoms have been present for most of the time during each symptomatic late luteal phase, at least one of the symptoms being 1, 2, 3 or 4:
   1. Marked affective lability, e.g., feeling suddenly sad, tearful, irritable, or angry.
   2. Persistent and marked anger or irritability.
   3. Marked anxiety, tension, feelings of being “keyed up” or “on edge.”
   4. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts.
   5. Decreased interest in usual activities, e.g., work, friends, hobbies.
   6. Easy fatigability or marked lack of energy.
   7. Subjective sense of difficulty in concentrating.
   8. Marked change in appetite, overeating, or specific food cravings.
   9. Hypersomnia or insomnia.
   10. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of “bloating,” weight gain.
3. The disturbance seriously interferes with work or with usual social activities or relationships with others.
4. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depression, panic disorder, dysthymia (chronic mild depression), or a personality disorder (although it may be superimposed on any of these disorders).
5. Criteria A, B, C, and D are confirmed by prospective daily self-ratings during at least two symptomatic cycles. (This diagnosis may be made provisionally prior to this confirmation.)