PMDD Symptoms: Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder—PMDD—is the most severe form of PMS. That is, the main difference between the two syndromes is the severity of their symptoms. Even that is not always clear, since there are severe cases of PMS that do not happen to meet the criteria for PMDD.
One characteristic that can distinguish PMDD from PMS is the intensity of the emotional or psychological symptoms. In PMS, physical symptoms or emotional symptoms can be the primary cause of concern. The main feature of PMDD is the degree to which it interferes with work and relationships. While severe (or even moderate) PMS can have a tremendous impact on a woman's enjoyment of life and her productivity at work and at home, PMDD is almost always worse. The diagnostic criteria listed below can help you understand the continuum of symptoms that characterize PMS and PMDD.
While most women are familiar with the emotional symptoms of PMS—irritability, premenstrual depression, moodiness, and the like—in PMDD these symptoms are so much more severe that it may be difficult for family members, friends, and coworkers to understand just what a premenstrual dysphoric disorder sufferer is going through. While we tend to assume that a person's behavior is under their control, most women with PMDD (and even with moderate to severe PMS) consistently remark that during those days (or weeks) of symptoms, they struggle to manage their emotions and their thought process—despite tremendous effort to do so.
The underlying cause of PMDD symptoms is physical, not psychological, or emotional, or mental. And although the precise mechanism is not completely understood and is still the subject of much research and debate, we do know that PMDD and PMS, and the type of emotions and thoughts and behaviors that can occur in the days and weeks before the period, are caused by hormonal and biochemical changes in a woman's body.
This point deserves repeating: the origin of PMDD and PMS symptoms is not psychological, mental, or emotional problems. Nor are they a failure of willpower: a woman with PMDD can't "just pull herself together." PMDD and PMS are caused by hormones and by biochemistry. It has even recently been proven that genetics play a role in PMDD. As research continues, more of the actual physical (hormonal and biochemical) causes of PMS and PMDD will be discovered.
A formal diagnosis of PMDD requires that a woman's symptoms be present for most of the week before her period, that those symptoms resolve within a few days of the onset of her period, and then not return in the week after her period. Five of the following symptoms must have been present during most menstrual cycles in the past year, and must be marked or severe:
- Depressed mood, feelings of hopelessness, self-deprecating thoughts
- Anxiety or tension, feeling "keyed up" or "on edge"
- Extreme mood changes such as feeling suddenly sad or tearful, or increased sensitivity to rejection
- Persistent irritability or anger, increased conflict in relationships
- Decreased interest in usual activities (school, work, family, hobbies) or social withdrawal
- Concentration difficulties
- Lack of energy, fatigability, lethargy
- Change in appetite, overeating, or food cravings
- Sleeping too much (hypersomnia) or insomnia
- Feeling overwhelmed or out of control
- Physical symptoms: breast tenderness, bloating, swelling of arms or legs, headache, joint or muscle pain, weight gain
And, as mentioned before, PMDD means the symptoms truly interfere with work, school, social activities, or relationships. Also—importantly—PMDD cannot be caused by another problem (for instance, an underlying psychiatric diagnosis.)
PMDD is believed to affect 3%–8% of reproductive-aged women, whereas 20%–50% have moderate to severe PMS based on the American College of Obstetricians and Gynecologists' definition of PMS . In both conditions, the diagnosis depends on the timing: symptoms must occur only before the period, during the luteal phase (after ovulation), and resolve after the period comes. However, we have seen women whose symptoms are clearly premenstrual and are obviously "hormone dysregulation," but which begin before ovulation. Of course, when PMDD and PMS symptoms last longer than two weeks, it creates even more suffering.
Strictly speaking, PMDD and PMS are supposed to be diagnosed only after two months of daily journal-keeping and recording of symptoms. In the real world, however, doctors and practitioners generally begin treatment—with medication or otherwise—without requiring this painstaking recording of symptoms. Thus, you can use our Self-Assessment, as well as the symptoms and criteria listed above, to gain a sense for whether you have PMS or PMDD.
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