PMDD and the DSM-V Manual

by Dr. Daniel J. Heller May 21, 2012

If you suffer from the debilitating symptoms of PMDD, also known as premenstrual dysphoric disorder, it may surprise you to learn that up until now, it has been at the margins—or, more accurately, in the appendix—of mainstream psychological thinking in the U.S. That’s because the formal guide to the diagnosis of mental illness, the DSM-IV, listed PMDD at the back of the book, in its appendix, where conditions that the psychiatric profession wasn’t sure about were listed. Now, PMDD appears to be poised to join other recognized illnesses and conditions in the main section of the upcoming new DSM-V.

If you’ve been diagnosed with PMDD, or wondered if you have PMDD, you might be a little disconcerted to learn that it is considered a mental illness – but for any condition to be treated by medical doctors with psychiatric medications like Prozac® or Sarafem® (Fluoxetine®) and other SSRIs, it has to be listed in the DSM and is then called a mental illness.

The downside of this, of course, is that there is a social stigma associated with the word “mental illness.” Many people don’t realize that by itself, it is just a label that doesn’t really mean anything, and that millions of people have depression and other “mental” illnesses that we now understand are physical ailments like any other – they just happen to affect the brain, instead of joints or kidneys or other structures.

One potential upside to PMDD’s promotion to the main section of the DSM-V, up from the appendix, is an increased recognition of premenstrual dysphoric disorder, with more attention to research and investigation on possible causes and cures likely to follow.

An interesting side note: with an increasing recognition of PMDD, there will be a tendency for general practitioners to make this diagnosis, even though gynecologists and psychiatrists are probably more familiar with the condition, its diagnostic criteria, and how to manage it. PMDD can’t be diagnosed in your typical 5-15 minute doctor’s visit.

Another evolving factor to keep an eye on: it is now recognized at the highest levels of research and medicine that SSRIs—selective serotonin reuptake inhibitors, like Prozac®, Sarafem® and Zoloft®—don’t work for depression through helping with serotonin levels in the brain. In fact, they don’t work any differently than placebo, a fact that is causing tremendous reverberations in the world of mental health.

This may not be true for PMDD: since it hasn’t been studied, we don’t know if SSRIs work differently in PMDD than they do in depression. But this is unlikely, since the use of Fluoxetine® for PMDD grew out of the similarities between depression and what used to be called late luteal phase disorder. So as the whole paradigm of serotonin deficiency begins to crumble, the treatment of PMDD may change too—perhaps just in time for the DSM-VI.

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About The PMS Comfort Blog

The PMS Comfort Blog is our informal way of keeping you up to date on women’s health issues that we think are important; timely; underappreciated; useful; or just interesting. And, we’ll admit, sometimes we can’t resist poking some good-natured fun at the way the mainstream media portrays health, natural health, and women’s health issues. As always, we’d love to hear from you and are interested in knowing what you think and feel about these or other topics. Leave a comment for us, we’ll always respond. And, if there’s a women’s health topic that’s of interest to you, or that you find confusing, let us know! We want this blog to be helpful to you.


Dr. Daniel Heller is the primary author of this blog, the developer of our PMS Natural Relief Programs, and the founder of He is a holistic naturopathic doctor in Northern California with over 16 years experience helping thousands of women recover from PMS, PMDD, as well as helping women, children, and families find natural answers to all manner of health challenges.


PMS Comfort is here to support you with detailed, practical knowledge presented in a balanced manner you can trust. We are committed to educating, informing, and empowering womenregarding PMS, PMDD, and women’s health, and to providing natural relief for premenstrual symptoms.



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