The terminology of premenstrual disorders is complex. Premenstrual tension was the original medical term but has now become the usual lay term; premenstrual syndrome (PMS) is the medical term most often used in the United Kingdom. Premenstrual dysphoric disorder (PMDD) is the extreme predominantly psychological end of the PMS spectrum estimated to occur in 3-9% of women  (Table 41.1). It is the term used increasingly by psychiatrists in the United States. Strictly speaking these are research and not clinical diagnostic criteria; it should be noted that much recent research into aetiology and treatment has been undertaken on women who fulfil the criteria for PMDD. Women designated as having PMDD also fulfil criteria for PMS but not necessarily vice versa. The term PMDD may become more established in Europe.
The term premenstrual syndrome (PMS) is defined in the Tenth Revision of the International Classification of Disease (ICD-10) . A woman is considered to have premenstrual syndrome if she complains of recurrent psychological or somatic symptoms (or both), occurring specifically during the luteal phase of the menstrual cycle and which resolve in the follicular phase at least by the end of menstruation.
Table 41.1 DSM-IV research diagnostic criteria for PMDD (1994)
A. In most menstrual cycles, five (or more) of the following symptoms are present, with at least one of the symptoms being either (1), (2), (3), or (4)
1 Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
2 Marked anxiety, tension, feeling of being 'keyed up' or 'on edge'
3 Marked affective lability (e.g. feeling suddenly sad or tearful or increased sensitivity to rejection)
4 Persistent and marked anger or irritability or increased interpersonal conflicts
5 Subjective sense of difficulty in concentrating
6 Decreased interest in usual activities (e.g., work, school, friends, hobbies)
7 Lethargy, easy fatigability, or marked lack of energy
8 Marked change in appetite, overeating, or specific food cravings
9 Hypersomnia or insomnia
10 A sense of being overwhelmed or out of control
B. Interference with work, school, or social relationships
C. Symptoms of PMDD must be present for most of the time during the last week of the luteal phase (premenses) and absent during the week after menses
D. The disturbance cannot merely be an exacerbation of the symptoms of another disorder
E. Confirmation by prospective daily ratings for two consecutive menstrual cycles
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