Differentiating premenstrual dysphoric disorder from premenstrual exacerbations of other disorders: A methods dilemma.

Abstract

Premenstrual dysphoric disorder (PMDD) and premenstrual exacerbations of other disorders are difficult to distinguish. Previous methods, such as excluding women with other disorders from a PMDD diagnosis, do not enable a dual diagnosis. Our objective is to advance conceptual and clinical thinking and stimulate dialogue regarding this methods dilemma. The discussion sheds light on comorbidity in general, regardless of the disorders. Considering fundamental criteria for severe premenstrual disorders helps distinguish the phenomena of interest. A proposed method allows identification of PMDD co‐occurring with other disorders. PMDD symptoms can be differentiated by their nature and timing (e.g., cyclic depressed mood could be a PMDD symptom, but cyclic binge eating or depressed mood all month long could not be). Impairment must increase premenstrually for a PMDD diagnosis. The proposed method is an advance, but specified unanswered questions remain.

Prevalence and correlates of current suicidal ideation in women with premenstrual dysphoric disorder

“…Although women with current psychiatric comorbidity or prior hospitalization for psychiatric disorders were excluded for the purposes of the trial from which the sample was included, women with a self-reported history of depression more frequently reported suicidal ideation. Notably, psychiatric comorbidity is not incompatible with the PMDD diagnosis if symptoms are unique in each disorder [ 9 ]. The exclusion of women with current psychiatric comorbidity may have led to an underestimation of the prevalence of suicidal ideation in women with PMDD in a real-world as opposed to a trial context.…”

Toward the Content Validity of Premenstrual Dysphoric Disorder: Do Anger and Irritability More than Depressed Mood Represent Treatment-Seekers' Experiences?

“…This is the third criterion. To ensure that symptoms of Premenstrual Dysphoric Disorder were not exacerbations of the symptoms of a woman's other ~sychiatric disorder(s), symptoms that overlapped with those of a woman's other existing psychiatric disorder(~) were excluded as ~ossible symptoms of her Premenstrual Dysphoric Disorder (Hartlage & Gehlert, 2001). This was done on a case by case basis.…”

“…The specific set of symptoms experienced by an individual woman may also vary from month to month (Halbreich, Endicott, & Nee, 1982). Many symptoms of Premenstrual Dysphoric Disorder, e.g., depressed mood, overlap with those of other psychiatric disorders, complicating the process of differentiating symptoms of Premenstrual Dysphoric Disorder from those of comorbid psychiatric disorders in women who have cornorbid disorders (Hartlage & Gehlert, 2001).…”

Premenstrual Disorders: A Primer and Research Agenda for Psychologists

“…It is important to recognize that neither PMDD nor PME are monolithic groups, and it is likely that some patients with PME are suffering from similar hormone sensitivities to those with prototypical PMDD and will therefore respond to similar treatments focused on reducing the negative effects of fluctuating hormones (see PMDD section above). While it is often the case that an individual has PMDD, PME, or neither, it is also possible to have both PMDD and PME (Hartlage & Gehlert, 2001). As an example, it is possible to have PME of depression (chronic depression with worsening before and during menses) and also have a PMDD pattern (i.e., luteal phase confinement) of five other symptoms-usually physical symptoms, mood swings, anger/irritability, rejection sensitivity, and anxiety symptoms that ONLY appear between ovulation and menses.…”