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Premenstrual Dysphoric Disorder (PMDD) (cont.)

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When should I call a doctor about PMDD?

It is appropriate to seek medical care for troubling physical or emotional symptoms related to the menstrual cycle.

It is important to note that the depressive symptoms of PMDD may be associated with thoughts of suicide and suicidal behavior. This is a medical emergency for which medical attention should be accessed immediately.

How is PMDD diagnosed?

PMDD must be distinguished from other physical and psychological conditions that can produce the same symptoms. The differential diagnosis (list of conditions that may produce the same symptoms) includes both mood and anxiety disorders as well as medical conditions such as thyroid disease. In addition to a thorough medical history and physical examination, blood tests may be performed to rule out whether medical conditions may be present that may account for the PMDD symptoms.

If PMDD is a concern, it is recommended that women complete a symptom chart or calendar prospectively (meaning that they record their symptoms each day for a given period) to establish the diagnosis. The symptom chart can be compared with the menstrual calendar to illustrate the relationship of symptoms to the menstrual cycle.

The American Psychiatric Association has established formal guidelines for the diagnosis of PMDD in their Diagnostic and Statistical Manual (DSM-IV). The DSM-IV diagnostic criteria for the diagnosis of PMDD require prospective documentation of symptoms being present for at least two consecutive menstrual cycles.

Five or more of the following symptoms must have been present during the week prior to the menstrual period and resolve within a few days of the start of the woman's period. The symptoms must interfere with the activities of a woman's daily living and not be a result of another condition or illness. At least one of the symptoms must be one of the first four on the list:

  • feeling sad, hopeless, or self-deprecating;
  • feeling tense, anxious, or "on edge;"
  • marked changes in mood, becoming sad or tearful;
  • persistent irritability, anger, and increased interpersonal conflicts;
  • decreased interest in usual activities, which may be associated with withdrawal from social relationships;
  • difficulty concentrating;
  • feeling fatigued, lethargic, or lacking in energy;
  • marked changes in appetite, which may be associated with binge eating or craving certain foods;
  • hypersomnia (excessive sleeping) or insomnia;
  • a subjective feeling of being overwhelmed or out of control; and
  • other physical symptoms, such as breast tenderness or swelling, headaches,joint or muscle pain, a sensation of bloating, weight gain.
Medically Reviewed by a Doctor on 8/17/2016


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