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Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that causes marked social impairment in approximately 5 of 100 women. Women can present with multiple symptoms, such as fatigue, headache, feelings of hopelessness, irritability, and bloating. These occur exclusively in the 10 to 14 days before menses. PREVALENCE PMS is a common condition that affects as many as 75% of women. It is characterized by a myriad of physical and behavioral symptoms that occur repetitively in the luteal phase of the menstrual cycle. Women with PMS often describe feelings of anger, fatigue, abdominal bloating, irritability, anxiety, breast tenderness, changes in appetite and sleep, headaches, and mood lability. These symptoms usually do not preclude a woman from performing her day-to-day activities. A small subgroup of women (3% to 8%)1 in their late 20s to mid-30s, however, suffer from a severe form of PMS that is serious enough to interfere with their daily functioning and personal relationships. These women suffer from PMDD, a condition first defined in 1987 in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) and subsequently modified in 1994 in the manual's fourth edition (DSM-IV). Table1: Differences Between PMS and PMDD Prevalence Number of symptoms required PMS PMDD 75% 3-8% 1 5 of 11 DSM-IV Diagnosis ICD-10* Social impairment Not required Required Prospective charting Not required Required *International Statistical Classification of Diseases and Related Health Problems, 10th revision.