Download CHAPTER 13: Premenstrual Dysphoric Disorder

CHAPTER 13:
Premenstrual Dysphoric Disorder
Introduction
• Menstrual cycle is a unique aspect of women’s
health.
• Mood fluctuations across the menstrual cycle
provide an example of how biological
differences between men and women may
have impacted social trajectories.
Introduction
• The negative impacts of premenstrual mood
disturbance on quality of life, daily function,
and economic burden have been well
established.
Diagnosis of PMDD
• PMS includes mild psychological and/or
physical discomfort in the premenstrual
period, but does not markedly impair a
woman’s ability to function in her daily life.
– 80% of women report some form of PMS.
Diagnosis of PMDD
• PMDD is a more severe form of premenstrual
disturbance that specifically requires the
presence of at least one psychiatric symptom
and must be associated with a marked
disturbance in function (i.e., social,
occupational, academic performance).
DSM-IV-TR Criterion A for PMDD
• In most menstrual cycles during the past year, five (or more) of the
following symptoms were present for most of the time during the last
week of the luteal phase, began to remit within a few days after the onset
of the follicular phase, and were absent in the week postmenses, 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, feelings 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) decreased interest in usual activities (e.g., work, school, friends, hobbies)
(6) subjective sense of difficulty in concentrating
(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 subjective sense of being overwhelmed or out of control
(11) other physical symptoms, such as breast tenderness or swelling, headaches, joint
or muscle pain, a sensation of “bloating,” weight gain
Physical Disorders as Differential
Diagnoses
• Some physical disorders can be accompanied
by premenstrual exacerbation of somatic and
psychological symptoms.
– Autoimmune disorders
– Diabetes mellitus
– Anemia
– Hypothyroidism
– Epilepsy
– Migraine
Psychiatric Disorders as Differential
Diagnoses
• Women who report premenstrual mood
disturbance should be screened for psychiatric
symptoms across the menstrual cycle.
– Major depressive disorder
– Dysthymic disorder
– Anxiety disorders
– Bipolar disorder
– Various personality disorders
Prospective Symptom Assessment and
Rating Scales
• There is concern that bias of retrospective
ratings may result in overdiagnosis of PMDD.
• Retrospective reports may be influenced by
phase of cycle during which reports are made.
• Visual analog or Likert rating scales are often
used.
Prevalence and Demographic
Correlates
• Population prevalence estimates are difficult
to obtain.
• PMDD risk is increased for women with family
history of the disorder and personal history of
depression.
• Day-to-day life stress and history of traumatic
life experiences are associated with PMDD.
Impact of PMDD
• Women report impairments in two main areas
of psychosocial function:
– Interpersonal relationships
– Work productivity and absenteeism
Potential Etiologic Factors
• Biological Factors
– Heritability
– Hormones
– Neurotransmitters
Potential Etiologic Factors
• Psychosocial Factors
– Sociocultural factors
– Potential impact of life stress and sexual abuse
Management of PMDD
• Psychoeducation
• Healthy lifestyle and dietary supplementation
• Relaxation skills and structured
psychotherapies
• Herbal, complementary, and other treatments
• Pharmacotherapy
• Manipulation of menstruation
Future Directions
• More work is needed to understand the
etiology of premenstrual mood disturbance
and to optimize treatment.
• One significant question that remains
unanswered:
– Why SSRI/SNRI medications work to alleviate
symptoms of premenstrual dysphoria when used
cyclically in the luteal phase of the menstrual cycle