Criteria for Premenstrual Dysphoric Disorder Secondary Analyses of Relevant Data Sets

Context: There is substantial information that premenstrual dysphoric disorder(PMDD) is a clinically significant disorder with biological underpinnings that differ from other psychiatric disorders. However, data regarding the symptoms noted in DSM-IV and timing of their expression in the menstrual cycle have had little empirical support. Objective: To provide evidence informing the definitional criteria for PMDD. Design: Prospective surveys. Setting: General community and clinical settings. Participants: Two cohorts that included a representative sample and a self-identified treatment-seeking cohort. Main Outcome Measure: Daily ratings of perimenstrual symptoms and functioning. Results: Mood and physical symptoms were most severe and were accompanied by impairment in the 4 days before through the first 2 days of menses for the selfidentified group and in the 3 days before through the first 3 days of menses in the community sample. The most problematic symptoms endorsed were those listed in DSM-IV, but depressed mood was less frequent than other affective symptoms. In the combined sample, 4 or more symptoms was the optimal cutoff point for maximizing both sensitivity and specificity when predicting impairment. Conclusions: This is informative for DSM-5 in that the most symptomatic period typically includes the few days before through the first 3 days of menses rather than only the premenstrual phase. Further, we validated the salience of PMDD symptoms included in DSM-IV. Although the number of symptoms most associated with distress and impairment differed between the 2 cohorts, results from the combined cohort suggest that 4 symptoms are linked with impairment from PMDD symptoms.