Premenstrual Dysphoric Disorder: Evidence for a New Category for DSM-5

Department of Psychiatry, Yale University, New Haven, Connecticut, United States
American Journal of Psychiatry (Impact Factor: 12.3). 05/2012; 169(5):465-75. DOI: 10.1176/appi.ajp.2012.11081302
Source: PubMed


Premenstrual dysphoric disorder, which affects 2%–5% of premenopausal women, was included in Appendix B of DSMIV, "Criterion Sets and Axes Provided for Further Study." Since then, aided by the inclusion of specific and rigorous criteria in DSM-IV, there has been an explosion of research on the epidemiology, phenomenology, pathogenesis, and treatment of the disorder. In 2009, the Mood Disorders Work Group for DSM-5 convened a group of experts to examine the literature on premenstrual dysphoric disorder and provide recommendations regarding the appropriate criteria and placement for the disorder in DSM-5. Based on thorough review and lengthy discussion, the work group proposed that the information on the diagnosis, treatment, and validation of the disorder has matured sufficiently for it to qualify as a full category in DSM-5. A move to the position of category, rather than a criterion set in need of further study, will provide greater legitimacy for the disorder and encourage the growth of evidence-based research, ultimately leading to new treatments.

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Available from: Kimberly Ann Yonkers, May 09, 2014
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    • "Epidemiology A large number of population-based studies addressing the prevalence of premenstrual complaints in Western countries has been undertaken (Woods et al. 1982; Andersch et al. 1986; Johnson et al. 1988; Rivera-Tovar and Frank, 1990; Ramacharan et al. 1992; Deuster et al. 1999; Sveindóttir and Bäckström 2000; Angst et al. 2001; Soares et al. 2001; Cohen et al. 2002a; Wittchen et al. 2002). Although these investigations have applied different inventories, and although most of them have been based on retrospective rather than prospective reporting, the outcomes have been reasonably congruent, suggesting a vast majority of women of fertile age to report at least one premenstrual symptom, and severe premenstrual complaints (including a condition meeting the criteria for Table 1 The classification of premenstrual disorders (adapted from O'Brien, 2011—note, this classification was misaligned in the table of the first publication) Premenstrual disorder category Characteristics Core premenstrual disorder a (PMD) Symptoms occur in ovulatory cycles Symptoms are not specified—they may be somatic and/or psychological Symptoms are absent after menstruation and before ovulation Symptoms recur in luteal phase Symptoms must be prospectively rated (two cycles minimum) Symptoms must cause significant impairment (work, school, social activities, hobbies, interpersonal relationships, distress) Variants PMDs Premenstrual exacerbation Symptoms of an underlying psychological, somatic or medical disorder significantly worsen premenstrually PMD due to non-ovulatory ovarian activity (rare) Symptoms result from ovarian activity other than those of ovulation Progestogen-induced PMD b Symptoms result from exogenous progestogen administration PMD with absent menstruation Symptoms arise from continued ovarian activity even though menstruation has been suppressed PMDD) to afflict 2–10 % (Halbreich et al. 2003; Epperson et al. 2012; Hartlage et al. 2012) "
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    ABSTRACT: The second consensus meeting of the International Society for Premenstrual Disorders (ISPMD) took place in London during March 2011. The primary goal was to evaluate the published evidence and consider the expert opinions of the ISPMD members to reach a consensus on advice for the management of premenstrual disorders. Gynaecologists, psychiatrists, psychologists and pharmacologists each formally presented the evidence within their area of expertise; this was followed by an in-depth discussion leading to consensus recommendations. This article provides a comprehensive review of the outcomes from the meeting. The group discussed and agreed that careful diagnosis based on the recommendations and classification derived from the first ISPMD consensus conference is essential and should underlie the appropriate management strategy. Options for the management of premenstrual disorders fall under two broad categories, (a) those influencing central nervous activity, particularly the modulation of the neurotransmitter serotonin and (b) those that suppress ovulation. Psychotropic medication, such as selective serotonin reuptake inhibitors, probably acts by dampening the influence of sex steroids on the brain. Oral contraceptives, gonadotropin-releasing hormone agonists, danazol and estradiol all most likely function by ovulation suppression. The role of oophorectomy was also considered in this respect. Alternative therapies are also addressed, with, e.g. cognitive behavioural therapy, calcium supplements and Vitex agnus castus warranting further exploration.
    Full-text · Article · Apr 2013 · Archives of Women s Mental Health
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    • "Approximately 10 percent of women with PMS experience a very severe form called premenstrual dysphoric disorder (PMDD), with similar prevalence in the United States [4], Canada [5], [6], Europe [7], India [8], Nigeria [9], and Japan [10]. As recently stated by Epperson and colleagues [11], PMDD shows comparable rates in Caucasians and African Americans in the United States [12], and symptoms appear to be relatively stable over time [7], [13]. PMDD is included in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Text Revision; the depressed mood that women with PMDD experience corresponds in severity to a major depressive episode (MDE) [14]. "
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    ABSTRACT: Premenstrual syndrome (PMS) is characterized by a cluster of psychological and somatic symptoms during the late luteal phase of the menstrual cycle that disappear after the onset of menses. Behavioral differences in emotional and cognitive processing have been reported in women with PMS, and it is of particular interest whether PMS affects the parallel execution of emotional and cognitive processing. Related to this is the question of how the performance of women with PMS relates to stress levels compared to women without PMS. Cortisol has been shown to affect emotional processing in general and it has also been shown that women with severe PMS have a particular cortisol profile. We measured performance in an emotional conflict task and stress levels in women with PMS (n = 15) and women without PMS (n = 15) throughout their menstrual cycle. We found a significant increase (p = 0.001) in the mean reaction time for resolving emotional conflict from the follicular to the luteal cycle phase in all subjects. Only women with PMS demonstrated an increase in physiological and subjective stress measures during the luteal menstrual cycle phase. Our findings suggest that the menstrual cycle modulates the integration of emotional and cognitive processing in all women. Preliminary data are supportive of the secondary hypothesis that stress levels are mediated by the menstrual cycle phase only in women with PMS. The presented evidence for menstrual cycle-specific differences in integrating emotional and cognitive information highlights the importance of controlling for menstrual cycle phase in studies that aim to elucidate the interplay of emotion and cognition.
    Full-text · Article · Apr 2013 · PLoS ONE
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    ABSTRACT: Diagnosis of psychiatric conditions is a topic that is currently receiving significant attention in light of the release of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. The process of the revisions is complex and involves political, social, and economic influences, all of which are amplified in an evolving corporate health care system in the United States. Of particular concern in the development of the revised nosology is the representation of gender-specific diagnoses and course specifiers to reflect the distinct manifestations of the psychiatric symptoms of women. Based on a growing body of psychobiological evidence related to gender differences in symptom manifestation, gender specific diagnoses remain palpably absent from the taxonomy. This article explores the issue of invisibility of women-specific diagnosis from the perspective of a women's health advanced practice nurse.
    No preview · Article · Sep 2012 · Issues in Mental Health Nursing
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