Update on Research and Treatment of Premenstrual Dysphoric Disorder

Department of Psychiatry, Yale University, New Haven, CT 06510, USA.
Harvard Review of Psychiatry (Impact Factor: 1.73). 02/2009; 17(2):120-37. DOI: 10.1080/10673220902891836
Source: PubMed


Many women in their reproductive years experience some mood, behavioral. or physical symptoms in the week prior to menses. Variability exists in the level of symptom burden in that some women experience mild symptoms, whereas a small minority experience severe and debilitating symptoms. For an estimated 5%-8% of premenopausal women, work or social functioning are affected by severe premenstrual syndrome. Many women in this group meet diagnostic criteria for premenstrual dysphoric disorder (PMDD). Among women who suffer from PMDD, mood and behavioral symptoms such as irritability, depressed mood, tension, and labile mood dominate. Somatic complaints, including breast tenderness and bloating, also can prove disruptive to women's overall functioning and quality of life. Recent evidence suggests that individual sensitivity to cyclical variations in levels of gonadal hormones may predispose certain women to experience these mood, behavioral, and somatic symptoms. Treatments include: antidepressants of the serotonin reuptake inhibitor class, taken intermittently or throughout the menstrual cycle; medications that suppress ovarian cyclicity; and newer oral contraceptives with novel progestins.

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Available from: Kimberly Ann Yonkers, Jan 10, 2014
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    • "Even if women who experience premenstrual anger/distress might show an increased sensitivity to cyclical variations in hormone levels (Cunningham et al. 2009), and if this may render them more susceptible to react to psychosocial stressors, that in itself could serve a productive function, alerting the individual to something wrong/harmful that should be addressed. Indeed, such an interpretation has been found in North American and Indian studies, in which a significant number of women state they experienced positive aspects of premenstrual changes when given the chance (Alagna and Hamilton 1986; Stewart 1989; Chaturvedi and Chandra 1990; Lee 2002). "
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    ABSTRACT: Premenstrual dysphoric disorder (PMDD) was recently moved to a full category in the DSM-5 (the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders). It also appears set for inclusion as a separate disorder in the ICD-11 (the upcoming edition of the World Health Organization's International Statistical Classification of Diseases and Related Health Problems). This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD is a culture-bound phenomenon, not a universal one. I also argue that even if (1) medication produces a desired effect, (2) there are biological correlates with premenstrual anger/distress, (3) such anger/distress seems to occur monthly, and (4) women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one's environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women's suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women's suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications.
    Full-text · Article · Aug 2014 · Journal of Bioethical Inquiry
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    • "Consequently, it has been suggested that PMS arises through an interaction between hormones and receptor or neurotransmitter variants (Mortola 1996; Dickerson et al. 2003). Likely candidate loci include those with roles in reception of oestrogen and progesterone (Cunningham et al. 2009; Biggs and Demuth 2011), or genes for neurotransmitter receptors, particularly serotonin, as intermittent use of selective serotonin reuptake inhibitors can ameliorate the symptoms of PMS (Dimmock et al. 2000; Brown et al. 2009; Pearlstein 2012). Advances in human behavioural genomics have begun to examine the role of genetic polymorphisms in the aetiology of PMS. "
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    ABSTRACT: Premenstrual syndrome (PMS) affects up to 80% of women, often leading to significant personal, social and economic costs. When apparently maladaptive states are widespread, they sometimes confer a hidden advantage, or did so in our evolutionary past. We suggest that PMS had a selective advantage because it increased the chance that infertile pair bonds would dissolve, thus improving the reproductive outcomes of women in such partnerships. We confirm predictions arising from the hypothesis: PMS has high heritability; gene variants associated with PMS can be identified; animosity exhibited during PMS is preferentially directed at current partners; and behaviours exhibited during PMS may increase the chance of finding a new partner. Under this view, the prevalence of PMS might result from genes and behaviours that are adaptive in some societies, but are potentially less appropriate in modern cultures. Understanding this evolutionary mismatch might help depathologize PMS, and suggests solutions, including the choice to use cycle-stopping contraception.
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    • "Similar to epilepsy, the increased prevalence of PMS (PMDD) and anorexia in women with ASC may represent shared psychiatric susceptibilities to hormones rather than shared alterations in sex steroids per se. Women with PMDD may have a severe experience of normal fluctuations in emotional processing and cognition across the menstrual cycle, and estrogen modification of serotonergic circuits and allopregnanolone modification of GABAergic signaling have both been implicated in the etiology of PMDD [81]. An increased prevalence of anorexia among women with ASC is consistent with suggestions that anorexia may have a similar cognitive phenotype to, and share risk factors with, ASC [82]. "
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    ABSTRACT: Prenatal exposure to increased androgens has been implicated in both polycystic ovary syndrome (PCOS) and autism spectrum conditions (ASC), suggesting that PCOS may be increased among women with ASC. One study suggested elevated steroidopathic symptoms ('steroidopathy') in women with ASC. As the symptoms are not independent, we conducted a latent class analysis (LCA). The objectives of the current study are: (1) to test if these findings replicate in a larger sample; and (2) to use LCA to uncover affected clusters of women with ASC. We tested two groups of women, screened using the Autism Spectrum Quotient - Group 1: n = 415 women with ASC (mean age 36.39 +/- 11.98 years); and Group 2: n = 415 controls (mean age 39.96 +/- 11.92 years). All participants completed the Testosterone-related Medical Questionnaire online. A multiple-group LCA was used to identify differences in latent class structure between women with ASC and controls. There were significant differences in frequency of steroid-related conditions and symptoms between women with ASC and controls. A two-class semi-constrained model best fit the data. Based on response patterns, we identified the classes as 'Typical' and 'Steroidopathic'. The prevalence of the 'Steroidopathic' class was significantly increased within the ASC group (DeltaG2 = 15, df =1, P = 0.0001). In particular, we confirmed higher frequencies of epilepsy, amenorrhea, dysmenorrhea, severe acne, gender dysphoria, and transsexualism, and differences in sexual preference in women with ASC. Women with ASC are at increased risk for symptoms and conditions linked to steroids. LCA revealed this steroidopathy despite the apparent underdiagnosis of PCOS.
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