Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 3–8% of people who menstruate.[3] The disorder consists of a "cluster of affective, behavioral and somatic symptoms" that recur monthly during the luteal phase of the menstrual cycle.[3] PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. The exact pathogenesis of the disorder is still unclear and is an active research topic. Treatment of PMDD relies largely on antidepressants that modulate serotonin levels in the brain via serotonin reuptake inhibitors as well as ovulation suppression using contraception.[3]
Premenstrual dysphoric disorder
Classification and external resources
Specialty Psychiatry
ICD-10 F38.8
ICD-9-CM 311,[1] 625.4[2]
MedlinePlus 007193
eMedicine article/293257
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Signs and symptoms
Causes
Diagnosis
Treatment
Epidemiology
History Edit
The diagnostic category was first made part of the DSM-IIIR in 1987, when it was named "Late Luteal Phase Dysphoric Disorder" and included in an appendix as a proposed diagnostic category needing further study. Preparations for the DSM-IV led to debate about whether to keep the category at all, keep it in the appendix, or remove it; the reviewers determined that the condition was still too poorly studied and defined, so it was kept in the appendix but elaborated with diagnostic criteria to aid further study.[30]
As preparations were underway in 1998 for the DSM-IV-TR, the conversation changed, as Eli Lilly and Company had paid for a large clinical trial of fluoxetine as a potential treatment for the condition that had been conducted by Canadian academics and published in the New England Journal of Medicine in 1995, and other studies had been conducted as well that all found that about 60% of people with PMDD in the trials improved with the drug;[30][31] representatives from Lilly and the FDA participated in the discussion.[30]
Various strong stances were taken in the discussion. For example, Sally Severino, a psychiatrist, argued that because PMDD symptoms were more prevalent in the US, it was a culture-bound syndrome and not a biological condition, and also said it was "an unnecessary pathologizing of cyclical changes in women."[30] Jean Endicott, another psychiatrist and chair of the committee, has argued that it is a valid condition from which people suffer and should be diagnosed and treated, and has said: "If men had PMDD, it would have been studied a long time ago."[30] In the end the committee kept PMDD in the appendix.[30]
The decision has been criticized as being driven by Lilly's financial interests, and possibly by financial interests of members of the committee who had received funding from Lilly.[30] Paula Caplan, a psychologist who had served on the committee for the DSM-IV, noted at the time of the DSM-IV-TR decision that there was some evidence that calcium supplements could treat PMDD but the committee hardly looked at them; she also had claimed that the diagnostic category is harmful to people with PMDD, leading them to believe they are mentally ill, and potentially leading others to mistrust them in situations as important as job promotions or child custody cases.[30] She has called PMDD "an invented disorder."[32] Nada Stotland has expressed concern that people with PMDD may actually have a more serious condition like major depressive disorder or may be in difficult circumstances, like suffering domestic abuse, may have their true issues remain undiagnosed and managed, if their gynecologist diagnoses them with PMDD and gives them drugs to treat that condition.[30]
The validity of PMDD was once more debated when it came to time to create the DSM-5 in 2008.[33] In the end it was included as a formal category; a review in the Journal of Clinical Psychiatry published in 2014 examined the arguments against inclusion, which it summarized as: "(1) the PMDD label will harm women economically, politically, legally, and domestically; (2) there is no equivalent hormonally based medical label for males; (3) the research on PMDD is faulty; (4) PMDD is a culture-bound condition; (5) PMDD is due to situational, rather than biological, factors; and (6) PMDD was fabricated by pharmaceutical companies for financial gain" and addressed each and found no evidence of harm, that no hormonally-driven disorder has been identified in men despite research seeking it; that the research base has matured; that PMDD has been identified worldwide; that a small minority of people do suffer from the condition; and that while there has been financial conflict of interest it has not made the research unusable. It concluded by noting that women have historically been under-treated and told that problems are "all in their heads", and that the formal diagnostic criteria would spur more funding, research, diagnosis and treatment for people who suffer