Dysmenorrhea. Dysmenorrhea is a syndrome of painful menses, but this is distinct from a syndrome characterized by affective changes. Moreover, symptoms of dysmenorrhea begin with the onset of menses, whereas symptoms of premenstrual dysphoric disorder, by defini- tion, begin before the onset of menses, even if they linger into the first few days of menses.
Bipolar disorder, major depressive disorder, and persistent depressive disorder (dysthymia). Many women with (either naturally occurring or substance/ medication- that they have premenstrual dysphoric disorder. However, when they chart symptoms, they realize that the symptoms do not follow a premenstrual pattern. Women with an- are unrelated to menstrual cycle phase. However, because the onset of menses constitutes a memorable event, they may report that symptoms occur only during the premenstruum or that symptoms worsen premenstrually. This is one of the rationales for the requirement that symptoms be confirmed by daily prospective ratings. The process of differential di- agnosis, particularly if the clinician relies on retrospective symptoms only, is made more difficult because of the overlap between symptoms of premenstrual dysphoric disorder and some other diagnoses. The overlap of symptoms is particularly salient for differenti- ating premenstrual dysphoric disorder from major depressive episodes, persistent de- pressive disorder, bipolar disorders, and borderline personality disorder. However, the rate of personality disorders is no higher in individuals with premenstrual dysphoric dis- order than in those without the disorder.
Use of hormonal treatments. Some women who present with moderate to severe pre- menstrual symptoms may be using hormonal treatments, including hormonal contracep- tives. If such symptoms occur after initiation of exogenous hormone use, the symptoms may be due to the use of hormones rather than to the underlying condition of premen- strual dysphoric disorder. If the woman stops hormones and the symptoms disappear, this is consistent with substance/medication-induced depressive disorder.
A major depressive episode is the most frequently reported previous disorder in individuals presenting with premenstrual dysphoric disorder. A wide range of medical (e.g., migraine, asthma, allergies, seizure disorders) or other mental disorders (e.g., depressive and bipolar disorders, anxiety disorders, bulimia nervosa, substance use disorders) may worsen in the premenstrual phase; however, the absence of a symptom-free period during the postmen- strual interval obviates a diagnosis of premenstrual dysphoric disorder. These conditions are better considered premenstrual exacerbation of a current mental or medical disorder. Al- though the diagnosis of premenstrual dysphoric disorder should not be assigned in situa— tions in which an individual only experiences a premenstrual exacerbation of another mental or physical disorder, it can be considered in addition to the diagnosis of another men- tal or physical disorder if the individual experiences symptoms and changes in level of func- tioning that are characteristic of premenstrual dysphoric disorder and markedly different from the symptoms experienced as part of the ongoing disorder.
A. A prominent and persistent disturbance in mood that predominates in the clinical pic- ture and is characterized by depressed mood or markedly diminished interest or plea- sure in all, or almost all, activities.
B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2): 1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Crite- rion A.
C. The disturbance is not better explained by a depressive disorder that is not substance/ medication-induced. Such evidence of an independent depressive disorder could in- clude the following: