3. Marked depressed mood, feelings of hopelessness, or seIf-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.
. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
. Subjective difficulty in concentration.
. Lethargy, easy fatigability, or marked lack of energy.
. Marked change in appetite; overeating; or specific food cravings.
. Hypersomnia or insomnia.
. A sense of being overwhelmed or out of control.
. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
Note: The symptoms in Criteria A—C must have been met for most menstrual cycles that occurred in the preceding year.
D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of so- cial activities; decreased productivity and efficiency at work, school, or home).
E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these dis- orders).
F. Criterion A should be confirmed by prospective daily ratings during at least two symptom- atic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hy- perthyroidism).
If symptoms have not been confirmed by prospective daily ratings of at least two symp- tomatic cycles, "provisional" should be noted after the name of the diagnosis (i.e., "pre- menstrual dysphoric disorder, provisional").
The essential features of premenstrual dysphoric disorder are the expression of mood la- bility, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the pre- menstrual phase of the cycle and remit around the onset of menses or shortly thereafter.
These symptoms may be accompanied by behavioral and physical symptoms. Symptoms must have occurred in most of the menstrual cycles during the past year and must have an adverse effect on work or social functioning. The intensity and / or expressivity of the ac- companying symptoms may be closely related to social and cultural background charac- teristics of the affected female, family perspectives, and more specific factors such as religious beliefs, social tolerance, and female gender role issues.
Typically, symptoms peak around the time of the onset of menses. Although it is not uncommon for symptoms to linger into the first few days of menses, the individual must have a symptom-free period in the follicular phase after the menstrual period begins.
While the core symptoms include mood and anxiety symptoms, behavioral and somatic symptoms commonly also occur. However, the presence of physical and/ or behavioral symptoms in the absence of mood and/ or anxious symptoms is not sufficient for a diag- nosis. Symptoms are of comparable severity (but not duration) to those of another mental disorder, such as a major depressive episode or generalized anxiety disorder. In order to confirm a provisional diagnosis, daily prospective symptom ratings are required for at least two symptomatic cycles.
Delusions and hallucinations have been described in the late luteal phase of the menstrual cycle but are rare. The premenstrual phase has been considered by some to be a risk period for suicide.