Premenstrual Dysphoric Disorder DSM-5

Explore the criteria of Premenstrual Dysphoric Disorder (PMDD) as outlined in DSM-5, shedding light on panic disorder and its impact on mental health.

By Joshua Napilay on May 15, 2024.

Fact Checked by Nate Lacson.

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What is PMDD according to the DSM-5?

Premenstrual Dysphoric Disorder (PMDD) is a condition classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) under depressive disorders. It is characterized by severe mood symptoms, emotional disturbances, and physical symptoms occurring during the late luteal phase of most menstrual cycles. PMDD symptoms markedly interfere with daily functioning and result in clinically significant distress. These symptoms may include marked irritability, mood swings, depressed mood, feelings of sadness, anger, anxiety, marked affective lability, and decreased interest in usual activities.

Physical symptoms commonly associated with PMDD include joint or muscle pain, breast tenderness, weight gain, food cravings, major depression, and other somatic symptoms. These symptoms typically appear following ovulation and improve with the onset of menses.

PMDD diagnosis requires the presence of specific depressive symptoms during most menstrual cycles and their resolution shortly after menstruation begins. Risk factors for PMDD include hormonal fluctuations, reproductive hormones, and underlying mood disorders such as major depressive disorder or persistent depressive disorder.

Treatment for PMDD may involve psychotherapy, lifestyle changes, and medication, including selective serotonin reuptake inhibitors (SSRIs) to alleviate symptoms. It's crucial to differentiate PMDD from other mood disorders, premenstrual syndrome (PMS), and medical conditions to provide appropriate management and support to individuals affected by this condition.

Printable Premenstrual Dysphoric Disorder DSM-5

Download this Printable Premenstrual Dysphoric Disorder DSM-5 to aid in accurate diagnosis and treatment planning for patients experiencing PMDD, enhancing mental health support and symptom management strategies.

How is PMDD distinguished from regular PMS?

Premenstrual Dysphoric Disorder (PMDD) is distinguished from regular Premenstrual Syndrome (PMS) by the severity, duration, and impact of symptoms on daily functioning. While both PMDD and PMS involve physical and emotional symptoms that occur in the late luteal phase of the menstrual cycle, PMDD is characterized by more severe and debilitating symptoms that significantly interfere with daily life. 

Here's how PMDD is distinguished from regular PMS:

  • Severity: PMDD symptoms are more severe and debilitating compared to PMS. Individuals with PMDD experience intense mood disturbances, such as severe irritability, depression, mood swings, and anxiety, which may significantly impair their ability to function normally.
  • Duration: PMDD symptoms are typically more persistent and last longer than those of PMS. While PMS symptoms usually resolve after menstruation begins, PMDD symptoms may persist throughout the menstrual cycle and improve only after the onset of menstruation.
  • Impact on daily functioning: PMDD symptoms cause significant distress and impairment in daily functioning, affecting various areas of life, including work, school, relationships, and social activities. In contrast, PMS symptoms may cause mild discomfort but generally do not disrupt daily activities to the same extent.
  • Specificity: PMDD is characterized by specific symptoms, such as marked irritability, mood swings, and affective lability, which are not typically present in regular PMS. These symptoms are listed in the diagnostic criteria for PMDD but may not be as pronounced in individuals with milder forms of premenstrual symptoms.
  • Response to treatment: PMDD often requires more intensive treatment approaches, such as medication (e.g., SSRIs) and psychotherapy, due to the severity of symptoms. PMS symptoms, on the other hand, may be managed with lifestyle changes, over-the-counter pain relievers, and self-care strategies.

What causes PMDD?

The exact cause of Premenstrual Dysphoric Disorder (PMDD) is not fully understood, but it is believed to involve a combination of biological, genetic, and environmental factors. Some potential contributors to the development of PMDD include:

  • Hormonal changes: Fluctuations in reproductive hormones, such as estrogen and progesterone, during the menstrual cycle may play a role in triggering PMDD symptoms. The transition from the follicular phase to the luteal phase, marked by changes in hormone levels, is particularly relevant to the onset of PMDD symptoms.
  • Neurotransmitter imbalance: PMDD may be associated with alterations in neurotransmitter activity, particularly serotonin, which regulates mood, emotions, and behavior. It is hypothesized that changes in serotonin levels during the menstrual cycle contribute to the mood disturbances and emotional symptoms characteristic of PMDD.
  • Genetic factors: There may be a genetic predisposition to PMDD, as it tends to run in families. Studies have suggested that certain genetic variations may increase susceptibility to PMDD or influence individual responses to hormonal fluctuations and stress.
  • Sensitivity to hormonal changes: Some individuals may be more sensitive to hormonal changes during the menstrual cycle, leading to exaggerated responses in mood and behavior. This heightened sensitivity may contribute to the development of PMDD symptoms.
  • Environmental and psychosocial factors: Stress, lifestyle factors, and psychosocial stressors can exacerbate PMDD symptoms or contribute to their severity. Poor coping mechanisms, inadequate social support, and environmental stressors may interact with hormonal changes to worsen symptoms.
  • Neuroendocrine dysregulation: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis regulates stress responses, and hormone levels have been implicated in PMDD. Dysfunction in the HPA axis may contribute to mood disturbances and exacerbate PMDD symptoms.

PMDD DSM-5 example (sample)

Discover a comprehensive example of documenting Premenstrual Dysphoric Disorder (PMDD) according to DSM-5 criteria! Download this free template to gain insights into assessing and managing PMDD in clinical practice. 

By utilizing this example, medical professionals can efficiently evaluate patients presenting with PMDD symptoms, formulate accurate diagnoses, and develop effective treatment plans tailored to individual needs. 

Take advantage of this valuable resource; click the link below to access the free PMDD DSM-5 example and enhance your clinical proficiency in managing this challenging medical condition.

Download this free Premenstrual Dysphoric Disorder DSM-5 example here

Premenstrual Dysphoric Disorder DSM-5

How common is PMDD?

Estimating the prevalence of Premenstrual Dysphoric Disorder (PMDD) can be challenging due to variations in diagnostic criteria, study methodologies, and cultural factors. However, research suggests that PMDD affects a significant proportion of individuals with menstrual cycles.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PMDD is estimated to affect approximately 2-5% of menstruating individuals. However, some studies have reported higher prevalence rates, ranging from 3% to 8%, depending on the population studied and the diagnostic criteria used.

PMDD tends to occur most commonly during the reproductive years, typically starting in the late teens or early twenties, and may persist until menopause. It is more prevalent among individuals with a personal or family history of mood disorders, such psychiatric disorders such as major depressive disorder or bipolar disorder.

It's important to note that while PMDD is less common than Premenstrual Syndrome (PMS), which affects a more significant proportion of individuals, PMDD is characterized by more severe symptoms and more significant impairment in daily functioning. Additionally, many cases of PMDD may go undiagnosed or misdiagnosed due to a lack of awareness among healthcare providers and individuals themselves.

What are the treatment options for PMDD?

Treatment options for Premenstrual Dysphoric Disorder (PMDD) aim to alleviate symptoms, improve quality of life, and reduce the impact of PMDD on daily functioning. Treatment choice depends on the severity of symptoms, individual preferences, and medical history. 

Here are some standard treatment options for PMDD:


  • Selective serotonin reuptake inhibitors (SSRIs): Antidepressant medications such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are often used as first-line treatment for PMDD. SSRIs can help reduce mood, irritability, and physical symptoms when taken continuously or during the luteal phase of the menstrual cycle.
  • Oral contraceptives: Combined oral contraceptives containing estrogen and progestin may help regulate hormonal fluctuations and improve PMDD symptoms. Continuous or extended-cycle regimens may be particularly beneficial in reducing symptoms.
  • Gonadotropin-releasing hormone (GnRH) Agonists: These medications suppress ovarian function and may be used in severe cases of PMDD that do not respond to other treatments. GnRH agonists are typically used short-term due to potential side effects and long-term implications for bone health.


  • Cognitive-behavioral therapy (CBT): CBT can help individuals with PMDD learn coping skills, identify negative thought patterns, and develop strategies to manage mood symptoms and stressors. CBT techniques may include cognitive restructuring, relaxation training, and problem-solving skills.
  • Interpersonal therapy (IPT): IPT focuses on improving interpersonal relationships and communication skills, which may be particularly helpful for addressing interpersonal conflicts and relationship stressors associated with PMDD.

Lifestyle modifications

  • Regular exercise: Regular physical activity, such as aerobic exercise or yoga, can help improve mood, reduce stress, and alleviate PMDD symptoms.
  • Dietary changes: Adopting a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while minimizing caffeine, alcohol, and sugar intake may help regulate mood and energy levels.
  • Stress management: Practicing relaxation techniques, such as deep breathing, meditation, or mindfulness, can help reduce stress and improve coping skills.
  • Sleep hygiene: Establishing a regular sleep schedule, optimizing the sleep environment, and practicing good sleep hygiene habits can promote better sleep quality and overall well-being.

Alternative therapies

  • Herbal supplements: Some individuals may relieve PMDD symptoms with herbal supplements such as chasteberry (Vitex agnus-castus), evening primrose oil, or St. John's wort. However, the evidence supporting the efficacy of these supplements is limited, and they may interact with other medications.
  • Acupuncture: Acupuncture may help alleviate PMDD symptoms by promoting relaxation, reducing stress, and restoring balance to the body's energy flow. Research on the effectiveness of acupuncture for PMDD is ongoing.

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What is the difference between premenstrual syndrome (PMS) and PMDD?
What is the difference between premenstrual syndrome (PMS) and PMDD?

Commonly asked questions

What is the difference between premenstrual syndrome (PMS) and PMDD?

PMS involves mild to severe mood disorder with moderate symptoms like bloating and mood swings, while PMDD is a severe form with intense mood disturbances like irritability and depression.

How do we distinguish PMDD from other mood and mental disorders marked by anxiety or menstrual conditions?

PMDD is differentiated by its specific symptoms occurring in the late luteal phase and resolving shortly after menstruation, distinct from other mood disorders or menstrual conditions.

Is PMDD considered a personality disorder or a mental illness?

Yes, PMDD is classified as a mental illness in the DSM-5 due to its significant impact on mood and functioning during the menstrual cycle.

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