What Is Premenstrual Dysphoric Disorder (PMDD)?

Learn More About the Most Severe Form of PMS

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Premenstrual dysphoric disorder (PMDD) is the most severe form of premenstrual syndrome (PMS). The diagnostic criteria for PMDD were included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) for the first time in 1994, this diagnostic manual's fourth edition.

How PMDD Differs From PMS

In addition to the physical and emotional symptoms required for a diagnosis of PMS, at least five of the following symptoms must occur for most of the time during the seven days before menstruation, and go away within a few days of the start of the menstrual period:

  • Feeling sad, hopeless, or suicidal
  • Severe feelings of stress, tension, or anxiety
  • Panic attacks
  • Mood swings that include bouts of crying
  • Constant irritability or anger that affects other people
  • Loss of interest in usual daily activities and relationships
  • Inability to concentrate or focus
  • Fatigue or loss of normal energy
  • Food cravings or binging


The diagnosis of PMDD begins with the information that you provide to your doctor. If you are planning to see a doctor about your premenstrual moodiness, collecting information about your symptoms. Keeping track of your symptoms will help your doctor make his diagnosis. He will also review your symptoms and medical history and give you a thorough medical exam.

Other mood disorders, such as depression or generalized anxiety disorder, will also have to be ruled out. In addition, underlying medical or gynecological conditions such as endometriosis, fibroids, menopause, or hormonal problems also must be ruled out.

What We Know (and Don't Know) About Causes

There's no sure answer to this, but recent research shows a correlation with the hormonal changes related to the menstrual cycle. Studies have also shown a connection between PMDD and low levels of serotonin. Certain brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep, and pain. Therefore, chronic changes in serotonin levels can lead to PMDD symptoms.


Basically, do what you do to manage your PMS symptoms. Follow the rules of good nutrition. Health experts recommend that women with PMDD limit their intake of salt, caffeine, refined sugar, and alcohol. Supplements such as calcium, vitamin B6, vitamin E, and magnesium are also recommended. You should also exercise. And antidepressants are also sometimes used to relieve the symptoms of PMDD. Finally, some over-the-counter (OTC) pain relievers may help with some symptoms, such as headaches, breast tenderness, backaches, and cramping. Diuretics can help with fluid retention and bloating.

Hormones can also be used to treat PMDD. Ovulation can be stopped either using medication or surgically (as a last resort). Or your doctor might suggest you use progesterone or estrogen to relieve symptoms. 

Some women suffering from the symptoms of PMDD also seek out counseling. They go to therapy in order to develop effective coping strategies, such as meditation, reflexology, and yoga.

In all of these cases, there has not been sufficient research to show the efficacy of any of these treatment options.

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