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Reilly TJ, Patel S, Unachukwu IC, Knox CL, Wilson CA, Craig MC, Schmalenberger KM, Eisenlohr-Moul TA, Cullen AE. The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. J Affect Disord 2024; 349:534-540. [PMID: 38199397 DOI: 10.1016/j.jad.2024.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Premenstrual dysphoric disorder is characterised by symptoms confined to the premenstrual phase of the menstrual cycle. Confirmed diagnosis requires prospective monitoring of symptoms over two cycles, otherwise the diagnosis is provisional. We aimed to measure the point prevalence of premenstrual dysphoric disorder. METHODS We searched for studies of prevalence using MEDLINE, EMBASE, PsycINFO and PubMed. For each study, the total sample size and number of cases were extracted. The prevalence across studies was calculated using random effects meta-analysis with a generalised linear mixed model. Potential sources of heterogeneity were explored by meta-regression and subgroup analyses. Pre-registration was with PROSPERO (CRD42021249249). RESULTS 44 studies with 48 independent samples met inclusion criteria, consisting of 50,659 participants. The pooled prevalence was 3.2 % (95 % confidence intervals: 1.7 %-5.9 %) for confirmed and 7.7 % (95 % confidence intervals: 5.3 %-11.0 %) for provisional diagnosis. There was high heterogeneity across all studies (I2 = 99 %). Sources of heterogeneity identified by meta-regression were continent of sample (p < 0.0001), type of sample (community-based, university, high school) (p = 0.007), risk of bias (p = 0.009), and method of diagnosis (p = 0.017). Restricting the analysis to community-based samples using confirmed diagnosis resulted in a prevalence of 1.6 % (95 % confidence intervals: 1.0 %-2.5 %), with low heterogeneity (I2 = 26 %). LIMITATIONS A small number of included studies used full DSM criteria in community settings. CONCLUSIONS The point prevalence of premenstrual dysphoric disorder using confirmed diagnosis is lower compared with provisional diagnosis. Studies relying on provisional diagnosis are likely to produce artificially high prevalence rates.
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Affiliation(s)
- Thomas J Reilly
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Siya Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ijeoma C Unachukwu
- Rutgers Robert Wood Johnson Medical School, NJ, USA; Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Clare-Louise Knox
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire A Wilson
- South London and Maudsley NHS Foundation Trust, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael C Craig
- South London and Maudsley NHS Foundation Trust, London, UK; Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katja M Schmalenberger
- Department of Psychiatry, University of Illinois Chicago, Chicago, USA; Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | | | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ross JM, Barone JC, Tauseef H, Schmalenberger KM, Nagpal A, Crane NA, Eisenlohr-Moul TA. Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality. Am J Psychiatry 2024; 181:57-67. [PMID: 38093647 PMCID: PMC11031249 DOI: 10.1176/appi.ajp.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVE Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle-suicidality relationship, and how these associations vary across individuals. METHODS Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models. RESULTS Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality. CONCLUSIONS Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.
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Affiliation(s)
- Jaclyn M Ross
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | - Jordan C Barone
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | - Hafsah Tauseef
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | | | - Anisha Nagpal
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
| | - Natania A Crane
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago
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Reilly TJ, Knox CL, Marsh MS, Craig MC. A case series of premenstrual disorders presenting to the UK's National Female Hormone Clinic. BJPsych Bull 2023; 47:263-266. [PMID: 36239445 PMCID: PMC10764883 DOI: 10.1192/bjb.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/28/2022] [Accepted: 09/10/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD We aimed to describe the clinical characteristics of female patients presenting with premenstrual disorders to a tertiary service in the UK. We conducted a retrospective case-note review of referrals to the National Female Hormone Clinic from April 2014 to August 2020. Based on clinical assessment, we determined whether the patient met criteria for premenstrual dysphoric disorder or premenstrual exacerbation of an underlying psychiatric disorder. RESULTS Of 146 patients seen in clinic for premenstrual disorders, an ICD-10 psychiatric diagnosis was made in 130 (89.0%); a minority 16 (11.0%) did not have a psychiatric diagnosis. Following assessment, 94 patients (64.4%) met criteria for premenstrual dysphoric disorder and 67 (45.6%) had exacerbation of a psychiatric disorder. CLINICAL IMPLICATIONS Patients presenting to this specialist service had complex psychiatric comorbidity; almost half presented with exacerbation of a psychiatric disorder.
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Affiliation(s)
- Thomas J. Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- National Female Hormone Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Clare-Louise Knox
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Michael S. Marsh
- National Female Hormone Clinic, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Obstetrics and Gynaecology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Michael C. Craig
- National Female Hormone Clinic, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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Nolan LN, Hughes L. Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies. Arch Womens Ment Health 2022; 25:831-852. [PMID: 35867164 DOI: 10.1007/s00737-022-01246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g. pregnancy, menopause), and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g. trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of preexisting mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of bias for individual studies was assessed using a modified version of the Newcastle-Ottawa Scale. The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for psychotic disorders, panic disorder, eating disorders, depression and borderline personality disorder. Less consistent evidence was found for anxiety, and a different pattern of symptom exacerbation was observed in bipolar disorder. Sample size and methodology varied considerably amongst studies. Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.
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Affiliation(s)
| | - Liz Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Frey BN, Allega OR, Eltayebani M, Syan SK, Mendes-Ribeiro J, Minuzzi L. A DSM-5-based tool to monitor concurrent mood and premenstrual symptoms: the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS). BMC Womens Health 2022; 22:96. [PMID: 35354450 PMCID: PMC8969316 DOI: 10.1186/s12905-022-01678-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite high co-morbidity between premenstrual dysphoric disorder and mood disorders, there is a gap of research-based tools to monitor concurrent premenstrual and mood symptoms. In this study, we developed a new DSM-5-based questionnaire to prospectively monitor concurrent premenstrual and mood symptoms.
Methods Fifty-two females with bipolar or major depressive disorder, ages 16–45, were enrolled in the study. Participants completed two months of prospective symptom charting including the McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS) and the Daily Record of Severity of Problems (DRSP). At the end of the prospective charting, participants also completed the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). The MAC-PMSS was correlated with the DRSP, MADRS, HDRS and YMRS. Results All individual items of the MAC-PMSS correlated strongly with the individual DRSP scores (all p < 0.001). The mood section of the MAC-PMSS also significantly correlated with MADRS (r = 0.572; p < 0.01), HDRS (r = 0.555; p < 0.01) and YMRS scores (r = 0.456; p < 0.01). Conclusions The MAC-PMSS is a reliable to tool to measure concurrent mood and premenstrual symptoms in women with mood disorders.
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Affiliation(s)
- Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada. .,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Olivia R Allega
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Maha Eltayebani
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sabrina K Syan
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Jeronimo Mendes-Ribeiro
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada
| | - Luciano Minuzzi
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Suite C124, Hamilton, ON, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Wikman A, Sacher J, Bixo M, Hirschberg AL, Kopp Kallner H, Epperson CN, Comasco E, Sundström Poromaa I. Prevalence and correlates of current suicidal ideation in women with premenstrual dysphoric disorder. BMC Womens Health 2022; 22:35. [PMID: 35148753 PMCID: PMC8832802 DOI: 10.1186/s12905-022-01612-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although previous studies report an association between Premenstrual Dysphoric Disorder (PMDD) and suicidal ideation, most studies have only established a provisional and retrospective diagnosis of PMDD fundamentally invalidating the diagnosis. Therefore, the aim of this study was to describe the prevalence and to explore correlates of current suicidal ideation in the late luteal phase in women with prospectively assessed and confirmed PMDD. Methods Participants were 110 women who attended the pre-randomization baseline visit of two randomized placebo-controlled clinical trials between January 15, 2017 and October 19, 2019. PMDD was diagnosed prospectively in line with DSM-5 criteria. Current suicidal ideation was measured by the MADRS-S in the late luteal phase. Descriptive statistics were presented and logistic regression analyses were carried out to explore the association between psychosocial and health characteristics and current suicidal ideation, presenting unadjusted odds ratios (OR) and 95% confidence intervals (CI). Results Current suicidal ideation was reported by nearly 40% of women with confirmed PMDD (n = 43, 39.1%). Previous psychological treatment for PMDD and higher depressive symptoms in the late luteal phase were positively associated with current suicidal ideation (OR 5.63, 95% CI 1.07–29.49, and OR 1.17, 95% CI 1.10–1.25, respectively), whereas higher ratings of self-rated health were associated with lower odds ratios for current suicidal ideation (OR 0.98, 95% CI 0.96–0.99). Conclusions A substantial proportion of women with confirmed PMDD report current suicidal ideation in the late luteal phase. Results point to a need for better awareness and screening of suicidal ideation in women with PMDD.
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Affiliation(s)
- Anna Wikman
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala University, 751 85, Uppsala, Sweden.
| | - Julia Sacher
- Emotion Neuroimaging (EGG) Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marie Bixo
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Angelica L Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erika Comasco
- Department of Neuroscience, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Inger Sundström Poromaa
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala University, 751 85, Uppsala, Sweden
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Richards MA, Oinonen KA. Psychometric Properties of a DSM-5-Based Screening Tool for Women's Perceptions of Premenstrual Symptoms. Psychol Rep 2021; 125:1186-1217. [PMID: 33583248 DOI: 10.1177/0033294120979696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A premenstrual screening tool is needed when time constraints and attrition limit the feasibility of daily ratings. The present study examines the utility of a novel, 33-item, retrospective, dimensional, DSM-5-based, screening measure developed to explore women's perceptions of premenstrual symptomatology. This is the first measure that examines perception of impairment for each DSM-5 symptom and assesses the frequency criterion. Participants (N = 331) reported symptoms ranging from none to a level consistent with a provisional DSM-5 diagnosis of Premenstrual Dysphoric Disorder (PMDD). Initial psychometric properties indicated a five-factor structure: (1) affective symptoms; (2) fatigue, sleep, and anhedonia; (3) symptom frequency; (4) impairment and severity of appetite change and physical symptoms; and (5) difficulty concentrating. The total symptom scale and the frequency, severity, and impairment subscales demonstrated high internal consistency. Strong correlations between this dimensional measure and other retrospective and prospective premenstrual symptom measures suggest strong convergent, concurrent, and predictive validity. Premenstrual symptom groups created using this screening measure (minimal, mild/moderate, severe) differed on other retrospective and prospective measures of premenstrual symptoms. There was evidence of divergent validity and lack of an acquiescence bias. We also report data describing women's perceptions of the frequency, level of impairment, and level of severity for each DSM-5 PMDD symptom over a 12-month period and discuss implications for future research on premenstrual phenomenology. Initial evidence for the reliability and construct validity of this symptom screening measure suggests potential value for assessing premenstrual symptomatology in research and practice.
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Affiliation(s)
- Meghan A Richards
- Department of Psychology, 7890Lakehead University, Thunder Bay, Ontario, Canada.,Meghan A. Richards is now at the Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Kirsten A Oinonen
- Department of Psychology, 7890Lakehead University, Thunder Bay, Ontario, Canada.,Meghan A. Richards is now at the Department of Psychology, University of New Brunswick, Fredericton, Canada
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Eisenlohr-Moul T. Premenstrual Disorders: A Primer and Research Agenda for Psychologists. THE CLINICAL PSYCHOLOGIST 2019; 72:5-17. [PMID: 32362679 PMCID: PMC7193982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago
- Department of Psychology, University of Illinois at Chicago
- International Association for Premenstrual Disorders Clinical Advisory Board
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Hartlage SA, Arduino KE. Toward the content validity of premenstrual dysphoric disorder: do anger and irritability more than depressed mood represent treatment-seekers' experiences? Psychol Rep 2002; 90:189-202. [PMID: 11898982 DOI: 10.2466/pr0.2002.90.1.189] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The content validity of Premenstrual Dysphoric Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) has been questioned in the literature. We tested whether mood-related symptoms reported by 26 women seeking treatment for premenstrual disorders were among the proposed criteria. These women were asked to list their premenstrual symptoms and rate the severities of listed symptoms daily for two menstrual cycles before treatment. They completed semistructured interviews to differentiate symptoms of Premenstrual Dysphoric Disorder from those of other psychiatric disorders in women who had other disorders. All participants reported functional interference due to the symptoms. 19 symptoms of or similar to those of Premenstrual Dysphoric Disorder were among the 22 most frequent premenstrual symptoms experienced. Premenstrual depressed mood was less frequent than premenstrual irritability or anger when other psychiatric disorders such as major depression were taken into account. Results suggest that the DSM-IV-TR criteria have generally good content validity but may need revision to represent treatment-seekers experiences more accurately.
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Affiliation(s)
- Shirley Ann Hartlage
- Department of Psychiatry and Psychology, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, IL 60612, USA.
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