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PMDD Presentation

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Erin Reale

on 14 August 2013

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Transcript of PMDD Presentation

Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD)
How do you
diagnosis PMDD?
Key terms:
Hypersomnia – Inability to
stay awake

Insomnia – Inability to sleep
Key terms:
First, some key terms...
In the majority of menstrual cycles,
at least 5 symptoms must be present in the final week before the onset of menses,
start to improve within a few days after the onset of menses,
and become minimal or absent in the week post menses.

What the DSM 5 Tells Us About PMDD
Marked anxiety, tension, and/or feelings of being keyed up or on edge
Must be 5 symptoms total when combined symptoms from Criteria B and C

Symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the previous year.

Criteria F & G
The symptoms are not related to the physiological effects of a substance or another medical condition
Symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others
The disturbance is not merely a cause of the symptoms of another disorder – although it may co-occur with others
Criteria A:
Criteria B:
Criteria C:
Criteria D & E:
1 or more
of the
following symptoms:
Decreased interest in usual activities
Subjective difficulty in concentration
Marked lack of energy
Overeating; or specific food cravings
Marked change in appetite
A sense of being overwhelmed or out of control
Hypersomnia or insomnia
breast tenderness or swelling
joint or muscle pain
a sensation of “bloating” or weight gain

1 or more of the following symptoms:
Marked affective lability
Marked irritability or anger or increased interpersonal conflicts
Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
Criteria A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles
If symptoms have not been confirmed by daily ratings of at least 2 symptomatic cycles, “provisional” should be noted after PMDD diagnosis
Diagnostic Features
May be accompanied by: behavioral and physical symptoms
Must have occurred in the last year
Must have an adverse affect on work or social functioning
Essential features:
Expression of mood,
and anxiety
Premenstrual Syndrome
Differential Diagnosis
Minimum of 5 symptoms is not required
Considered less severe than PMDD
Painful menses, characterized by affective changes.
Symptoms begin with the onset of menses instead of before the onset of menses
How to diagnose…
No physical examination or lab tests can diagnose PMDD.
A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be done to rule out other conditions.
Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times when they are likely
Menses – The time of menstruation

Lability – Mood swings

What are some
treatments for PMDD?
Non-pharmacologic treatments

A healthy lifestyle
Good nutrition: limiting intake of salt, caffeine, refined sugar, and alcohol
Supplements: calcium, vitamin B6, vitamin E, and magnesium
Counseling: develop effective coping strategies, relaxation therapy, mediation, reflexology, and yoga
CBT Model

Selective serotonin-reuptake inhibitor (SSRI), i.e. Sarafem, Paxil, Zoloft, Celexa
Sexual side effects
Other antidepressants that are effective are Effexor and Lexapro
Over the counter: aspirin, ibuprofen (Motrin), naproxen (Aleve)
Gonadotropin-releasing hormone agonists
Anti-anxiety drugs
Birth Control Pills

Herbal Treatment: Chasteberry

AKA: Vitex agnus-castus fruit extract Ze (in tablet form)
Treats premenstrual symptoms:
mood swings
breast pain and tenderness
Supporting evidence
Possible side effects
What causes PMDD?
The exact causes of PMDD are unknown
It is known that it is related to your menstrual cycle
Theories of causes of PMDD=

Serotonin levels
Hormone Levels

Serotonin Levels

Hormone Levels
Alcohol abuse

Large caffeine intake

Lack of exercise

High stress

Vitamin B6, Calcium or magnesium deficiency

Poor diet
A family history of PMDD or PMS


Previous anxiety, depression, or other mental health problems.
History of PMDD
There’s an association between PMDD and a history of sexual abuse and physical abuse

Trauma and posttraumatic stress disorder are independently associated with PMDd

Women with abuse histories had higher blood pressure measurements at rest and during stress and showed higher vascular tone
Symptoms must appear a week before menstruation and remit soon after the onset of menses
At least Five symptoms must occur during the premenstrual period
Symptoms are similar to the physical and emotional symptoms of premenstrual syndrome (PMS)

Premenstrual dysphoric disorder
Lifetime Prevalence (%)

2.0-8.0 of women of reproductive age

Most common in women with personal or family history of mood disorder

Age of Onset

Late 20’s although onset can be earlier
Exams and tests

No physical examination or lab test can diagnose PMDD


A healthy lifestyle

Eat more foods with more whole grains, vegetables, fruits, etc

get regular aerobic exercise throughout the month to reduce severity of PMS symptoms
Case Study
Needs help: effective contraception, pre-menstrual symptoms

Diagnostic work-up must be done, but based on self-report PMDD likely
Catherine and the people around her are suffering from symptoms that appear in the days before her period, and some diagnostic work is required in order to tailor the most appropriate treatment for her. Her treatment options will also be guided by her weight and the strong family history of obesity, depression, hypertension, and diabetes. In Catherine’s case, a PMDD diagnosis seems likely based on her self-report, the reactions of people around her, notably her boyfriend and students, and a lack of symptoms and signs of other disorders turning up in her history and physical examination. She could keep a symptom diary for 2 to 3 months to confirm this diagnosis, but, given the severity of her personal and professional situation, she may benefit from initiating treatment sooner
Catherine, 24 year old
Graduate Student
Seeks help for symptoms: depressed, sleepless, tired, and distracted in the 7-10 days before onset of her period.

Crisis Point: Academic work is impaired, other students have complained about how she treats them.
Physical Symptoms/ History: she is over-weight (BMI 28), mother has hypertension, sister has depression, maternal grandmother died of diabetes complications, Multiple family members are obese

uses condoms for contraception, had pregnancy scare 3 months ago
What is PMDD?
What was all the
commotion about?

Categorized as an example of "not otherwise specified"
Categorized as a Depressive Disorder
Does the diagnosis stigmatize women?

Does this give voice to those suffering?
A reaction to life experiences


caused biogically?
Or both?
CHEN, INGFEI . "A Clash of Science and Politics Over PMS." The New York Times 18 Dec. 2008: n. pag. nytimes.com. Web. 6 Aug. 2013.

Perry, Susan . "The billion-dollar debate over premenstrual syndrome heats up." MinnPost [Minneapolis] 27 Feb. 2012: n. pag. minnpost.com. Web. 7 Aug. 2013.
Meltzer-Brody, S., & Girdler, S. (2012, April). Premenstrual Dysphoric Disorder: How to Alleviate Her Suffering. Retrieved from Current Psychiatry: http://currentpsychiatry.com/pdf/1104/1104cp_meltzer-brody.pdf

Premenstrual Dysphoric Disorder. (2013, March 22). Retrieved from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/007193.htm

Sue, D., Sue, D. W., Sue, D., & Sue, S. (2013). Understanding Abnormal Behavior. Belmont: Wadsworth Cengage Learning.



(2013) Diagnostic and statistical manual of mental disorders: DSM-V. 5th Ed. Washington, DC: American Psychiatric Association.
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