Premenstrual Dysphoric Disorder

Criterion A

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 postmenses.

Criterion B

At least 1 of the following symptoms must be present:

  1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or in creased sensitivity to rejection)
  2. Marked irritability or anger or increased interpersonal conflicts
  3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
  4. Marked anxiety, tension, and/or feelings of being keyed up or on edge
Criterion C

At least 1 of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion B above.

  1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
  2. Subjective difficulty in concentration
  3. Lethargy, easy fatiguability, or marked lack of energy
  4. Marked change in appetite; overeating; or specific food cravings
  5. Hypersomnia or insomnia
  6. A sense of being overwhelmed or out of control
  7. 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.
Criterion 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 social activities; decreased productivity and efficiency at work, school, or home).

Criterion 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 disorders).

Criterion F

Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)

Criterion 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., hyperthyroidism).

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