Table 1 Premenstrual Dysphoric Disorder (PMDD) diagnostic criteria according to the DSM-5

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.

B.

One (or more) of the following symptoms must be present:

1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful or increased sensitivity to rejection)*

2. Marked irritability or anger or increased interpersonal conflicts*

3. Markedly depressed mood, feelings of hopelessness or self-deprecating thoughts*

4. Marked anxiety, tension and/or feelings of being keyed up or on edge*

C.

One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above.

1. Decreased interest in usual activities (e.g. school, work, friends, hobbies)*

2. Subjective difficulty in concentration*

3. Lethargy, easy fatigability, 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*

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)*

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)*

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.)*

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)*