115 Premenstrual Syndrome and Premenstrual Dysphoric Disorder ...

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115
Premenstrual
Syndrome and Premenstrual Dysphoric Disorder
. Figure 115-2
Diagnostic criteria for premenstrual syndrome (PMS). These criteria allow healthcare providers to
make a diagnosis of PMS by assessing the presence of an affective and somatic symptom and
their cyclical nature. a Symptoms appear alphabetically and are not in order of importance or
prevalence. PMS, premenstrual syndrome
age, four different studies report very similar findings. In a community sample in Munich,
Germany, Wittchen et al. (2002) identified 6% with PMDD. The prevalence in US women is
between 5% (Sternfeld et al., 2002) and 6% (Cohen et al., 2002), and 5% among Canadian
women (Steiner and Born, 2000).
It is worth noting that the prevalence difference between PMS and PMDD may be related
to the self-report measures used to diagnose the two conditions. When the ACOG guidelines
are used to diagnose PMS, women have the opportunity to report each symptom, including
physical symptoms separately (> Figure 115-2). Conversely, the DSM-IV-TR criteria for
PMDD tethers all physiological symptoms other than fatigue and appetite changes together
as a single item (see item 11 in > Figure 115-3). Also, the presence of five symptoms is required
for diagnosis. It may be that a woman suffers from all five of the physical symptoms listed in
item 11 along with only one affective symptom. In this situation, she would meet the criteria
for diagnosis of PMS but not for PMDD. On one hand, these strict criteria may prevent over
diagnosing or pathologizing women. On the other hand, it may cause women who just miss
the cut-off criteria to go without beneficial treatments.
These difficulties surrounding diagnoses are further compounded by the fact that the
etiologies of PMS/PMDD are unknown. Research which takes a biomedical approach has