The idea has existed since the late 1970s that there is a subtype of premenstrual syndrome (PMS) that is primarily distinguished by severe debilitating mood disturbance. The condition, first called late luteal phase dysphoric disorder, was included as a provisional diagnostic category in the appendices of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R (APA, 1987
). It remained as an appendix in DSM-IV, after being renamed premenstrual dysphoric disorder (PMDD) (APA, 1997
PMDD is defined by a set of four research criteria, all of which must be met to confirm the diagnosis (APA, 1997
). Eleven possible symptoms are listed for the disorder, representing physical changes, changes in sleep, appetite, energy level, and interest in usual activities, difficulty in concentrating, anger/irritability, affective lability, sense of being overwhelmed, depressed mood, and anxiety, The first criterion is that at least five of the 11 possible symptoms, one of which is affective, must be present for most of last week of the luteal phase and be absent in the week post-menses. The second criterion is that PMDD must interfere markedly with school, work, or interpersonal relationships and the third that its symptoms cannot represent an exacerbation of another psychiatric disorder. The fourth criterion requires that the first three criteria must be confirmed by prospective daily ratings of symptoms for two consecutive menstrual cycles.
Although a few prior studies have attempted to determine the prevalence of PMDD, they either failed to take into account all four research criteria that define the disorder, or derived potentially biased prevalence estimates, because they did not use probability sampling. Samples from restricted age ranges or those made up exclusively of women seeking treatment for premenstrual symptoms, for example, likely would yield prevalence estimates that fail to represent the full range of women of reproductive age.
Rivera-Tovar & Frank (1990)
reported a 30% increase in prospectively rated symptoms between post-menstrual and late luteal weeks of the cycle in 4.6% of 217 female university college students, but did not assess other psychiatric disorders. Hurt et al. (1992)
followed the symptoms of 670 women seeking treatment for premenstrual complaints and found 14–45% to meet criteria for the disorder, depending on the method of assessing post-menstrual to premenstrual symptom change used. Cohen et al. (2002)
prospectively measured the premenstrual symptoms of 513 women aged 36–44 years for one menstrual cycle for whom data on current psychiatric morbidity were available. The diagnosis was confirmed in 6.4% of women.
In Germany, Wittchen et al. (2002)
found that 5.3% of a group of 1251 young women (aged 14–24 years) met criteria for PMDD. Instead of participants rating symptoms daily, however, they reported symptoms experienced over the previous 12 months to trained interviewers. Participants did undergo psychiatric diagnostic testing. Using a random sample of 83 women drawn from the National Registry of Iceland, Sveindottir & Backstrom (2000)
found 2–6% to meet criteria for PMDD. Women completed daily symptom diaries for at least one menstrual cycle, but did not undergo psychiatric diagnostic testing. Banerjee et al. (2000)
followed the symptoms of 62 non-treatment-seeking women in India for two menstrual cycles and found 6.4% to meet the diagnosis of PMDD, yet no psychiatric testing was done. In Japan, Takeda et al. (2006)
found 1.2% of 1152 women aged 20–49 years recruited from a cancer-screening clinic to meet the diagnosis of PMDD. Women completed daily symptoms and were asked whether symptoms interfered with functioning. The authors do not report for how long women were followed, however, and no psychiatric testing was done.
In a pilot to the present study to test methods to operationalize all four DSM-IV criteria for PMDD in a sample of women aged 13–55 years checking into a variety of out-patient clinics, Gehlert & Hartlage (1997)
followed the symptoms of 99 women for two consecutive ovulatory menstrual cycles. Women rated their symptoms each day as well as to what extent how they felt that symptoms interfered with functioning at home, school, or work. Past and present psychiatric disorders were measured and phase of cycle was confirmed by researchers analyzing urine samples for luteinizing hormone (LH) using ovulation predictor kits. Depending upon the method of determining post-menstrual to premenstrual change, 1.0–7.1% of women met diagnostic criteria for PMDD.
Although the study by Gehlert & Hartlage (1997)
provided a preliminary design for addressing all four DSM-IV criteria for PMDD, its sample was small and made up of volunteers seeking treatment for medical problems. The present study followed a randomly selected sample of 1246 rural and urban women in their homes, using the methods successfully employed by Gehlert & Hartlage (1997)
to determine the prevalence of PMDD.