A PMDD (Premenstrual Dysphoric Disorder) diagnosis is dependent on daily tracking of the severity of one’s symptoms for at least two menstrual cycles. The International Association for Premenstrual Disorders (IAPMD) notes that there are currently no blood tests that can diagnose PMDD, but in the process of diagnosis, blood tests should be done to rule out any other possible conditions or deficiencies.
According to the DSM-5, a diagnosis of PMDD is made if at least five of the following symptoms are experienced in the week preceding the start of one’s period, improve within a few days after the start, and are minimal or absent in the week post-period. The experienced symptoms also cause significant distress and usually interfere with one’s life, quality of life, and relationships.
Affective (relating to moods, feelings, and emotions) Symptoms (1)
- Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
- Marked irritability or anger or increased interpersonal conflicts.
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
- Decreased interest in usual activities (e.g., work, school, friends, hobbies).
- Subjective difficulty in concentration (brain fog)
- Lethargy, extreme fatigue, or marked lack of energy.
- Marked change in appetite; overeating; or specific food cravings.
- Hypersomnia (oversleeping) or insomnia (trouble or inability to sleep)
- A sense of being overwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating or weight gain.
*For diagnosis, the individual must experience at least one affective symptom and at least one behavioral/cognitive symptom for a total of at least five symptoms
These symptoms should be tracked daily for at least two menstrual cycles to confirm the diagnosis.
The key to a diagnosis of PMDD is that the symptoms are not present for the entire cycle, in that individuals experience a time of relief post-period. If symptoms are experienced throughout the entire cycle, but significantly worsen in the premenstrual phase, this could be premenstrual exacerbation (PME) of an underlying or co-existing condition such as depression or anxiety (2). This is not uncommon, so it is important to track symptoms daily to understand your unique experience and receive the most helpful treatment, be it for PMDD or another condition. To learn more about PME click here.
1. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.