Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder is an extreme type of premenstrual syndrome (PMS). This disorder causes many emotional and physical symptoms that can start as early as 2 weeks before your period. PMDD isn’t just about being a little moody or short-tempered. PMDD typically causes intense emotions that severely impact interpersonal relationships. In the most severe cases, some even have suicidal thoughts. An estimated 5 – 8% of women live with PMDD.

PMDD vs PMS

Although both PMDD and PMS are tied to your menstrual cycle and the resulting hormonal fluctuations, PMDD differs from PMS in some important ways. While many symptoms are similar, PMDD is much more severe than PMS. PMDD can potentially interrupt your life and lessen your overall quality of life.

Levels of estrogen and progesterone can be the same in two women, yet one will experience PMS while the other has PMDD symptoms. We don’t know exactly why this is, but one theory is that some women are more sensitive to hormone levels changes than others.

A whopping 90% of women report experiencing some PMS symptoms, including headaches, bloating, or moodiness. While these symptoms can interfere with life and, in extreme cases, cause some women to miss work or school, PMS is nowhere near the intensity of PMDD. 

“PMDD is not simply a more intense version of PMS. PMDD can significantly impact your life. The symptoms experienced, both physical and emotional, can be overwhelming. It’s important to know you do not have to struggle with this on your own. Talk to your healthcare provider about treatment options.” - Talkspace therapist Jill E. Daino, LCSW-R

Premenstrual dysphoric disorder symptoms can be divided into emotional and physical symptoms.

Emotional symptoms of PMDD include:

• Having dramatic mood swings
• Feeling unusually emotional and crying easily
• Experiencing a lack of energy
• Feeling “on edge”
• Being unable to focus or finding it difficult to concentrate
• Not being interested in activities that used to be enjoyable
• Feeling anxious and tense
• Being angry and irritable
• Feeling totally out of control or wildly overwhelmed
• Experiencing negative or even suicidal thoughts

Physical PMDD symptoms often include:

• Joint and muscle pain
• Breast tenderness
• Being bloated
• Headaches
• Trouble sleeping or sleeping too much
• Change in appetite and cravings

The exact cause of PMDD isn’t fully understood. Many researchers believe it’s due to unusual or extreme sensitivity to hormonal changes in a woman’s body (levels of estrogen and progesterone).

“While research is still emerging around the causes for PMDD, it’s important to note that genetics likely play a role. Tracking your symptoms over time will help you discuss them with your healthcare provider and help you plan your self care and medical strategies in advance.” - Talkspace therapist Jill E. Daino, LCSW-R

A woman is more likely to suffer from PMDD if her mother, sister, or another close relative also suffers or suffered from it. Other factors that may influence whether a woman develops PMDD or not can include smoking cigarettes and suffering physical or emotional trauma.

PMDD is diagnosed using the criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to this guide, a woman must experience five or more of the following premenstrual dysphoric disorder symptoms during most menstrual cycles over a year, and at least one symptom must be in the first four on the list.

• Depressed mood, feeling hopeless, having self-deprecating thoughts
• Feeling tense or having extreme anxiety
• Affective lability (having strong emotions)
• Feeling constantly angry or irritable
• Loss of interest in normal activities
• Trouble concentrating
• Feeling lethargic
• Change in appetite, food cravings, overeating
• Insomnia or hypersomnia
• Feeling overwhelmed or out of control
• Physical symptoms like breast tenderness, joint pain, muscle pain, headaches, bloat, or weight gain

For a PMDD diagnosis, symptoms must be severe enough to hamper your ability to function well in school, at work, and/or in social situations or relationships. The symptoms also must not be explainable by any other mental or physical health condition, including clinical depression, anxiety disorder, or bipolar disorder. Comorbid PMDD refers to PMDD that appears alongside bipolar disorder.

PMDD is generally considered an endocrine disorder since it’s related to hormone levels. However, the DSM-5 lists PMDD as a mental health condition since women with PMDD experience a wide range of mental health symptoms like depression, anxiety, and in extreme cases, suicidal thoughts.

As part of the diagnostic process, a mental health professional or doctor will meet with you, interview you about your symptoms, and review medical history.