Premenstrual dysphoric disorder

Premenstrual dysphoric disorder
Classification and external resources
Specialty	Psychiatry
ICD-10	F38.8
ICD-9-CM	311, 625.4
MedlinePlus	007193
eMedicine	article/293257
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Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 3–8% of menstruating women. The disorder consists of a "cluster of affective, behavioral and somatic symptoms" that recur monthly during the luteal phase of the menstrual cycle. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. The exact pathogenesis of the disorder is still unclear and is an active research topic. Treatment of PMDD relies largely on antidepressants that modulate serotonin levels in the brain via serotonin reuptake inhibitors as well as ovulation suppression using contraception.

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins. On average, the symptoms last six days but can start up to two weeks before menses. The most intense symptoms occur two days before the start of menstrual blood flow through the first day of menstrual blood flow. The symptoms should cease shortly after the start of the menstrual period.

The symptoms in PMDD can be both physical and emotional with mood symptom being dominant. The most debilitating symptoms are emotional and include "irritability, depression, mood lability, anxiety, feelings of ‘loss of control’, difficulty concentrating and fatigue." The physical symptoms include "abdominal bloating, breast tenderness, headache and generalized aches."

The etiology of PMDD is still an active area of research. While the timing of symptoms suggests hormonal fluctuations as the cause of PMDD, a demonstrable hormonal imbalance in women with PMDD has not been identified. In fact, levels of reproductive hormones in women with and without PMDD are indistinguishable. It is instead hypothesized that women with PMDD are more sensitive to normal levels of hormone fluctuations, predominantly estrogen and progesterone which produces biochemical events in the nervous system that cause the premenstrual symptoms. These symptoms are more predominant in women who have a predisposition to the disorder.

While the etiology of the PMDs is still under investigation, it is apparent that these disorders are biologically driven and are not simply psychological or cultural phenomena. PMDD is found in women worldwide, indicating a biological basis. Most psychologists infer that this disorder is caused by both reaction to hormone influx and genetic components. There is evidence of heritability of premenstrual symptoms not accounted for by family environment suggesting a genetic component to PMDD; however, which genes are involved is a broader question that is still being investigated. Environmental stress can also be a large contributor to triggering PMDD. While there is likely a genetic component to PMDs, the environment must also be considered. Genetics do not operate in a vacuum, and environmental effects such as stress, hormonal fluctuation, and epigenetics likely play a role as well. History of traumatic stress has been associated with PMDD.

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