Women suffering from severe premenstrual issues could have more access to effective treatment starting next year.
Premenstrual dysphoric disorder (PMDD) will be an official disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), according to Dr. John Oldham, the immediate past president of the American Psychiatric Association.
The new manual is expected to come out in the spring of 2013.
In the fourth edition of the DSM (DSM-IV-TR), premenstrual dysphoric disorder is placed in Appendix B, which is used for disorders that require more research.
The basic definition in DSM-IV-TR is: “The essential features are symptoms such as markedly depressed mood, marked anxiety, marked affective lability, and decreased interest in activities.
These symptoms have regularly occurred during the last week of the luteal phase in most menstrual cycles during the past year.
The symptoms begin to remit within a few days of the onset of menses (the follicular phase) and are always absent in the week following menses.”
Marked affective lability refers to “feeling suddenly sad or tearful or increased sensitivity to rejection,” according to the DSM. Other symptoms of PMDD include sleep issues, fatigue, concentration issues, increased irritability and anger, and feeling overwhelmed.
Rachel Thomasian, a licensed marriage and family therapist in Los Angeles, said in an email that she helps many women who are suffering from PMDD.
She described PMDD as a severe form of PMS, adding that symptoms can vary for each individual. She believes there is plenty of evidence to support a diagnosis of PMDD.
Women can tell there is a difference between common PMS symptoms and PMDD, because PMDD is a “much more severe experience of shifts in mood,” Thomasian said.
For women suffering from PMDD, there is a feeling of loss of control. Other signs that PMS symptoms could actually be PMDD is that women are having difficult relationships with others during the menstrual time.
They might be upset and fighting constantly with others, friends might say they are too moody, and they might have a lot of regrets over what they did and said right before their period started.
“Much of the pain comes from women, and those around them, not understanding that this is a serious problem, and frustration that results from not being able to ‘just control it,’” Thomasian said.
“There is already so much stigma and ridicule associated with a women who is unable to control her mood during ‘that time of the month’ that we need all the advocacy we can get.”
She said that with an official diagnosis, women suffering from PMDD will be able to get more support from others for a very real problem, and new research can begin to create effective treatments.
She already works with several clients who have more frequently complained about suffering from PMDD within the last couple years. This might also be due to an increase in medication advertisements for PMDD within the last couple years, so many people might already think it’s an official disorder.
Although medication could help patients, Thomasian believes the most effective treatment for PMDD is cognitive behavioral techniques.
She has coping tips for women suffering from PMDD, such as journaling to release emotions and keep track of patterns of moods and behaviors, and talking to someone reliable.
Another technique might be to create a plan when you’re not suffering from PMDD symptoms of what you can do when you are having difficulties.
Make sure to take care of your general health and well-being during that time.
“If something makes you upset, write it down and try not to react until the next week,” Thomasian said.
“Chances are, you won't be as upset about it. Most women find that if they wait until their PMDD symptoms have passed to react to a situation, they don't find the situation as upsetting as they initially did. This really helps reduce the number of arguments.”
Mary Ann Block, an author and physician, said in an email that she doesn’t support the inclusion of PMDD in the new DSM, and doesn’t believe there is enough evidence to make it an official mental disorder.
She believes it is just a hormone imbalance, not a psychiatric condition. For women who might receive this diagnosis in the future, she thinks it would be best to go to a doctor to try balancing their hormones first.
“This diagnosis will hurt women,” Block said. “It makes it easy for doctors to just write off women and give them a quick psychiatric label and a drug, rather than doing the hormone tests and balancing the hormones.”
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder: Fourth Edition: Text Revision. Arlington, VA: American Psychiatric Association, 2000.
Oldham, John. Email interview. Dec. 5, 2012.
Thomasian, Rachel. Email interview. Dec. 12, 2012.
Block, Mary Ann. Email interview. Dec. 12, 2012.
Reviewed December 13, 2012
by Michele Blacksberg RN
Edited by Jody Smith