Psychologists and psychiatrists at Shier Private Practice in Scottsdale, AZ specialize in the treatment of premenstrual dysphoric disorder (PMDD). Our private outpatient clinic offers a comprehensive psychiatric/medical assessment and treatment plan. Treatment may include medications, behavioral therapies or a combination of treatments.

Premenstrual dysphoric disorder (PMDD) is characterized by debilitating emotional and physical symptoms accompanying menstruation in women. While it is common for women to experience some form of premenstrual syndrome during or preceding menstruation, PMDD differs from PMS in the severity of symptoms experienced and their effects on daily functioning.

The 12 month prevalence of premenstrual dysphoric disorder in menstruating women is between 1.8% and 5.8%.

The DSM-5 provides the following criteria for premenstrual dysphoric disorder:

1. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses and become minimal or absent in the week post menses
2. One or more of the following symptoms must be present:
   1. • Marked affective lability (e.g. mood swings, sadness, tearfulness)
      • Marked irritability or anger or increased interpersonal conflicts
      • Marked depressed mood, feelings of hopelessness or self-depreciating thoughts
      • Marked anxiety, tension, and/or feelings of being keyed up or on edge
3. One or more of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above
   1. • Decreased interest in usual activities
      • Subjective difficulty in concentration
      • Lethargy, easy fatigability, or marked lack of energy
      • Marked change in appetite; overeating; or specific food cravings
      • Hypersomnia or insomnia
      • 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.
4. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities or relationships with others
5. The disturbance is not merely an exacerbation of the symptoms of another disorder such as major depressive disorder, panic disorder, persistent depressive disorder or a personality disorder, although they may cooccur.
6. Criterion 1 should be confirmed by prospective daily ratings during at least two symptomatic cycles
7. The symptoms are not attributable to the physiological effects of a substance or another medical condition

While the exact cause is unknown, it is suspected that the symptoms of PMDD may be due to an abnormal reaction to hormonal changes that accompany menstruation and the menstrual cycle. hormonal changes may cause a deficiency in serotonin lead to mood changes and other physical symptoms.  Women with a family history of premenstrual syndrome or premenstrual dysphoric disorder may be at higher risk of developing PMDD, as are women with family histories of depression, postpartum depression or mood disorders.

In the diagnosis of PMDD, a thorough biopsychosocial psychiatric and medical assessment or psychological assessment will be used to confirm the diagnosis and rule out other emotional or medical conditions that present with similar symptomatology.

Cognitive behavioral therapy, medication, or a combination of the two, may be used in the treatment of premenstrual dysphoric disorder.

The FDA approved serotonin reuptake inhibitors (SSRIs) to be used in the treatment of PMDD include Fluoxetine/Prozac, Sertraline/Zoloft, and Paroxetine/Paxil. Medication is helpful in treating the immediate symptoms of PMDD, its benefits start to diminish once the medication is stopped. For this reason, medication is often supplemented with CBT to work through negative thoughts and develop healthy coping strategies.

1. Diet – Maintaining a diet of fruits, veggies, whole grains and protein can help manage cravings and fatigue associated with PMDD. Try to control your caffeine, salt, sugar and carb intake to reign in these symptoms.
2. Exercise – 30 minutes of aerobic exercise every day may help decrease symptoms of PMDD and provide psychological benefits.
3. Relaxation – PMDD may cause an increase in stress or anxiety, participating in relaxation techniques or mindfulness meditation may relieve stress and have a positive impact on other symptoms of PMDD.
4. Herbal supplements – Herbal supplements such as chasteberry and L-tryptophan have shown to be beneficial in reducing the emotional symptoms of PMDD.
5. Sleep – Getting enough sleep can promote a stronger emotional equilibrium and help you manage the symptoms of PMDD.

Last update: February 25, 2019

The content on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.