Shirah Vollmer MD

The Musings of Dr. Vollmer

PMDD Walks Into DSM 5

Posted by Dr. Vollmer on March 12, 2013


PMDD, premenstrual dysphoric disorder is currently a diagnosis in the appendix of DSM IV, meaning that if a physician believes the patient has PMDD, then he/she must write Depression NOS (not otherwise specified). At the same time, there are currently drugs approved for PMDD, despite the fact that it has not achieved diagnostic status. Well, come May, 2013, after Bill Clinton speaks to the American Psychiatric Association in San Francisco, California, the DSM 5 will be announced and the criteria for mental illnesses, in the United States, at least, but probably around the world, will change, including more folks, causing a large stir about the wider scope of psychiatric disease.  DSM IV came out in 1994, making almost ten years of a classification system, which for the most part, has not matched the explosion in psychopharmacology. DSM 5 has taken a long time, mostly, as I can tell, because the debates over the diagnostic system were tense. So, it is very likely that PMDD will hit the light of day and now women who suffer from terrible irritability before their periods will merit a psychiatric diagnosis. The good news is that there will be more acceptance of the biology of mood swings, and then hopefully more acceptance of psychopharmacological interventions. The bad news is that some women, through no fault of their own, will be labeled, potentially increasing their premiums for health insurance, life insurance and disability insurance. The triad of emotional lability, irritability and anger, during the luteal, or last phase of the menstrual cycle, in about 2-5% of menstruating women, had been validated in the research over the past 20 years. This additional research, the DSM 5 committee argued, gave good reason for PMDD to be “promoted” to  a diagnosis and out of the appendix. PMDD now joins the ranks of a full blown mood disorder; it is in parallel with bipolar disorder, which also has prominent mood lability and irritability, but PMDD symptoms cease on the first or second day of menses. Plus, PMDD comes with physical symptoms of bloating and breast tenderness, making it easily distinguishable from bipolar disorder. What about heritability? You ask, knowing that most psychiatric diagnoses run in families. The heritability of PMDD ranges from 30-80% which is indeed, a wide range, but enough to merit a full diagnosis. What about treatment? PMDD is ameliorated with an SSRI (Prozac and his cousins), quickly, unlike when an SSRI is used to treat Major Depression. Also, intermittent or continuous treatment are both helpful, suggesting that a constant blood level is not necessary, but rather more serotonin in the premenstrual or late luteal phase, seems to do the trick. So, the world will change in May, 2013, the psychiatric world, that is, and hence all of us who work, love and/or experience others who suffer with negativity, irritability, and quickly shifting moods. Now, women who cycle in and out of these mind states will be legitimized on the one hand, and maybe, but hopefully not, stigmatized, on the other.

11 Responses to “PMDD Walks Into DSM 5”

  1. Shelly said

    Shirah, you have got to be kidding me. Women who are pre-menstrual and are irritable and moody get their own label and diagnosis, but patients who suffer from Asperger’s Syndrome get tossed from DSM 5? What gives? What can people be thinking? Think of all the patients who now will have to fight for services because of the DSM, who will be paying thousands of dollars out of pocket for medications, etc…, all because AS has been tossed, whereas PMDD, a new “mood disorder” is in? What gives?

    • Shirah said

      Aspergers disorder has been folded into autism spectrum disorders, so there is hope that services will still be payed for. As for PMDD being a mental illness, what can I say?

    • KateofM said

      I beg to differ – as someone who has PNDD – it is like having severe depression 2 weeks out of every month – i can’t work, my relationship is jepordised – it is not simply irritability and moody! It is much, much more than that!

  2. DeeDee said

    I would mind the label a lot less if it meant I could have accommodation or wouldn’t be sneered at for being literally unable to function. The DSM doesn’t mean overnight legitimization. In fact, I don’t expect anyone (including medical professionals) to know about, much less “believe in” PMDD for another 20 years. I’ll get through menopause before people start understanding how serious this disorder can be. My PMDD symptoms are so severe that I was initially diagnosed with bipolar disorder – which is eligible for accommodation, and despite the stigma that goes with it, it’s at least recognized as being something a sufferer cannot control, and which requires both treatment and appropriate accommodation.

    Calling PMDD sufferers “irritable and moody” is insulting. PMDD’s “irritable” is more like explosive rage, and “moody” is along the lines of “suicidal ideation and crying nonstop for days at a time.” It’s not just emotional/physical, either – the cognitive dysfunction is pretty severe for some women, but you won’t see anything on the Internet telling you about that. Perhaps because anyone who discusses her suffering is ridiculed and put down as being just “irritable and moody” for no fault of her own. Stigma much?

    • Thanks. I think “irritable” is a disabling symptom, but perhaps the lay public does not see it that way. That is interesting. Thanks again.

      • DeeDee said

        I think most people interpret “irritable” as cranky, not as “fly off the handle at the least provocation.” I get as irritated by being irritable as I am by all the things that trigger irritability!

        • Thank you, DeeDee. It is helpful to clarify the language, so perhaps we need a new word to replace ‘irritable’. I will think some more about that. Thanks again.

  3. T said

    Dear Dr. Vollmer, I agree with DeeDee concerning the definition associated with PMDD. I was diagnosed approximately 4 years ago and have successfully been treated through hormone-therapy since. One is irritable when she has PMSs. One is in a state of exploding rage and follows a deep unbearable and uncontrollable need to hurt when one has PMDD. Before my diagnosis I spent years wondering what was wrong with me. I fit the bill for bipolar disorder but my symptoms were too cyclical. For 1 week out of the month at first, and then with time for 2 weeks out of the month, as I part of the minority of women who also has symptoms during her ovulation, I was a monster. Think Dr. Jekyll and Mr Hyde. Thinking that someday my mediation might be discontinued or that my treatment would no longer be efficient puts me in a complete and utter state of panic. Now that I know what being normal is, I can’t go back. Hopefully this full inclusion in DMV-V will help develop the research for PMDD.

    • Thanks, T, for sharing your experience.

    • RSK said

      I agree here, as a male sufferer of PMDD (My girlfriend suffers) – I wholeheartedly agree with this debilitating disorder finally being recognized as it’s own entity. Women should no longer sit and suffer in silence over what they are going through. Its about time the medical community started giving it its due process.

      This isn’t just some arbitrary disorder that only effects the woman in question, it effects everything and everyone around them. Yes, the woman suffers greatly, and us men do too. To see someone you love more than anyone, having their life thrown into shambles and knowing there is nothing you can do to help them.

      Huzzah to the committees, Dr’s. etc that are finally making PMDD something to acknowledge!

      • Thanks, RSK. You remind me that diagnoses can serve for good as well as for ill. Sometimes diagnoses stigmatize folks, but other times, as you suggest, it helps family members understand them. Thanks Again.

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