PMDD Criteria Exclude Too Many Patients

OB/GYN News, Oct 1, 2001 by Winnie Anne Imperio

NEW ORLEANS -- The diagnostic criteria for premenstrual dysphoric disorder may be too stringent, according to a National Institute of Mental Health--sponsored study.

Among 430 women who rated their daily functioning and premenstrual symptoms for two cycles, only 7 met all DSMIV-TR criteria for premenstrual dysphoric disorder (PMDD), Shirley Hartlage, Ph.D., reported in a poster presentation at the annual meeting of the American Psychiatric Association.

All of the women who met diagnostic criteria for PMDD reported that premenstrual symptoms interfered with their activities and relationships, said Dr. Hartlage of the department of psychology at Rush Medical College in Chicago. An additional 61 women who reported similar differences in pre- and postmenstrual function did not meet full diagnostic criteria for PMDD.

This preliminary study raises the concern that women who experience difficulty functioning premenstrually may not receive needed treatment because they do not meet the criteria for the disorder, she said.

The average level of premenstrual impairment appeared generally mild. The reported level of premenstrual impairment was less than the reported level of premenstrual symptom severity. This disparity between impairment and symptom severity may be due to a response bias against admitting to the study women who reported difficulty functioning. Or, it may be due to including women who were able to function well despite moderate to severe symptoms, Dr. Hartlage said.

The mean age of subjects was 34 years; most were Caucasian.