A 32-year-old woman reports severe irritability, mood swings, breast tenderness, and bloating exclusively in the luteal phase of her cycle for the past 6 months, resolving completely within 2-3 days of menses onset. These symptoms significantly impair her work relationships. The DSM-5 diagnosis is:

• A Major depressive disorder, perimenstrual pattern
• B Premenstrual dysphoric disorder (PMDD) ✓
• C Premenstrual syndrome (PMS)
• D Cyclothymia

Explanation

PMDD (DSM-5) requires at least 5 symptoms in the luteal phase (including at least 1 affective symptom — marked mood lability, irritability, depressed mood, or anxiety), confirmed prospectively over 2 cycles, with significant functional impairment, resolving completely after menses. It differs from PMS (milder, not requiring affective predominance or functional impairment) and is distinct from MDD which is not cycle-dependent. First-line treatment is SSRIs (continuous or luteal-phase dosing).

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.