A 32-year-old woman reports that for the past 6 months she experiences severe irritability, depressed mood, hopelessness, and physical symptoms (breast tenderness, bloating) that begin consistently 5–7 days before her period and remit completely within 2–3 days of its onset. Her symptoms significantly impair her work. She has no inter-episode mood disorder. The correct diagnosis per DSM-5 is:
- A Dysthymia with premenstrual exacerbation
- B Premenstrual syndrome (PMS)
- C Premenstrual Dysphoric Disorder (PMDD) ✓
- D Cyclothymia
Explanation
PMDD (DSM-5) requires at least 5 symptoms (including ≥1 core affective symptom: depressed mood, hopelessness, irritability, or anxiety) in the luteal phase with remission within a few days of menses onset, documented across 2 prospective cycles, and causing significant impairment. PMS is a broader, less severe clinical entity without the impairment or DSM diagnostic threshold. Cyclothymia requires 2 years of sub-threshold hypomania/depression without clear cyclical-menstrual pattern. The first-line pharmacological treatment is a luteal-phase or continuous SSRI (fluoxetine, sertraline); second line includes GnRH analogues for severe cases.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.