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Published Online: 1 May 2012

Premenstrual Dysphoric Disorder: Evidence for a New Category for DSM-5

C. Neill Epperson, M.D., Meir Steiner, M.D., Ph.D., S. Ann Hartlage, Ph.D., Elias Eriksson, M.D., Peter J. Schmidt, M.D., Ian Jones, M.D., and Kimberly A. Yonkers, M.D.Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 169, Number 5
https://doi.org/10.1176/appi.ajp.2012.11081302
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Abstract

Premenstrual dysphoric disorder affects 2%–5% of premenopausal women. Criteria proposed for DSM-5 include the occurrence of at least five symptoms in most menstrual cycles during the past year, such as affective lability, irritability, depressed mood, anxiety, loss of interest, lethargy, changes in appetite or sleep, loss of control, or bloating. These symptoms need to begin the week before and improve a few days after menses onset. Response to serotonin reuptake inhibitors as well as to oral contraceptives containing the progestin drospirenone is noted.

Abstract

Premenstrual dysphoric disorder, which affects 2%–5% of premenopausal women, was included in Appendix B of DSM-IV, “Criterion Sets and Axes Provided for Further Study.” Since then, aided by the inclusion of specific and rigorous criteria in DSM-IV, there has been an explosion of research on the epidemiology, phenomenology, pathogenesis, and treatment of the disorder. In 2009, the Mood Disorders Work Group for DSM-5 convened a group of experts to examine the literature on premenstrual dysphoric disorder and provide recommendations regarding the appropriate criteria and placement for the disorder in DSM-5. Based on thorough review and lengthy discussion, the work group proposed that the information on the diagnosis, treatment, and validation of the disorder has matured sufficiently for it to qualify as a full category in DSM-5. A move to the position of category, rather than a criterion set in need of further study, will provide greater legitimacy for the disorder and encourage the growth of evidence-based research, ultimately leading to new treatments.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 169 • Number 5 • May 2012
Pages: 465 - 475
PubMed: 22764360

History

Received: 29 August 2011
Revision received: 22 December 2011
Accepted: 3 January 2012
Published online: 1 May 2012
Published in print: May 2012

Authors

Details

C. Neill Epperson, M.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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Meir Steiner, M.D., Ph.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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S. Ann Hartlage, Ph.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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Elias Eriksson, M.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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Peter J. Schmidt, M.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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Ian Jones, M.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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Kimberly A. Yonkers, M.D.
From the Departments of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; the Department of Psychiatry, McMaster University, Hamilton, Ontario; the Department of Psychiatry, Rush University Medical Center, Chicago; the Department of Pharmacology and the Institute of Physiology and Neuroscience, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden; NIMH Intramural Research Program, Bethesda, Md.; the Department of Psychological Medicine, Cardiff University, Cardiff, U.K.; and the Department of Psychiatry, Yale University, New Haven, Conn.
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Notes

Address correspondence to Dr. Epperson ([email protected]).

Funding Information

Dr. Epperson has received research support from Shire for an investigator-initiated study, has received donation of products for research purposes from Novartis, and holds equity in Johnson & Johnson and Merck. Dr. Steiner has served as a consultant for AstraZeneca, Azevan, Bayer Canada, and Servier, has received research grants from the Canadian Institutes of Health Research, and has received honoraria from AstraZeneca and the Society for Women's Health Research. Dr. Hartlage received funding from APA to conduct secondary analyses of data sets on premenstrual dysphoric disorder. Dr. Eriksson has served on advisory boards for Lundbeck and Schering-Bayer and has received consultancy fees and research grants from Lundbeck. Dr. Schmidt reports no financial relationships with commercial interests. Dr. Jones has received honoraria or consultancy fees from AstraZeneca, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, and Sanofi-Aventis and has received research funding from GlaxoSmithKline. Dr. Yonkers has received research support from Eli Lilly, NIMH, and the National Institute on Drug Abuse, study medication from Pfizer for an NIMH-funded trial, and royalties from UpToDate; she also received funding from APA to conduct secondary analyses of data sets on premenstrual dysphoric disorder.

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