October 25, 2013 — Premenstrual dysphoric disorder, or PMDD, is classified as a distinct mental disorder in the American Psychiatric Association's latest Diagnostic and Statistical Manual of Mental Disorders, but some experts are concerned that the diagnosis could be used against women, NPR's "Shots" reports.
According to "Shots," psychiatrists define PMDD as a disabling emotional and sometimes physical reaction to the hormonal changes during a woman's menstrual cycle. PMDD begins during the luteal phase of the menstrual cycle -- the two-week span between ovulation and the first day of a woman's period.
PMDD is different and much more severe than premenstrual syndrome, or PMS, which affects about 85% of women sometime during their menstrual cycle, according to the American College of Obstetricians and Gynecologists. PMDD affects about 1% of women in the U.S.
The criteria for PMDD diagnosis include that the symptoms correspond with the menstrual cycle for at least two successive months and disrupt a woman's ability to normally carry out her daily activities. A woman with PMDD does not experience depression regularly, but only in the days leading up to her period.
Controversy About Defining PMDD as a 'Disorder'
The decision to define PMDD as a mental disorder was controversial, according to Neill Epperson, director of the Penn Center for Women's Behavior Wellness and a member of the work group for the DSM.
He noted, "I think any time a disorder occurs more frequently in women or only in women, there's going to be a group of individuals who have concern that this will diminish women's role in society." The decision to classify PMDD as a mental disorder stemmed from the fact women experience "symptoms under a certain hormonal state that are not there under another hormonal state," Epperson said.
However, Sarah Gehlert, who studies health disparities in the school of social work at Washington University in St. Louis, cautioned that overdiagnosis of PMDD could lead to pathologizing women who are experiencing normal hormonal shifts. She also noted that pharmaceutical companies stand to make money by marketing drugs to treat the disorder.
Gehlert also worries that categorizing PMDD as a disorder could have negative legal repercussions for women. She notes, "Say a poor woman was in court, trying to see whether she could keep custody of her child. Her partner's or spouse's attorney might say, 'Yes, your honor, but she has a mental disorder.' And she might not get custody of her children" (Standen, "Shots," NPR, 10/21).