DSMIV Criteria for Premenstrual Dysphoric Disorder

• Five or more symptoms

• At least one of the following four symptoms:

Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

Marked anxiety, tension, feeling of being "keyed up" or "on edge"

Marked affective lability

Persistent and marked anger or irritability or increase in interpersonal conflicts

• Additional symptoms that may be used to fulfill the criteria:

Decreased interest in usual activities Subjective sense of difficulty in concentrating Lethargy, easy fatigability, or marked lack of energy Marked change in appetite, overeating, or specific food cravings

Hypersomnia or insomnia Subjective sense of being overwhelmed or out of control

• Other physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain

• Symptoms occurring during last week of luteal phase

• Symptoms are absent postmenstrually

• Disturbances that interfere with work or school or with usual social activities and relationships

• Disturbances that are not an exacerbation of symptoms of another disorder

Differential Diagnosis of Premenstrual Syndrome

Affective disorder (eg, depression, anxiety, dysthymia, panic) Anemia

Anorexia or bulimia Chronic medical conditions (eg, diabetes mellitus) Dysmenorrhea

Endometriosis

Hypothyroidism

Oral contraceptive pill use

Perimenopause

Personality disorder

Substance abuse disorders

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