Will Premenstrual Dysphoric Disorder Get Reclassified? Expert Analysis from the International Congress of Medicine and Women's Mental Health

Article excerpt

MEDELLIN, COLOMBIA - After years of debate and controversy, premenstrual dysphoric disorder could be closer to getting recognized as a full category of mood disorder in the DSM-5, a leading researcher in women's mental health predicts.

Dr. Meir Steiner, who served as an adviser to the DSM-5's Mood Disorders Work Group dealing with PMDD, sees the possible repositioning of PMDD within the revised manual as something of a triumph.

The proposed new criteria for PMDD, a severe variant of premenstrual syndrome estimated to affect up to 5% of premenopausal women (Am. J. Psychiatry 2012; AiA: 1-11), differ somewhat from those described in the DSM-IV.

The order of symptoms likely will be shuffled, with mood swings and irritability now at the top of the list, where markedly depressed moods' had topped the DSM-IV's, Dr. Steiner said at the congress.

PMDD first appeared as "late luteal phase dysphoric disorder" in Appendix A of the DSM-III-R in 1987, over the objections of some women's groups and clinicians, who viewed its inclusion as pathologizing the menstrual cycle.

The name of the disorder was changed to PMDD for the DSM-IV. Debate over PMDD intensified in 2000, when the Food and Drug Administration approved the rebranding of the selective serotonin reuptake inhibitor (SSRI) fluoxetine under the marketing name Sarafem to treat PMDD. Critics saw in the new indication an example of "disease mongering" benefiting pharmaceutical manufacturers (PLoS Med. 2006;3:e 198).

Proponents of PMDD such as Dr. Steiner counter that the menstrual fluctuations in physical and emotional symptoms most women experience would not be considered pathological under the DSM-IV or DSM-5 diagnostic criteria, which require that 5 or more of 11 listed symptoms occur in most men-strual cycles during the luteal phase, begin to improve within a few days after the onset of menses, and are minimal or absent in the week post menses.

Moreover, they say, the criteria can prevent affected women from being incorrectly diagnosed with a depressive or personality disorder.

In the past decade, the debate on PMDD has calmed considerably, thanks in part to evidence from randomized controlled trials using the DSM-IV criteria for PMDD. The European Medicines Agency, which long refused to validate the indication, changed its position in 2010, opening up the possibility for PMDD treatments to be tested and marketed in the European Union. …