Premenstrual Dysphoric Disorder - Diagnosis

Diagnosis

Originally called late luteal phase dysphoric disorder (LLPDD), the disorder was renamed PMDD by the American Psychiatric Association in its May 1993 revision of the DSM-IV. It was not recognized as a disorder in the DSM-IV, but was noted in the appendix of the manual as a "disorder requiring further study." The DSM-5, due for release in 2013, recognizes PMDD and gives precise and sophisticated guidelines for diagnosis. The DSM-5 draft resembles the expert guidelines for the treatment of severe PMS, PMDD, and comorbidities proposed by Steiner and co-authors.

PMDD is accepted as an illness by the Food and Drug Administration (FDA) but has not as yet been listed as a separate disorder in the World Health Organization's International Classification of Diseases (ICD-10). Listing may be imminent, however, since the current alpha draft of ICD-11 extends recognition, albeit in a way lacking the clinical sophistication of the DSM-5 approach.

In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for fluoxetine sold in Europe. Reflecting the approach of the ICD-10, the committee found that

...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.

In Australia, although PMDD is recognized by the Therapeutic Goods Administration, SSRIs are not reimbursed for it under the Pharmaceutical Benefits Scheme.

Some commentators suggest that PMDD (along with heart disease, borderline high blood pressure, mild hypercholesterolemia, social anxiety disorder, restless leg syndrome, and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments. Some psychiatrists and women's groups say that labeling this severe form of PMS as a psychiatric disorder, rather than a physical disorder, is stigmatizing. Psychologist Peggy Kleinplatz has criticized the diagnosis as part of a trend in medicalization of normal human behavior.