Premenstrual dysphoric disorder (PMDD), a severe mood disorder, is characterised by cognitive–affective and physical symptoms in the week before menses and affects millions of women worldwide
Recognised in the DSM-5, the criteria for which includes symptoms such as:
Irritability or anger, often with increased interpersonal conflicts
Depressed mood, hopelessness, or self-deprecating thoughts
Anxiety, tension or feeling on edge
Mood swings, tearfulness, sensitivity to rejection
Sense of feeling overwhelmed or out of control
Other symptoms can include loss of interest in usual activity, fatigue, sleep and appetite changes, as well as symptoms often associated with PMS such as breast tenderness, swelling or bloating.
To be diagnosed with PMDD symptoms a minimum number of these symptoms must have been present for the majority of menstrual cycles in the past year, and greatest severity of symptoms must be present from 3-4 days prior to menses onset, and up to three days post-menses onset. Symptoms must be absent in the post-menstrual week. Other psychiatric diagnoses must be excluded.
What causes PMDD?
Potential initiating factors include central nervous system sensitivity to reproductive hormones, genetic factors, stress and a history of trauma. It appears that PMDD occurs not due to differences in hormones between women with PMDD and those without, but more altered sensitivity to normal fluctuations of estrogen and progesterone.
History of trauma and significant stress exposure, including emotional and physical abuse has been strongly associated with moderate to severe PMS and PMDD in multiple studies, though not all corroborate this association. PTSD and PMDD have likewise been strongly associated comorbidities. A potential mechanism leading to heightened PMDD in women with history of chronic stress and trauma is due to the blunting of allopregnenaole, which has been shown to occur in animal models after exposure to repeated or chronic stress. Administration of exogenous allopregnenalone has been shown in preclinical research to correct Hypothalamic-Pituitary-Adrenal axis function and reduce chronic stress-induced depressive and anxiety-like behaviour.
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