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A 31-year-old woman presents reporting that for the past 2 years she experiences severe irritability, mood lability, depressed mood, and anxiety that begin approximately 7-10 days before the onset of menses and resolve within a few days of menstrual onset. She describes these symptoms as markedly different from her baseline functioning and states they significantly impair her work performance and relationships. She has been keeping a prospective daily symptom diary for the past 3 months at the request of her gynecologist, which confirms the cyclical pattern with symptom-free intervals during the follicular phase. She reports that during the luteal phase she also experiences breast tenderness, bloating, and difficulty concentrating. She denies any symptoms consistent with depression or anxiety outside of the luteal phase and her mood charting confirms this. She has no history of major depressive disorder, anxiety disorders, or personality disorders. Her thyroid function and other laboratory studies are within normal limits. Which of the following is the most accurate diagnosis?
Explanation
PMDD is diagnosed when at least five symptoms including at least one core affective symptom occur during the luteal phase and resolve after menses onset, causing significant functional impairment. Prospective daily symptom charting for at least two cycles is required to confirm the diagnosis and distinguish it from MDD, cyclothymia, and PMS. This patient's 3-month diary demonstrating clear cyclical patterns with symptom-free follicular phases confirms PMDD.
Key Takeaway
PMDD diagnosis requires prospective daily symptom charting for at least two menstrual cycles demonstrating luteal-phase symptom onset, peri-menstrual resolution, and a symptom-free follicular phase, distinguishing it from underlying mood or anxiety disorders.