National Network of Depression Centers

Premenstrual Dysphoric Disorder and the Brain

C. Neill Epperson, M.D.

In early December 2012, the APA Board of Trustees approved the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). With this vote, the board made history with respect to the classification of premenstrual disorders. By moving premenstrual dysphoric disorder (PMDD) from DSM-IV-TR Appendix B, “Criterion Sets and Axes Provided for Further Study,” to a full diagnosis with a distinct diagnostic code under the category of mood disorders, the long-suspected biological and brain basis of this disorder has been emphasized. Since the time of Hippocrates (Figure 1), philosophers, physicians, and scientists have written about the links between menstruation, the brain, and behavior (1). However, recent decades have witnessed a backlash against the inclusion of PMDD and its previous diagnostic versions in the DSM. The argument is typically based on the concern that a formal diagnosis of premenstrual syndrome (PMS) or PMDD would pathologize the normal premenstrual physical and behavioral changes experienced by the majority of women or would suggest that all women are somehow compromised by the menstrual cycle.

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Posted to Members in the News & Publications on March 05, 2013