Premenstrual Syndrome - Symptoms

Emotional Symptoms

Depression. Severe depression before menstruation, called premenstrual dysphoric disorder, occurs in about 5% of women with PMS.
Anxiety and panic attacks.
Insomnia.
Change in sexual interest and desire. (Although some women lose interest, others have a heightened drive.)
Irritability.
Hostility and outbursts of anger. In severe cases, violence toward self and others.
Paranoia.
Increased appetite often with specific food cravings (especially salt and sugar).
Delusions and hallucinations. (These symptoms are very rare and most likely caused by an accompanying psychologic disorder).

Behavioral and Mental Symptoms

Mood swings. (Although angry outburst or negative emotions are common, some women experience very positive bursts of creative energy before a period.)
Inability to concentrate and some memory loss. (It should be noted that although women often report these symptoms, small studies have reported no actual differences in mental and thinking tasks between women with PMS or premenstrual dysphoric disorder and women without these syndromes during the premenstrual stage.)
Withdrawal from other people.
Confusion.
Being accident prone.
Lethargy and fatigue.

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD), also called late-luteal dysphoric disorder, is a condition marked by severe depression, irritability, and tension before menstruation. Studies in Europe and the US estimate that PMDD affects between 3 - 8% of women in their reproductive years. PMDD has features of both anxiety and depression disorders, although increasingly experts believe it is a distinct disorder with specific biochemical actions.

Diagnostic Criteria. Symptoms must occur during the last week of the premenstrual (luteal) phase in most menstrual cycles. They should resolve within a few days after the period starts.

Five or more of the following symptoms must be present:

Feeling of sadness or hopelessness, possible suicidal thoughts.
Feelings of tension or anxiety. (Panic attacks, in fact, may be much more common in patients with PMDD than in the general population.)
Mood swings marked by periods of teariness.
Persistent irritability or anger that affects other people.
Disinterest in daily activities and relationships.
Trouble concentrating.
Fatigue or low energy.
Food cravings or bingeing.
Sleep disturbances.
Feeling out of control.
Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain.

Some experts are concerned that the inclusion of premenstrual dysphoric disorder (PMDD) in the psychiatric diagnostic literature may misrepresent the physical nature of the problem. They warn that such categorization may restrict research on PMS only to psychiatric areas. Furthermore, both women with PMDD and their doctors may view their PMS only as a psychiatric disorder and not as a condition that may have physiologic causes unrelated to classic depression.

From The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, DC, ŠAmerican Psychiatric Association 1994.