Premenstrual Disorders: A Primer and Research Agenda for Psychologists

Females are two times more likely to develop an affective disorder and three times more likely to make a suicide attempt. The etiology of these sex differences is complex, and cannot be reduced to biology alone. However, the growing field of reproductive mood disorders highlights how lifetime exposure to fluctuations in neuroactive sex hormones (including across the menstrual cycle) do contribute to greater female risk, specifically among those females who are neurobiologically sensitive to normal hormone changes (e.g., those with premenstrual disorders). Psychologists--and particularly clinical psychologists-- are trained to be expert in skills relevant to the study and treatment of premenstrual disorders, including assessment, differential diagnosis, and mechanisms of complex behaviors, and often develop other relevant expertise in the neurobiology of affective disorders and advanced longitudinal methods. The purpose of this article is to clarify how psychologists’ strengths can be readily applied to advance scientific knowledge and improve patient care in premenstrual disorders. In order to increase psychologist involvement in this emerging field, this article includes a primer on premenstrual disorders such as premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME) of underlying disorders. It then provides recommendations for research psychologists interested in engaging this field, and outlines critical research areas for future work. Finally, brief recommendations for psychologists in clinical practice are provided.

Diagnosis, Etiology, and Treatment of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) was recognized as an official psychiatric diagnosis among depressive disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The exact etiology of PMDD is not yet fully understood, and it is a topic of current research. The hope is that learning more about PMDD can lead to improved treatment modalities for this disorder and better understanding of other related disorders (such as premenstrual mood exacerbation and postpartum- or menopause-related mood disorders). Often misdiagnosed and likely underdiagnosed, PMDD has a 12-month prevalence that ranges from 1.8 to 5.8% for women who menstruate. Mental health providers who treat women of reproductive age should be familiar with the diagnostic criteria, related differential diagnosis, and available treatment modalities for PMDD. This review contains 5 figures, 5 tables and 59 references Key words: mood disorder, premenstrual dysphoric disorder, premenstrual exacerbation, premenstrual syndrome, reproductive mental health, reproductive psychiatry, women’s mental health