Premenstrual syndrome and anxiety disorders: a psychobiological link.

The term premenstrual syndrome (PMS) has been used for many years to describe disturbances of mood or physical symptoms occurring regularly 7–10 days before menses and remitting during menses. The Diagnostic and Statistical Manual of Mental Disorders (DSM III-R) included PMS among the ‘proposed Diagnostic Categories Needing Further Study’ under the name of Late Luteal Phase Dysphoric Disorder (LLPDD), and established among its diagnostic criteria the need for daily prospective symptoms self-ratings during at least two cycles, for confirmation [1]. The more recent fourth edition of DSM maintained PMS among the categories needing further study, adding the new category of Premenstrual Dysphoric Disorder (PMDD) [2]. PMDD is distinguished from PMS in several respects: It requires at least one mood symptom; the symptoms must be severe enough to cause functional impairment, and they must not be a mere exacerbation of another psychiatric disorder. Since no other diagnostic criteria have been proposed, many studies have compared the scores from the premenstrual and follicular phases: a 30–50% increase found in prospectively administered diaries is now normally accepted as an indicator of the diagnosis of PMS [3], no attention being paid to the quality of symptoms. On the other hand, no specific hormone changes or other biological markers are able to distinguish between PMS sufferers and normal women [4]. Therefore, the absence of both a universally accepted definition and an objective biological or clinical marker makes it impossible to study the etiology of PMS. Accordingly, the therapeutic approach is presently indefinite. Steinberg [5] correctly stated that the time-honored medical adage maintaining that ‘in the absence of cure, treatments multiply’ seems to be appropriate to PMS. Nevertheless, it is well accepted that the severe form of PMS, i.e. the one characterized by psychosocial impairment and thus requiring medical treatment, is present in 5–8% of women during their 40s. This implies that we should multiply our efforts toward the understanding of the disorder.