Evaluation and Recognition of PREMENSTRUAL DYSPHORIC DISORDER

symptoms so that effective therapy can be started. How are PMS and PMDD diagnosed? The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV ), describes the 11 groups of symptoms instrumental in establishing a diagnosis of PMDD: (1) feeling sad, hopeless; (2) feeling tense, anxious; (3) lability of mood; (4) persistent irritability; (5) decreased interest in usual activities, social withdrawal; (6) lack of concentration; (7) fatigue, lethargy; (8) changes in appetite, food cravings; (9) hypersomnia or insomnia; (10) feeling overwhelmed; and (11) breast tenderness, headache, bloating, or other physical symptoms. Five of these 11 symptoms had to have occurred during the second, postovulatory phase of the menstrual cycle and disappeared with the onset of menstruation or by the end of menstruation for most of the previous year. The patient must be symptom-free in the follicular phase, i.e., between menstruation and ovulation. For accuracy, symptoms G E TT Y IM A G E S