Premenstrual Dysphoric Disorder (PMDD): Impact on Depression, Mood, Behaviour, and Functioning

PMDD feels at times driving you crazy

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) characterised by marked mood disturbances, behavioural changes, and functional impairment. PMDD is recognised in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and affects approximately 3–8% of women of reproductive age (Epperson et al., 2012). Symptoms typically emerge during the luteal phase of the menstrual cycle and resolve within days after menstruation begins.

PMDD significantly influences mental health, particularly in relation to mood and depression. Women with PMDD frequently experience intense irritability, sadness, hopelessness, and heightened anxiety, which can exacerbate existing depressive disorders (Halbreich, 2003). Research highlights a higher prevalence of comorbid mood disorders among women with PMDD, indicating a bidirectional relationship where depression increases vulnerability to PMDD and PMDD intensifies depressive symptoms (Yonkers & Simoni, 2018).

Behaviourally, PMDD can manifest as impulsivity, interpersonal conflict, and reduced motivation. These changes may disrupt relationships and contribute to feelings of isolation (Pearlstein, 2021). Emotional dysregulation, including anger outbursts and hypersensitivity to rejection, often reduces social participation and self-esteem.

In occupational and academic settings, PMDD can lead to substantial impairment. Women report reduced concentration, fatigue, and cognitive difficulties that affect productivity and learning (Rapkin & Lewis, 2013). Absenteeism, presenteeism, and decreased academic performance are commonly reported, particularly during symptomatic phases (Borenstein et al., 2005). This functional impairment can negatively affect career progression, educational attainment, and overall quality of life.

Overall, PMDD represents a serious but often under-recognised condition. Its cyclical interaction with depression, mood instability, and behavioural changes creates profound challenges for women in both personal and professional domains. Early diagnosis, psychoeducation, and treatment—including cognitive-behavioural therapy, pharmacological options, and lifestyle interventions—are essential to reducing the burden of PMDD and supporting women to manage their mental health, academic performance, and work responsibilities effectively. #pmdd #women #womenshealth

References

Borenstein, J. E., Dean, B. B., Endicott, J., Wong, J., Brown, C., Dickerson, V., & Yonkers, K. A. (2005). Health and economic impact of the premenstrual syndrome. Journal of Reproductive Medicine, 50(9), 723–730.

Epperson, C. N., Steiner, M., & Hartlage, S. A. (2012). Premenstrual dysphoric disorder: Evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465–475.

Halbreich, U. (2003). The etiology, biology, and evolving pathology of premenstrual syndromes. Psychoneuroendocrinology, 28(3), 55–99.

Pearlstein, T. (2021). Premenstrual dysphoric disorder: Burden of illness and treatment update. Journal of Psychiatry & Neuroscience, 46(3), E320–E331.

Rapkin, A. J., & Lewis, E. I. (2013). Treatment of premenstrual dysphoric disorder. Women’s Health, 9(6), 537–556.

Yonkers, K. A., & Simoni, M. K. (2018). Premenstrual disorders. American Journal of Obstetrics and Gynecology, 218(1), 68–74.