Premenstrual Dysphoric Disorder (PMDD) is listed as a depressive disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). It's no surprise that the 1994 addition of PMDD in the DSM-IV was one of the most controversial contributions in DSM history.
Premenstrual Dysphoric Disorder indicates serious premenstrual distress with associated deterioration in functioning, causing women to experience severe depression, irritability and/or mood swings, which interfere with relationships, social functioning, and work or school (American Psychiatric Association [DSM-IV-TR], 2000). Feminist journals, columnists, and medical professionals have criticized the American Psychiatric Association’s decision to include PMDD as a diagnosable mental disorder. In this blog, I'll try to narrow down the vast amount of literature in order to challenge the inclusion and classification of PMDD, while discussing three key ideas outlining the overall questionability of the diagnosis. The APA made an enormous mistake by adding PMDD as a mental disorder -- Here's why:
1. Very significant hormonal differences exist between PMDD and Major Depressive Disorder, causing the DSM-IV classification of PMDD as a ‘depressive disorder’ to be questionable.
2. PMDD’s classification as a mental illness has been capitalized on by marketing campaigns, namely Eli Lily, to promote and sell the drug Sarafem.
3. Premenstrual Dysphoric Disorder as a depressive disorder was not formulated through empirical testing. PMDD seems to have been developed as a socially constructed diagnosis rather than a psychiatric disorder.
Is PMDD a Depressive Disorder?
Premenstrual Dysphoric Disorder is listed in the DSM-IV as a “depressive disorder not otherwise specified.” The symptoms of Major Depressive Disorder closely resemble those of PMDD, and are depressed mood, diminished pleasure or interest, lack of energy, and hypersomnia or insomnia . The symptoms seem remarkably similar, but are symptoms enough to justify PMDD’s inclusion under depressive disorders? Psychologist J. Endicott states that most important difference in symptoms between PMDD and MDD is that Premenstrual Dysphoric Disorder occurs in a cycle, subsiding with onset of menstration. Daily self-ratings are conducted by the patient for two or more menstrual cycles before a PMDD diagnosis can be confirmed. These self-ratings are said to determine if the symptoms are continuous or cyclical. ‘It’s the timing of the symptoms that makes a difference,” states Hartlage. With timing fluctuations aside, what are the standards for distinguishing between PMDD and Major Depressive Disorder? Is it ethical for the mental and behavioural consequences of physiological changes to be construed as symptoms of a mental disorder? Endicott and a panel of experts have recently proven that PMDD is a distinct clinical entity separate from major depression, based research conducted in 1996. PMDD sufferers are shown to have “normal functioning of the hypothalamic-pituitary-adrenal axis, show biologic characteristics generally related to the serotonin system, and a genetic component as well.” Although the symptoms appear similar, the biological bases of clinical depression and PMDD are now known to be very different. The classification of PMDD in depressive disorders without empirical evidence seems like a very questionable decision.
The Treatment of Female Horomones with SSRIs – An Ethical Battle Two medications are currently approved by the Food and Drug Administration to treat PMDD: Sarafem (fluoxetine) and Zoloft. In the seven-month period after Sarafem’s approval, manufacturer Eli Lilly spent more than $33 million promoting Sarafem to consumers, and, physicians gave out more than 200,000 prescriptions for the drug . Many experts have protested that what most consumers are naive to is that Sarafem is the same drug as Prozac. In 1999, when the patent for Prozac...
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Caplan, P. (2004). “The Debate About PMDD and Sarafem: Suggestions for Therapists,” Women and Therapy: A Feminist Quarterly. 27 (3): 55-67/
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Cordon, L (2005). Popular Psychology: An Encyclopedia. Greenwood Publishers.
Daw, J. (2002). “Is PMDD Real? Researchers, physicians and psychologists fall on various sides of the debate over premenstrual dysphoric disorder,” Monitor of Psychology, American Psychological Association 33 (9): 58.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Figert, A. (1996). Women and the Ownership of PMS: The Structuring of a Psychiatric Disorder Aldine De Gruyter.
Gallant, S., D. Popiel, D. Hoffman, P. Chakrabory, and J. Hamilton (1992). Using daily ratings to confirm Prementrual Syndrome/Late Luteal Phase Dysphoric Disorder, Part II. What makes a ‘real’ difference? Psychosomatic Medicine 54, 167-81.
Hartlage, S.A., Arduino, K.E. & Gehlert, S. (2001). ‘Premenstrual dysphoric disorder and risk for major depressive disorder: A preliminary study.” Journal of Clinical Psychology, 57 (12).
Miller, K. and S. Rogers (2007). The Estrogen-Depression Connection: The Hidden Link Between Horomones and Women’s Depression. New Harbinger Publications.
Offman, A. & Kleinplatz, P.J. (2004). “Does PMDD belong in the DSM? Challenging the medicalization of women 's bodies,” The Canadian Journal of Human Sexuality, 28
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